Current practices and barriers to referral for cytoreductive surgery and HIPEC among colorectal surgeons: A binational survey |
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| Affiliation: | 1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia;2. Central Clinical School, University of Sydney, Sydney, New South Wales, Australia;1. Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden;2. Department of Medicine/Huddinge Karolinska Institutet and ANOVA, Karolinska University Hospital, Stockholm, Sweden;3. Surgical Clinic, Sergelkliniken, Stockholm, Sweden;4. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;5. Function Promoting Therapies, Waltham, MA, USA;6. Research Program in Men''s Health: Aging and Metabolism, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA, USA;1. Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom;2. Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom |
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| Abstract: | IntroductionCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained traction for the management of peritoneal metastases. The number of specialist units globally offering CRS/HIPEC is increasing. The aim of this survey was to assess current practices and barriers to referral for CRS/HIPEC among colorectal surgeons in Australia and New Zealand (ANZ).Materials and methodsAn online questionnaire was emailed to members of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). The survey contained 3 sections: namely; demographics, referral patterns and clinical scenarios. Questions on referral patterns included number of peritoneal metastases patients seen per year and referred to a CRS/HIPEC unit, awareness of such a unit and distance from principle place of practice. Different pathologies referred were also explored, as well as investigations performed. Barriers to referral were also surveyed.ResultsThe response rate was 28% (83/296). Twenty-five percent received CRS training. Most surgeons (95%) were aware of a CRS/HIPEC unit and had referred to one previously. Thirty-nine percent would refer all patients. Provision of good service and/or relationship with CRS/HIPEC specialist were the main reasons for referring to the nearest unit, followed by accessibility. Major factors preventing referral included extent of peritoneal disease (48%), patient characteristics and comorbidities (44%) and lack of evidence (20%). The most common pathologies referred included colorectal and appendiceal peritoneal metastases and pseudomyxoma peritonei.ConclusionColorectal specialist awareness of CRS/HIPEC units and accessibility is high. Strategies to improve referring physician/surgeon knowledge on patient selection and indications for CRS/HIPEC should be investigated and instituted to ensure all appropriate patients are referred to specialist units for discussion of suitability. |
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| Keywords: | Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Peritoneal metastases Survey Barriers to referral CRS/HIPEC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" Cytoreductive surgery/Hyper-thermic intraperitoneal chemotherapy. CSSANZ Colorectal Surgical Society of Australia and New Zealand. CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" Computed Tomography. PET Positron Emission Tomography. MRI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" Magnetic Resonance Imaging. MDT Multidisciplinary team meeting. PCI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" Peritoneal cancer index |
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