Evaluating geographical disparities on clinical outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

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Abstract

Background

Rural Australians typically encounter disparities in healthcare access leading to adverse health outcomes, delayed diagnosis and reduced quality of life (QoL) parameters. These disparities may be exacerbated in advanced malignancies, where treatment is only available at highly specialised centres with appropriate multidisciplinary expertise. Thus, this study aims to determine the association between patient residence on oncological, surgical and QoL outcomes following cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC).

Methods

A retrospective analysis was conducted on consecutive patients undergoing CRS and HIPEC at Royal Prince Alfred Hospital from January 2017 to March 2022. On the basis of their postcode of residence, patients were stratified into metropolitan and regional groups. Data encompassing demographics, oncological, surgical and QoL outcomes were compared. Statistical analysis included chi-square test, t-tests and Kaplan–Meier survival curves.

Results

Among the 317 patients, 228 (72%) were categorised as metropolitan and 89 (28%) as regional. Metropolitan patients presented higher rates of recurrence (61.8% versus 40.0%, p = 0.014) and shorter overall mean survival [3.8 years (95% CI: 3.44–4.09) versus 4.2 years (95% CI: 3.76–4.63), p = 0.019] compared with regional patients. No other statistically significant differences were observed in oncological, surgical and QoL outcomes.

Conclusions

Most oncological, surgical and QoL parameters did not differ by geographical location of patients undergoing CRS and HIPEC for peritoneal malignancies at a high-volume quaternary referral centre. Observed differences in recurrence and survival may be attributed to the selective nature of surgical referrals and variable follow-up patterns. Future research should focus on characterising referral pathways and its influence on post-operative outcomes.

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Most cited references 33

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Author and article information

Contributors

Adrian Siu: adriansiu7@hotmail.com

Journal

Journal ID (nlm-ta): Tech Coloproctol

Journal ID (iso-abbrev): Tech Coloproctol

Title: Techniques in Coloproctology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1123-6337

ISSN (Electronic): 1128-045X

Publication date (Electronic): 20 February 2024

Publication date PMC-release: 20 February 2024

Publication date (Print): 2024

Volume: 28

Issue: 1

Electronic Location Identifier: 35

Affiliations

[1 ]Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, ( https://ror.org/05gpvde20) Missenden Road, PO Box M 157, Camperdown, NSW 2050 Australia

[2 ]Faculty of Medicine and Health, Central Clinical School, The University of Sydney, ( https://ror.org/0384j8v12) Sydney, NSW Australia

[3 ]Department of Colorectal Surgery, Royal Prince Alfred Hospital, ( https://ror.org/05gpvde20) Sydney, NSW Australia

[4 ]Peritoneal Malignancy Institute, North Hampshire Foundation Trust, Basingstoke, UK

Article

Publisher ID: 2911

DOI: 10.1007/s10151-024-02911-9

PMC ID: 10879398

PubMed ID: 38376623

SO-VID: 1bbaa521-e023-4d49-8217-b13ac27d6ef9

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 13 December 2023

Date accepted : 4 February 2024

Funding

Funded by: University of Sydney

Open Access :

Open Access funding enabled and organized by CAUL and its Member Institutions

Custom metadata

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: cytoreductive surgery,hyperthermic intraperitoneal chemotherapy,peritoneal malignancy,surgical outcomes,oncological outcomes

Data availability:

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, peritoneal malignancy, surgical outcomes, oncological outcomes

Evaluating geographical disparities on clinical outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

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Karger: Gastroenterology

Most cited references 33

Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.

Low health literacy and health outcomes: an updated systematic review.

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