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Bin Traiki TA, AlShammari SA, AlOtaibi WS, AlAnazi SN, Alnmry MM, Albdah AM, Alhassan NS. The attitude and practice of general surgeons toward cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A cross-sectional study. Ann Med Surg (Lond) 2021; 66:102440. [PMID: 34141418 PMCID: PMC8187938 DOI: 10.1016/j.amsu.2021.102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) mandate well-established HIPEC and oncology centers, which are not available in many medical institutions. This study assessed the knowledge, attitude, and practice toward CRS and HIPEC of general surgeons in Riyadh, Saudi Arabia. Patients and methods General surgeons (n = 266) from nine hospitals who treat patients with gastrointestinal cancer were surveyed. The responses of surgeons who work in HIPEC and academic centers (Group A) and surgeons working in tertiary and secondary hospitals (Group B) were compared. The survey response rate was 48.1% (128/266). Results Surgeons in group B treated significantly more patients with peritoneal carcinomatosis per year than surgeons in group A (P = .001). Group B reported having a HIPEC specialist at their hospital, and 71.4% reported that the nearest HIPEC center was within 30 miles, compared to 4.5% of respondents in group A (P = .001). Lack of access to a HIPEC specialist was reported by 15.5% of surgeons in group B and 0% of surgeons in group A (P = .006). HIPEC as a possible therapeutic option for appendiceal cancer was cited by 60.7% of surgeons in group B compared to 84.1% of surgeons in group A (P = .007) and as a therapeutic option for ovarian cancer by 52.4% of surgeons in group B and 81.8% of surgeons in group A (P = .001). Conclusion New strategies are needed to improve the knowledge and implementation of the referral system for HIPEC among general surgeons. Our study was limited by a low response rate. Exposure to HIPEC centers during residency or fellowship training was reported by half of our respondents. Surgeons in tertiary and secondary hospitals treated significantly more patients with peritoneal carcinomatosis per year than surgeons in HIPEC and academic centers. Lack of access to a HIPEC specialist was significantly reported by surgeons working in tertiary and secondary hospitals. HIPEC was significantly cited as an option for appendiceal cancer by surgeons in HIPEC and academic centers compared to surgeons in tertiary and secondary hospitals.
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Affiliation(s)
- Thamer A Bin Traiki
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Sulaiman A AlShammari
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Wadha S AlOtaibi
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Shahad N AlAnazi
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Mashal M Alnmry
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Abdullah M Albdah
- Trauma and Acute Care Surgery Fellow, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Noura S Alhassan
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11461, Saudi Arabia
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Sjoquist KM, Renfro LA, Simes RJ, Tebbutt NC, Clarke S, Seymour MT, Adams R, Maughan TS, Saltz L, Goldberg RM, Schmoll HJ, Van Cutsem E, Douillard JY, Hoff PM, Hecht JR, Tournigand C, Punt CJA, Koopman M, Hurwitz H, Heinemann V, Falcone A, Porschen R, Fuchs C, Diaz-Rubio E, Aranda E, Bokemeyer C, Souglakos I, Kabbinavar FF, Chibaudel B, Meyers JP, Sargent DJ, de Gramont A, Zalcberg JR. Personalizing Survival Predictions in Advanced Colorectal Cancer: The ARCAD Nomogram Project. J Natl Cancer Inst 2018; 110:638-648. [PMID: 29267900 PMCID: PMC6005015 DOI: 10.1093/jnci/djx253] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/09/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022] Open
Abstract
Background Estimating prognosis on the basis of clinicopathologic factors can inform clinical practice and improve risk stratification for clinical trials. We constructed prognostic nomograms for one-year overall survival and six-month progression-free survival in metastatic colorectal carcinoma by using the ARCAD database. Methods Data from 22 674 patients in 26 randomized phase III clinical trials since 1997 were used to construct and validate Cox models, stratified by treatment arm within each study. Candidate variables included baseline age, sex, body mass index, performance status, colon vs rectal cancer, prior chemotherapy, number and location of metastatic sites, tumor mutation status (BRAF, KRAS), bilirubin, albumin, white blood cell count, hemoglobin, platelets, absolute neutrophil count, and derived neutrophil-to-lymphocyte ratio. Missing data (<11%) were imputed, continuous variables modeled with splines, and clinically relevant pairwise interactions tested if P values were less than .001. Final models were internally validated via bootstrapping to obtain optimism-corrected calibration and discrimination C-indices, and externally validated on a 10% holdout sample from each trial (n = 2257). Results In final models, all included variables were associated with overall survival except for lung metastases, and all but total white cell count associated with progression-free survival. No clinically relevant pairwise interactions were identified. Final nomogram calibration was good (C = 0.68 for overall and C = 0.62 for progression-free survival), as was external validity (concordance between predicted >50% vs < 50% probability) and actual (yes/no) survival (72.8% and 68.2% concordance, respectively, for one-year overall and six-month progression-free survival, between predicted [>50% vs < 50% probability] and actual [yes/no] overall and progression-free survival). Median survival predictions fell within the actual 95% Kaplan-Meier confidence intervals. Conclusions The nomograms are well calibrated and internally and externally valid. They have the potential to aid prognostication and patient-physician communication and balance risk in colorectal cancer trials.
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Affiliation(s)
- Katrin M Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | | | - R John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | | | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | | | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Jean-Yves Douillard
- European Society for Medical Oncology (ESMO) Chief Medical Officer (CMO), Institut de Cancérologie de l'Ouest (ICO) René Gauducheau, Saint-Herblain, France
| | - Paulo M Hoff
- Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paolo, Sao Paolo, Brazil
| | - Joel Randolph Hecht
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Christophe Tournigand
- University of Paris Est Creteil, Paris, France
- Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Creteil, France
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Miriam Koopman
- University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Volker Heinemann
- University of Munich, Department of Medical Oncology and Comprehensive Cancer Center, Munich, Germany
| | | | - Rainer Porschen
- Klinikum Bremen-Ost Klinik fur Innere Medizin, Bremen, Germany
| | | | - Eduardo Diaz-Rubio
- Department of Oncology, Hospital Clínico San Carlos, CIBERONC Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Aranda
- Department of Medical Oncology IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC Instituto de Salud Carlos III, Córdoba, Spain
| | | | | | - Fairooz F Kabbinavar
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | | | | | | | | | - John R Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
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