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dc.contributor.authorAbudeeb, Haytham
dc.contributor.authorSelvasekar, Chelliah
dc.contributor.authorO'Dwyer, Sarah T
dc.contributor.authorChakrabarty, Bipasha
dc.contributor.authorMalcomson, Lee
dc.contributor.authorRenehan, Andrew G
dc.contributor.authorWilson, Malcolm S
dc.contributor.authorAziz, Omer
dc.date.accessioned2020-02-27T16:55:26Z
dc.date.available2020-02-27T16:55:26Z
dc.date.issued2020en
dc.identifier.citationAbudeeb H, Selvasekar CR, O'Dwyer ST, Chakrabarty B, Malcolmson L, Renehan AG, et al. Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for perforated low-grade appendiceal mucinous neoplasms. Surg Endosc. 2020.en
dc.identifier.pmid31993814en
dc.identifier.doi10.1007/s00464-019-07349-xen
dc.identifier.urihttp://hdl.handle.net/10541/622773
dc.description.abstractINTRODUCTION: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an established treatment for pseudomyxoma peritonei (PMP) from perforated low-grade appendiceal mucinous neoplasms (LAMN II). In a selected group of LAMN II patients without established PMP, CRS/HIPEC can be performed laparoscopically (L-CRS/HIPEC); however the short-term benefits and safety of this approach have yet to be determined. This study aims to determine the short-term outcomes from a series of L-CRS/HIPEC LAMN II patients compared to those who have undergone a similar open operation (O-CRS/HIPEC) for low-volume PMP. METHODS: LAMN II patients undergoing L-CRS/HIPEC at a UK national peritoneal tumour centre were compared to O-CRS/HIPEC patients (peritoneal cancer index???7). Outcomes of interest included Clavien-Dindo complication grade, operative time, blood transfusions, high dependency unit (HDU) admission, length of hospital stay, and histopathological findings. RESULTS: 55 L-CRS/HIPEC were compared to 29 O-CRS/HIPEC patients (2003-2017). Groups were matched for age, sex, and procedures. Median operative time was 8.8 (IQR 8.1-9.5) h for L-CRS/HIPEC versus 7.3 (IQR 6.7-8) h for O-CRS/HIPEC (Mann-Whitney test p?<?0.001). Post-operative HDU admission was 56% versus 97% (OR 0.04 95% CI 0.01-0.34) and median length of stay?=?6 (IQR 5-8) versus 10 (IQR 8-11) days (p?<?0.001) for L- versus O-CRS/HIPEC. Despite a normal pre-operative CT scan, 13/55 (23.6%) L-CRS/HIPEC patients had acellular mucin and 2/55 (3.5%) had mucin with epithelium present in their specimens. Residual appendix tumour was identified in 2/55 patients (3.6%). Clavien-Dindo Grade 1-4 complications were similar in both groups with no mortality. CONCLUSION: L-CRS/HIPEC for LAMN II takes longer; however patients have significantly reduced length of HDU and overall stay, without increased post-operative complications. A significant proportion of LAMN II patients undergoing L-CRS/HIPEC have extra-appendiceal acellular mucin with some cases demonstrating residual cellular epithelium from the LAMN II. The risk of these patients developing PMP without surgery is under current review.en
dc.language.isoenen
dc.relation.urlhttps://dx.doi.org/10.1007/s00464-019-07349-xen
dc.titleLaparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for perforated low-grade appendiceal mucinous neoplasmsen
dc.typeArticleen
dc.contributor.departmentColorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UKen
dc.identifier.journalSurgical Endoscopyen
dc.description.noteen]
refterms.dateFOA2020-03-03T13:35:11Z


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