ABSTRACT
AIM: The cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has showed promising results for the survival in patients with recurrent ovarian carcinomatosis, however, some of them will recur within the first year. The aim of this study is focussed on identifying the risk factors to develop the recurrence within the first year after an optimal CRS-HIPEC in patients with recurrent ovarian carcinomatosis. METHODS: A total of 100 patients with peritoneal carcinomatosis from recurrent ovarian cancer treated by CRS + HIPEC were selected for analysis. Multivariate logistic regression analysis was performed to evaluate the relationship between the variables and the early recurrence. RESULTS: The mean follow-up was 42.5 months. The mean age was 56.2 years. Early recurrence was observed in the 36%. The group early recurrence presented a higher rate of optimal cytoreductions CC1 (16.2% vs. 3.5%), lymph nodes (32.5% vs. 15%) and the use of hemoderivates (40.5% vs. 33%). Others parameters as Peritoneal Cancer Index, major morbidity? 3, re-operations rate and time to adjuvant chemotherapy were similar in both groups. The five years OS was 58%, for the non-early recurrence was higher than the early recurrence group (64% vs. 41%). In the multivariate analysis, CC-1 (OR 5.73; 1.16-32.04) and positive lymph nodes (OR 2.26; 1.01-4.32) proved to be independent factors for the early recurrence. CONCLUSION: The combination of both (CC1 and positive lymph nodes) makes that the indication of CRS and HIPEC should be individualised. However, the major morbidity, stage IV and the time to the adjuvant treatment were not associated with an early recurrence, so that, a major aggressiveness is recommended to achieve a CC0.
Subject(s)
Chemotherapy, Adjuvant/methods , Cytoreduction Surgical Procedures/methods , Hyperthermia, Induced/methods , Ovarian Neoplasms/therapy , Peritoneal Neoplasms/therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Ovarian Neoplasms/mortality , Ovarian Neoplasms/pathology , Peritoneal Neoplasms/mortality , Peritoneal Neoplasms/pathology , Prospective Studies , Recurrence , Retrospective Studies , Risk Factors , Survival AnalysisABSTRACT
A positive linear trend (P<.001) between the National Noscomial Infection Surveillance system (NNIS) risk index and mortality was observed in 2,848 general surgery patients followed up 6 years after discharge. In stratified analyses, the NNIS risk index predicted mortality in patients with chronic disease (P=.007, by test for trend) but not in the remaining patients.
