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Behrenbruch C, Hollande F, Thomson B, Michael M, Warrier SK, Lynch C, Heriot A. Treatment of peritoneal carcinomatosis with hyperthermic intraperitoneal chemotherapy in colorectal cancer. ANZ J Surg 2017; 87:665-670. [PMID: 28664645 DOI: 10.1111/ans.14077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 03/29/2017] [Accepted: 04/17/2017] [Indexed: 12/20/2022]
Abstract
The peritoneum is the second most common site of metastasis after the liver and the only site of metastatic disease in approximately 25% of patients with colorectal cancer (CRC). In the past, peritoneal carcinomatosis in CRC was thought to be equivalent to distant metastasis; however, the transcoelomic spread of malignant cells is an acknowledged alternative pathway. Metastasectomy with curative intent is well accepted in patients with liver metastasis in CRC despite the paucity of randomized trials. Therefore, there is rationale for local treatment with peritonectomy to eliminate macroscopic disease, followed by hyperthermic intraperitoneal chemotherapy to destroy any residual free tumour cells within the peritoneal cavity. The aim of this paper is to summarize the current evidence for cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis in CRC.
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Affiliation(s)
- Corina Behrenbruch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Pathology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Frédéric Hollande
- Department of Pathology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin Thomson
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Michael
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Craig Lynch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Hsieh MC, Lu CY, Chang WW, Wu SY, Hsiao PK, Liu TJ. Experiences with cytoreduction surgery plus hyperthermic intraperitoneal chemotherapy in Taiwan. Medicine (Baltimore) 2017; 96:e7306. [PMID: 28658135 PMCID: PMC5500057 DOI: 10.1097/md.0000000000007306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Our hospital was the first institution to offer cytoreduction surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in Taiwan. Therefore, we report our experience and outcomes among patients who underwent HIPEC.Since 2002, 164 eligible patients underwent HIPEC, and we excluded cases of laparoscopic or prophylactic HIPEC. The cases were categorized according to whether they were treated before 2012 (Period 1: 80 cases) or after 2012 (Period 2: 84 cases).The rates of surgical morbidity were 46.3% during Period 1 and 20.2% during Period 2 (P < .01), and the rates of severe complications were 25% during Period 1 and 9.5% during Period 2 (P < .01). The 5-year overall survival rate was 35.8%, with rates of 13.4% for gastric cancer, 27.3% for colon cancer, 70.0% for appendiceal cancer, and 52.4% for ovarian cancer (median follow-up: 34 months). The survival rate was 42.1% when we achieved a cytoreduction score of 0/1, compared with 21.1% in the group with a cytoreduction score of 2/3 (P < .01). Severe complications were associated with a 5-year survival rate of 23.4%, compared with 37.9% among cases without severe complications (P = .01). Complete cytoreduction was achieved in 78.6% of the patients if they underwent their first surgery at our hospital.We have become an experienced hospital for CRS plus HIPEC. Although our complication rate for CRS plus HIPEC was high, it was within the acceptable range. Long-term survival was achieved in a few cases.
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Affiliation(s)
- Mao-Chih Hsieh
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine
| | - Chang-Yun Lu
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
| | - Wei-Wen Chang
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
| | - Szu-Yuan Wu
- Department of Radiation Oncology, Wan Fang Hospital
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei
- Department of Biotechnology, Hungkuang University, Taichung, Taiwan
| | - Ping-Kun Hsiao
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
| | - Tse-Jia Liu
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine
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Maciver AH, Al-Sukhni E, Esquivel J, Skitzki JJ, Kane JM, Francescutti VA. Current Delivery of Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery (CS/HIPEC) and Perioperative Practices: An International Survey of High-Volume Surgeons. Ann Surg Oncol 2016; 24:923-930. [DOI: 10.1245/s10434-016-5692-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 12/19/2022]
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Mahmoud AMA, Hussein MM, Moneer MM. Outcome and surgical strategy in critical sites in cases of psuedomyxoma peritonei. J Egypt Natl Canc Inst 2016; 28:249-255. [PMID: 27658904 DOI: 10.1016/j.jnci.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/28/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND For a long time peritoneal neoplasms were considered beyond surgical intervention and beyond cure, till the concept of cytoreductive surgery (CRS) and adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) was introduced. However this surgical intervention is technically demanding and associated with considerable postoperative morbidity. OBJECTIVE To describe the surgical strategy in resection of critical sites loaded by heavy tumor deposits and to evaluate short and long term results of CRS and HIPEC, in a cohort of Egyptian patients with pseudomyxoma peritonei (PMP) from appendiceal origin. PATIENTS AND METHODS 21 patients with PMP, age ranged from 40 to 63years, 12 males and 9 females. All were recruited from the department of surgery at the National Cancer Institute (NCI), Cairo University over the period from February 2011 to February 2016. They were subjected to CRS and HIPEC with mitomycin-C. RESULTS The median peritoneal carcinoma index (PCI) was 22 (range: 10-39). Optimal cytoreduction (CCR-0/1) was achieved in 19 patients (90.4%) of whom 17 patients (80.9%) had a complete cytoreduction (CCR-0). The median follow up period was 51.5months (range: 0.07-82.3months). The cumulative overall survival was 85.7% while the cumulative disease free survival was 76.9%. CONCLUSION To the best of our knowledge, this is the first study reporting five years postoperative outcome of CRS and HIPEC in Egyptian patients with PMP from appendiceal origin. Our results support that although technically demanding this treatment modality is safe and associated with favorable outcome.
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Affiliation(s)
| | | | - Manar Mohamed Moneer
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Egypt
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Di Fabio F, Mehta A, Chandrakumaran K, Mohamed F, Cecil T, Moran B. Advanced Pseudomyxoma Peritonei Requiring Gastrectomy to Achieve Complete Cytoreduction Results in Good Long-Term Oncologic Outcomes. Ann Surg Oncol 2016; 23:4316-4321. [DOI: 10.1245/s10434-016-5389-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Indexed: 12/11/2022]
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Sugarbaker PH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of gastrointestinal cancers with peritoneal metastases: Progress toward a new standard of care. Cancer Treat Rev 2016; 48:42-9. [PMID: 27347669 DOI: 10.1016/j.ctrv.2016.06.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/14/2022]
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Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy with lobaplatin and docetaxel to treat synchronous peritoneal carcinomatosis from gastric cancer: Results from a Chinese center. Eur J Surg Oncol 2016; 42:1024-34. [DOI: 10.1016/j.ejso.2016.04.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/05/2016] [Accepted: 04/18/2016] [Indexed: 12/29/2022] Open
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Benhaim L, Honoré C, Goéré D, Delhorme JB, Elias D. Huge pseudomyxoma peritonei: Surgical strategies and procedures to employ to optimize the rate of complete cytoreductive surgery. Eur J Surg Oncol 2016; 42:552-7. [DOI: 10.1016/j.ejso.2016.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/31/2015] [Accepted: 01/18/2016] [Indexed: 11/27/2022] Open
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Delhorme JB, Elias D, Varatharajah S, Benhaim L, Dumont F, Honoré C, Goéré D. Can a Benefit be Expected from Surgical Debulking of Unresectable Pseudomyxoma Peritonei? Ann Surg Oncol 2015; 23:1618-24. [PMID: 26678404 DOI: 10.1245/s10434-015-5019-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE This study evaluated the role of surgical debulking in improving pseudomyxoma peritonei (PMP)-related symptoms if complete cytoreductive surgery (CCRS) of huge PMP is unachievable. METHODS This was a retrospective analysis of a prospective database of all patients in our tertiary care center treated for PMP between 1992 and 2014. All cases of surgical debulking in patients scheduled for CCRS that proved unachievable during the operation were selected for the present study. RESULTS Among the 338 patients operated on for PMP, 39 (11.5 %) had undergone surgical debulking because CCRS was unachievable. All of these patients were symptomatic before surgery, and the median PCI was 32 (5-39). More than 80 % of the disease burden was resected in 23 patients (59 %). Mortality and major morbidity rates were 2.5 and 23 %, respectively. After debulking surgery, symptoms gradually subsided over a median time of 23 months and 50 % of the patients no longer experienced PMP-related symptoms after a median follow-up of 24.5 months. After a median follow-up of 46.4 months (range 3-120), median overall (OS) and progression-free (PFS) survival times were 55.5 and 20 months, respectively. Five-year OS and PFS rates were 46 and 11 %, respectively. CONCLUSIONS Aggressive debulking surgery in case of unachievable CCRS for huge PMP can offer prolonged relief of PMP-related symptoms and long-term survival, in experienced centers that are able to be sufficiently aggressive to resect the major part of the disease, and conservative enough to achieve low mortality and good quality of life.
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Affiliation(s)
- Jean-Baptiste Delhorme
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France
| | - Dominique Elias
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France
| | - Sharmini Varatharajah
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France
| | - Léonor Benhaim
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France
| | - Frédéric Dumont
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France
| | - Diane Goéré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France.
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Malfroy S, Wallet F, Maucort-Boulch D, Chardonnal L, Sens N, Friggeri A, Passot G, Glehen O, Piriou V. Complications after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis: Risk factors for ICU admission and morbidity prognostic score. Surg Oncol 2015; 25:6-15. [PMID: 26979635 DOI: 10.1016/j.suronc.2015.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/03/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES For patients suffering from peritoneal carcinomatosis, cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the only curative option. We focused on severe complications in the postoperative course of HIPEC. METHODS We studied perioperative data from patients who underwent HIPEC between January 2010 and August 2011. Our primary objective was to identify perioperative risk factors for ICU admission. Our secondary objective was to identify patient that may be re-admitted to the ICU thanks to a prognostic score. RESULTS 122 patients underwent HIPEC. 32 presented severe adverse events (26.2%) and 7 died (5.7%). Reasons for ICU admission were septic shock in 28.1% of patients, hemorrhagic shock for 21.9%, hemodynamic instability for 15.6%, respiratory causes for 6.2% and post-operative acidosis for 6.2%. Vasopressors were required for 34% and 40.6% were mechanically ventilated. CONCLUSION Peritoneal cancer index, diaphragmatic peritonectomy, the need of vasopressive therapy, total volume of fluid leakage collected in drains and total volume of fluid therapy administered at day 1 reported on ideal body weight were the 5 significant variables that we combined to build a morbidity prognostic score. One patient over 4 is likely to present severe complications. A predictive morbidity score provide informative data for clinicians.
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Affiliation(s)
- Sylvain Malfroy
- Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France.
| | - Florent Wallet
- Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France
| | - Delphine Maucort-Boulch
- Biostatistic Unit, Hospices Civils de Lyon, F-69003, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Laurent Chardonnal
- Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France
| | - Nicolas Sens
- Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France
| | - Arnaud Friggeri
- Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France
| | - Guillaume Passot
- Department of Surgical Oncology, CHU Lyon Sud, Lyon 1 University, EMR 3738, Pierre Benite, France
| | - Olivier Glehen
- Department of Surgical Oncology, CHU Lyon Sud, Lyon 1 University, EMR 3738, Pierre Benite, France
| | - Vincent Piriou
- Anesthesiology and Critical Care Department, CHU Lyon Sud, Université Lyon 1, Pierre Benite, France
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Poston GJ. Global cancer surgery: The Lancet Oncology review. Eur J Surg Oncol 2015; 41:1559-61. [PMID: 26412556 DOI: 10.1016/j.ejso.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- G J Poston
- School of Translational Studies, University of Liverpool, Liverpool, UK; Department of Surgery, Aintree University Hospital, Liverpool, UK.
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Huang Y, Alzahrani NA, Liauw W, Morris DL. Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis. ANZ J Surg 2015; 87:49-54. [DOI: 10.1111/ans.13280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Yeqian Huang
- St George Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Nayef A. Alzahrani
- Department of Surgery; St George Hospital; Sydney New South Wales Australia
- College of Medicine; Imam Muhammad ibn Saud Islamic University; Riyadh Saudi Arabia
| | - Winston Liauw
- Department of Medical Oncology; St George Hospital; University of New South Wales; Sydney New South Wales Australia
| | - David L. Morris
- Department of Surgery; St George Hospital; University of New South Wales; Sydney New South Wales Australia
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