PTH-348 The outcome of an enhanced recovery programme applied to minimally invasive cytoreductive surgery. (22nd June 2015) - Bullen, T
Abstract : Introduction: Pseudomyxoma peritoneii (PMP) is a rare neoplasm arising from the appendix, characterised by disseminated peritoneal mucinous tumour and progressive accumulation of mucinous ascites. For established disease, treatment by cytoreductive surgery (CRS) and heated intra-peritoneal chemotherapy (HIPEC) is the accepted standard of care. 1 Through a UK national treatment centre, we increasingly identify patients with localised extra- appendiceal mucin without evidence of diffuse dissemination of disease (referred to as LAMN II tumours). 2 We developed a programme of risk-reducing cytoreductive surgery (RCRS) and HIPEC, initially by open surgery (period 1); subsequently by laparoscopically assisted CRS and HIPEC (period 2); and more recently adding an enhanced recovery protocol (ERP) (period 3). 3 Here, we describe key outcome measures through this evolution. Method: Using a prospective database we recorded patients undergoing RCRS and HIPEC between 2003 and 2014; Operative time and length of stay and morbidity graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) were recorded. Results: Sixty patients with LAMN II appendiceal tumours had RCRS and HIPEC: There was no difference in the demographics or ASA grade. There was no mortality in all groups. Conclusion: We demonstrate that the combined approach of laparoscopic CRS with HIPEC and ERP in patients with localised LAMN II tumours is associated with very low morbidity and short hospital stay, desirable criteria for a risk-reducing programme. There were no complications due to ERP. Disclosure of interest: None Declared. References: Chua TC, Moran BJ, Sugarbaker PH. Early and long-term outcome data of patients with pseudomyxoma peritoneii from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol . 2012;30(20):2449–56 McDonald JR, O'Dwyer ST, et al . Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms. Br J Surg. 99(7):987–92 Fish R, Selvasekar C, et al . Risk-reducing laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for low-grade appendiceal mucinous neoplasm: early outcomes and technique. Surg Endosc. 28(1):341–5