Effects of distal pancreatectomy and splenectomy on outcomes in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with CC/0 resection

Background and Aims: This study aims to determine the early andlate postoperative effects of distal pancreatectomy plus splenectomy inpatients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and achieved CC0 resection due to peritonealcarcinomatosis. Materials and Method: All patients who underwent acytoreductive surgery and hyperthermic intraperitoneal chemotherapyprocedure due to peritoneal carcinomatosis of various tumors in ourclinic between 2014 and 2020 were included in the study. Data from allpatients who underwent additional distal pancreatectomy plus splenectomy were analyzed retrospectively. Results: The cytoreductive surgeryand hyperthermic intraperitoneal chemotherapy procedure with CC/0resection was performed on 85 of 136 patients diagnosed with peritoneal carcinomatosis. Of these patients, 13 (15.3%) had undergonedistal pancreatectomy plus splenectomy together with the main procedure. The mean hospital stay was 15 (range, 5–50) days in patientswho underwent distal pancreatectomy plus splenectomy, whereas itwas 13 (range, 4–109) days in those who did not, and the differencewas statistically insignificant. The most common major complicationsseen in the distal pancreatectomy plus splenectomy group were ananastomotic leak, enterocutaneous fistula, and intraabdominal abscess.The 30-day mortality was two (15.38%) and one (1.38%) in the groupwith and the group without distal pancreatectomy plus splenectomy,respectively. When the groups were evaluated, the median survivaltime was 19 months in the cytoreductive surgery and hyperthermic intraperitoneal chemotherapy group and 18 months in the cytoreductivesurgery and hyperthermic intraperitoneal chemotherapy + distal pancreatectomy plus splenectomy group. This difference was statisticallyinsignificant (p = 0.382). Conclusion: The addition of distal pancreatectomy plus splenectomy increased major postoperative complications inpatients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy but did not affect overall survival. We think distalpancreatectomy plus splenectomy can be performed for a completecytoreduction if necessary. However, it increases major postoperativecomplications, and patient follow-up should be done accordingly.

Sitoredüktif cerrahi ve CC/0 rezeksiyonla hipertermik intraperitoneal kemoterapi uygulanan hastalarda distal pankreatektomi ve splenektominin sonuçlara etkisi

Giriş ve Amaç: Bu çalışmanın amacı, peritoneal karsinomatozis nedeniyle sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi uygulanan ve komplet sitoredüksiyon sağlanan hastalarda distal pankreatektomi+splenektominin erken ve geç postoperatif etkilerini belirlemektir. Gereç ve Yöntem: Kliniğimizde 2014-2020 yılları arasında çeşitli tümörlerin peritoneal karsinomatozisi nedeniyle sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi işlemi yapılan tüm hastalar çalışmaya dahil edildi. Ek distal pankreatektomi ve splenektomi yapılan tüm hastaların verileri retrospektif olarak analiz edildi. Bulgular: Peritoneal karsinomatozis tanısıyla ameliyat edilen 136 hastanın 85’ine (komplet sitoredüksiyon rezeksiyonla) sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi işlemi uygulandı. Bu hastaların 13’ünün (%15.3) ana işleme ek olarak distal pankreatektomi + splenektomi uygulandı. Distal pankreatektomi ve splenektomi yapılan hastalarda ortalama yatış süresi 15 (5-50) gün iken, yapılmayanlarda 13 (4-109) gündü ve aradaki fark istatistiksel olarak anlamsızdı. Distal pankreatektomi ve splenektomi yapılan grupta en sık görülen majör komplikasyon anastomoz kaçağı, enterokutanöz fistül ve intraabdominal apse idi. 30 günlük mortalite distal pankreatektomi ve splenektomi eklenen ve eklenmeyen gruplarda sırası ile 2 (%15.38) ve 1 (%1.38) idi. Gruplar değerlendirildiğinde; medyan sağkalım süresi sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi grubunda 19 ay, sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi + distal pankreatektomi ve splenektomili grupta 18 aydı ve istatistiksel olarak anlamlı değildi (p = 0.382). Sonuç: Distal pankreatektomi ve splenektomi eklenmesi, sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi uygulanan hastalarda postoperatif majör komplikasyonları arttırmaktadır, fakat genel ortalama sağkalımı etkilememiştir. Tam bir sitoredüksiyon için gerekirse distal pankreatektomi ve splenektomi yapılabileceğini düşünüyoruz ancak bu işlemin postoperatif majör komplikasyonların gelişimini arttırdığı bilinmeli ve buna göre hasta takibi yapılmalıdır.

Kaynakça

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Kaynak Göster

Akademik Gastroenteroloji Dergisi
  • ISSN: 1303-6629
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 2002
  • Yayıncı: Jülide Gülay Özler

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