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Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3627–3635 | Cite as

Short- and Long-Term Outcomes of Patients Requiring Gastrectomy During Cytoreductive Surgery and Intraperitoneal Chemotherapy for Lower-Gastrointestinal Malignancies: A Propensity Score-Matched Analysis

  • Bhavneet Singh
  • Oliver M. Fisher
  • Gurkirat Singh
  • Joshua Lansom
  • Michael Bock
  • Mathew Kozman
  • Nayef Alzahrani
  • Winston Liauw
  • David L. MorrisEmail author
Gastrointestinal Oncology
  • 74 Downloads

Abstract

Objectives

This study was designed to assess the short- and long-term outcomes of gastric resection in cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for lower gastrointestinal (GI) malignancies.

Methods

Patients with adenocarcinoma and appendiceal mucinous neoplasms were included. Redo and incomplete cytoreductions were excluded. A total of 756 patients were identified. Of these, 65 underwent gastric resection, 11 underwent wedge, 43 distal, and 11 subtotal and total gastrectomy. Preoperative differences were assessed for and addressed with matching. Perioperative outcomes, overall survival (OS), and risk-free survival (RFS) were assessed in two analyses: first all gastric resections were included and the second excluded wedge resections. Subgroup analysis according to diagnosis subtype was conducted.

Results

Demographic analysis revealed that markers of tumor aggression and poor nutrition were prevalent in the gastrectomy group. The matched analysis for gastric resections revealed higher rates of reoperation (38% vs. 22%, p = 0.028). After excluding wedge resections, increased rates of reoperation (40% vs. 22%, 0.019), grade 3/4 morbidity (76% vs. 59%, p = 0.036), and hospital stay (34 vs. 27 days, p = 0.012) were observed. For the unmatched cohort, OS (103 vs. 69 months, p = 0.501) and RFS (17 vs. 18 months, p = 0.181) for patients with CC = 0 were insignificantly different. In comparison for CC > 0, OS (31 vs. 83 months, p < 0.001) and RFS (9 vs. 20 months, p < 0.001) were significantly reduced in gastric resection. For the matched cohort, after excluding wedges, gastrectomy did not significantly decrease OS. However, RFS was decreased (11 vs. 20 months, p = 0.016).

Conclusions

Despite high postoperative morbidity, when complete cytoreduction is achieved, the need for gastric resection is not associated with inferior long-term outcomes.

Notes

Author contributions

BS, OMF, GS, MAK, JL, MB, NA, WL, and DLM conception, design, acquisition, analysis, and interpretation of data. BS statistical analysis and interpretation of data. All authors drafting and revising of article content and final approval of manuscript prior to submission.

Disclosure

Nothing to disclose.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Bhavneet Singh
    • 1
  • Oliver M. Fisher
    • 1
    • 2
    • 3
  • Gurkirat Singh
    • 1
  • Joshua Lansom
    • 1
  • Michael Bock
    • 1
  • Mathew Kozman
    • 1
    • 2
  • Nayef Alzahrani
    • 1
    • 4
  • Winston Liauw
    • 1
    • 5
  • David L. Morris
    • 1
    • 6
    Email author
  1. 1.Liver and Peritonectomy UnitSt George HospitalSydneyAustralia
  2. 2.St George & Sutherland Clinical SchoolUniversity of New South WalesSydneyAustralia
  3. 3.School of MedicineUniversity of Notre DameSydneyAustralia
  4. 4.College of MedicineAl Imam Mohammad Ibn Saud Islamic University (IMSIU)RiyadhSaudi Arabia
  5. 5.Cancer Care ClinicSt George HospitalSydneyAustralia
  6. 6.Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Research and Education CentreUniversity of New South WalesKogarah, SydneyAustralia

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