Article Text
Abstract
Introduction In the TORPEDO (CTRI/2018/12/016789) study, a systematic total parietal peritonectomy (TPP) was performed in all patients undergoing interval cytoreductive surgery (iCRS). We report the heterogeneity in the organ resections at the four participating centers stratified according to disease extent, its impact on grade 3-4 morbidity and progression-free survival (PFS).
Methods Organ resections were performed in this study when required to achieve a complete gross resection. The 90-day morbidity was reported using ‘common toxicology criteria for adverse events’ (CTCAE) version 4.3. A comparison of outcomes was made in between different centers among patients with a surgical peritoneal cancer index (PCI) 0-15 and > 15.
Results Overall, 88/218(40.3%) patients had PCI>15. Patients with PCI>15 were significantly higher at centres 1-3 compared to centre 4 (32/62(51.6%), 38/69(55.0%), 13/26(50.0%) and 5/61(8.1%) respectively; p<0.001). Median duration of surgery(p=0.82), blood loss(p=0.51), ICU stay (p=0.27) and hospital stay(p=0.49) did not vary significantly among centers. Rectosigmoid resections and cholecystectomies were significantly higher at centers 1 and 2 while fewer splenectomies were performed at centre 4 (table 1). Overall, grade 3-4 morbidity was significantly higher at centre 1 but was similar in patients with PCI>15. The median PFS was 22 months with no significant difference between the four centres (figure 1). On multivariate analysis, PFS was better in patients not undergoing a splenectomy and in those not experiencing grade 3-4 morbidity.
Conclusion/Implications There were significant differences in organ resections performed at the 4 centers. Correlation with pathological findings is essential to elucidate benefit of a more radical versus conservative approach to organ resections.