Agustos 2021
Sitoredüktif cerrahi ve CC/0 rezeksiyonla hipertermik intraperitoneal kemoterapi uygulanan hastalarda distal pankreatektomi ve splenektominin sonuçlara etkisi
Effects of distal pancreatectomy and splenectomy on outcomes in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with CC/0 resection
- Ana Sayfa
- Sayılar
- Agustos 2021
- Sitoredüktif cerrahi ve CC/0 rezeksiyonla hipertermik intraperitoneal kemoterapi uygulanan hastalarda distal pankreatektomi ve splenektominin sonuçlar...
Department of 2Gastroenterological Surgery, University of Health Science, Ankara City Hospital, Ankara
Özet
Giris ve Amaç: Bu çalismanin amaci, peritoneal karsinomatozis nedeniyle sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi uygulanan ve komplet sitoredüksiyon saglanan hastalarda distal pankreatektomi+splenektominin erken ve geç postoperatif etkilerini belirlemektir. Gereç ve Yöntem: Klinigimizde 2014-2020 yillari arasinda çe- sitli tümörlerin peritoneal karsinomatozisi nedeniyle sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi islemi yapilan tüm hastalar çalismaya dahil edildi. Ek distal pankreatektomi ve splenektomi yapi- lan tüm hastalarin verileri retrospektif olarak analiz edildi. Bulgular: Peritoneal karsinomatozis tanisiyla ameliyat edilen 136 hastanin 85’ine (komplet sitoredüksiyon rezeksiyonla) sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi islemi uygulandi. Bu hastalarin 13’ünün (%15.3) ana isleme ek olarak distal pankreatektomi + splenektomi uygulandi. Distal pankreatektomi ve splenektomi yapilan hastalarda ortalama yatis süresi 15 (5-50) gün iken, yapilmayanlarda 13 (4-109) gündü ve aradaki fark istatistiksel olarak anlamsizdi. Distal pankreatektomi ve splenektomi yapilan grupta en sik görülen majör komplikasyon anastomoz kaçagi, enterokutanöz fistül ve intraabdominal apse idi. 30 günlük mortalite distal pankreatektomi ve splenektomi eklenen ve eklenmeyen gruplarda sirasi ile 2 (%15.38) ve 1 (%1.38) idi. Gruplar de- gerlendirildiginde; medyan sagkalim süresi sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi grubunda 19 ay, sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi + distal pankreatektomi ve splenektomili grupta 18 aydi ve istatistiksel olarak anlamli degildi (p = 0.382). Sonuç: Distal pankreatektomi ve splenektomi eklenmesi, sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi uygulanan hastalarda postoperatif majör komplikasyonlari arttirmaktadir, fakat genel ortalama sagkalimi etkilememistir. Tam bir sitoredüksiyon için gerekirse distal pankreatektomi ve splenektomi yapilabilecegini düsünüyoruz ancak bu islemin postoperatif majör komplikasyonlarin gelisimini arttirdigi bilinmeli ve buna göre hasta takibi yapilmalidir
Abstract
Background and Aims: This study aims to determine the early and late postoperative effects of distal pancreatectomy plus splenectomy in patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and achieved CC0 resection due to peritoneal carcinomatosis. Materials and Method: All patients who underwent a cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure due to peritoneal carcinomatosis of various tumors in our clinic between 2014 and 2020 were included in the study. Data from all patients who underwent additional distal pancreatectomy plus splenectomy were analyzed retrospectively. Results: The cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure with CC/0 resection was performed on 85 of 136 patients diagnosed with peritoneal carcinomatosis. Of these patients, 13 (15.3%) had undergone distal pancreatectomy plus splenectomy together with the main procedure. The mean hospital stay was 15 (range, 5–50) days in patients who underwent distal pancreatectomy plus splenectomy, whereas it was 13 (range, 4–109) days in those who did not, and the difference was statistically insignificant. The most common major complications seen in the distal pancreatectomy plus splenectomy group were an anastomotic leak, enterocutaneous fistula, and intraabdominal abscess. The 30-day mortality was two (15.38%) and one (1.38%) in the group with and the group without distal pancreatectomy plus splenectomy, respectively. When the groups were evaluated, the median survival time was 19 months in the cytoreductive surgery and hyperthermic intraperitoneal chemotherapy group and 18 months in the cytoreductive surgery and hyperthermic intraperitoneal chemotherapy + distal pancreatectomy plus splenectomy group. This difference was statistically insignificant (p = 0.382). Conclusion: The addition of distal pancreatectomy plus splenectomy increased major postoperative complications in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy but did not affect overall survival. We think distal pancreatectomy plus splenectomy can be performed for a complete cytoreduction if necessary. However, it increases major postoperative complications, and patient follow-up should be done accordingly.
