Optimizing patient selection for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

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    Abstract

    Carefully selected patients with resectable and limited colorectal peritoneal metastases (PM) can be treated with curative intent by cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC). It remains a serious challenge to weigh the potential survival benefit from this extensive treatment against the risks of substantial treatment−related morbidity, mortality, and potential diminished QoL. We identified some new and promising preoperative factors that can predict postoperative morbidity and survival outcomes after CRS+HIPEC. Performing a diagnostic laparoscopy (DLS) routinely during the preoperative workup for CRS+HIPEC prevents non−therapeutic laparotomies (i.e., open−close procedures). DLS is feasible and safe and we recommend performing this laparoscopic screening in an experienced HIPEC center. The extent of surgery (ES) during cytoreductive surgery is a well−known risk factor for major postoperative morbidity. For the first time, we discovered that experienced HIPEC surgeons in most cases fail to predict the resections that are necessary to achieve a complete cytoreduction, with an underestimation of the ES in almost 40% of the cases. At this moment, two investigations are still ongoing (i.e., SELECT trial and MUSCLE POWER study) to further optimize patient selection for CRS+HIPEC. The SELECT trial aims to improve the staging of colorectal PM during DLS by using the fluorescent tracer bevacizumab−IRDye800CW. The MUSCLE POWER study focusses on (the prevention of) clinically relevant surgery−related muscle loss (SRML) in cancer patients after major abdominal surgery. Ultimately, these new strategies might reduce overtreatment, morbidity, and costs while maintaining the same or better effectiveness with a lower recurrence rate and improved QoL.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • van Dam, Go, Supervisor
    • Kruijff, Schelto, Co-supervisor
    Award date11-Nov-2020
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-94-028-1836-9
    DOIs
    Publication statusPublished - 2020

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