Methods to increase the effectiveness of cytoreductive surgical interventions in patients with complicated disseminated tumors of the abdominal cavity and pelvis

Abstract

The expediency of performing two-stage cytoreductive interventions in patients with complicated disseminated tumors of the abdominal cavity and pelvis is presented. Ninety-two patients with complicated disseminated tumors of the abdominal cavity and pelvis were examined into two groups. The main group consisted of 33 patients who received surgical treatment by two-stage cytoreductive surgery. The control group included 59 patients who underwent single-stage cytoreductive operations. In both groups, life-threatening complications were dominated by primary tumor necrosis (main group, n = 15; control group, n = 31) and impaired intestinal patency (main group, n = 12; control group, n = 16, respectively). The average Charlson comorbidity index was 7.85 ± 1.37 and 7.53 ± 1.5 points, respectively. Anesthetic risk of grades III–IV according to the classification of the American Society of Anesthesiologists was detected in 23 (69.7%) and 45 (76.27%) patients of the main and control groups, respectively. Functional status of 2–3 points on the Eastern Cooperative Oncological Group was established in 23 (69.7%) and 46 (77.9%) patients of the main and control groups, respectively. The peritoneal carcinomatosis index was significantly higher in the main group (13.1 ± 6 vs 9.9 ± 4.8 points) than in the control group (p = 0.012). A comparative analysis of the results obtained in the treatment of the main and control groups demonstrated that the two-stage cytoreductive surgical interventions can reduce the frequency of postoperative complications, primarily Clavien–Dindo grades III–IV from 40.7 to 18.2% (p = 0.049) and mortality from 16.9% to 9.1% (p = 0.468) and increase the frequency of achieving complete cytoreduction from 49.1% to 90.9% (p = 0.002) and the frequency of intraperitoneal hyperthermic chemoperfusion from 40.7 to 93.9% (p < 0.001). Thus, two-stage cytoreductive surgical interventions are a safe and effective technique in the surgical treatment of complicated disseminated tumors of the abdominal cavity and pelvis.

Keywords

peritoneal cancer index / tumor dissemination / complication / tumor necrosis / tense ascites / intestinal obstruction / cytoreductive surgery / two-stage strategy

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RIGHTS & PERMISSIONS

Nguyen V., Prosvetov V.A., Bromberg B.B., Dymnikov D.A., Loginov V.A., Demko A.E., Solovеv I.A., Surov D.A.