Your browser doesn't support javascript.
loading
Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery.
Vierra, Mason; Bansal, Varun V; Morgan, Ryan B; Witmer, Hunter D D; Reddy, Biren; Dhiman, Ankit; Godley, Frederick A; Ong, Cecilia T; Belmont, Erika; Polite, Blasé; Shergill, Ardaman; Turaga, Kiran K; Eng, Oliver S.
Afiliación
  • Vierra M; University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
  • Bansal VV; Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
  • Morgan RB; Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
  • Witmer HDD; Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
  • Reddy B; Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
  • Dhiman A; Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA.
  • Godley FA; Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
  • Ong CT; Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
  • Belmont E; Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA.
  • Polite B; Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA.
  • Shergill A; Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA.
  • Turaga KK; University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
  • Eng OS; Department of Surgery, University of California, Irvine, Orange, CA, USA. oeng@hs.uci.edu.
Ann Surg Oncol ; 31(1): 645-654, 2024 Jan.
Article en En | MEDLINE | ID: mdl-37737968
ABSTRACT

BACKGROUND:

The delivery of multimodal treatment at a high-volume center is known to optimize the outcomes of gastrointestinal malignancies. However, patients undergoing cytoreductive surgery (CRS) for peritoneal metastases often must 'fragment' their surgical and systemic therapeutic care between different institutions. We hypothesized that this adversely affects outcomes. PATIENTS AND

METHODS:

Adults undergoing CRS for colorectal or appendiceal adenocarcinoma at our institution between 2016 and 2022 were identified retrospectively and grouped by care network 'coordinated care' patients received exclusively in-network systemic therapy, while 'fragmented care' patients received some systemic therapy from outside-network providers. Factors associated with fragmented care were also ascertained. Overall survival (OS) from CRS and systemic therapy-related serious adverse events (SAEs) were compared across the groups.

RESULTS:

Among 85 (80%) patients, 47 (55%) had colorectal primaries and 51 (60%) received fragmented care. Greater travel distance [OR 1.01 (CI 1.00-1.02), p = 0.02] and educational status [OR 1.04 (CI 1.01-1.07), p = 0.01] were associated with receiving fragmented care. OS was comparable between patients who received fragmented and coordinated care in the colorectal [32.5 months versus 40.8 months, HR 0.95 (CI 0.43-2.10), p = 0.89] and appendiceal [31.0 months versus 27.4 months, HR 1.17 (CI 0.37-3.74), p = 0.55] subgroups. The frequency of SAEs (7.8% versus 17.6%, p = 0.19) was also similar.

CONCLUSIONS:

There were no significant differences in survival or SAEs based on the networks of systemic therapy delivery. This suggests that patients undergoing CRS at a high-volume center may safely receive systemic therapy at outside-network facilities with comparable outcomes.
Asunto(s)
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias del Apéndice / Neoplasias Peritoneales / Neoplasias Colorrectales / Hipertermia Inducida Tipo de estudio: Prognostic_studies Límite: Adult / Humans Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias del Apéndice / Neoplasias Peritoneales / Neoplasias Colorrectales / Hipertermia Inducida Tipo de estudio: Prognostic_studies Límite: Adult / Humans Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos