Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology

Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures

BACKGROUND

Peritoneal dissemination of abdominal malignancy (PSD) has a clinical course marked by bowel obstruction and death. We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (IPHC) to treat PSD. The purpose of this article was to review our experience with IPHC.

STUDY DESIGN

A prospective database of patients undergoing IPHC has been maintained since 1991. Patients were uniformly evaluated and treated. Demographics, performance status, resection status, primary site, and experience quartile were compared with outcomes. Univariate and multivariate analyses were performed.

RESULTS

A total of 460 patients underwent 501 IPHC procedures. Average age was 53.0 years, and 50.4% were women. The 30-day mortality rate was 4.8%, the complication rate was 43%, and median hospital stay was 9 days. Median followup was 55.4 months, median survival was 22.2 months, and 5-year survival rate was 27.8%. Factors correlating with improved survival were performance status (p=0.0001), primary tumor (p=0.0001), resection status (p=0.0001), complications (p=0.002), previous IPHC (p=0.006), and experience quartile (p=0.031). On multivariate analysis, primary tumor site, performance status, resection status, and development of complications (p < 0.001) predicted outcomes.

CONCLUSIONS

Our experience demonstrated that preoperative criteria for better outcomes include primary tumor site and performance status. Completeness of resection and development of postoperative complications are also crucial, and outcomes have improved over time. Cytoreductive surgery and IPHC represent substantial improvements in outcomes compared with historic series and best-available systemic therapy. Longterm survival is possible for selected patients who undergo the procedure.

Selection of Patients with Colorectal Peritoneal Carcinomatosis for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy

BACKGROUND

Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has been suggested as a treatment option for patients with colorectal peritoneal carcinomatosis. However, the survival benefit is achieved at the expense of moderate to high perioperative morbidity and mortality.

METHODS

This review summarized the important prognostic factors for survival; outlined the patient selection process from major peritonectomy centers, paying particular attention to preoperative evaluation; and identified areas for potential improvement. Emphasis was placed on a strict patient selection process to avoid futile aggressive treatments.

RESULTS

Currently, contrast-enhanced computed tomography, magnetic resonance imaging, positron emission tomography, and laparoscopy have been utilized in the preoperative evaluation process to identify potential surgical candidates. Patients with good performance status, low volume of peritoneal disease, and absence of extra-abdominal metastases are more likely to benefit from the combined treatment.

CONCLUSIONS

Quantitative assessment of the extent of disease is possible and should be performed at the time of primary cancer operation. Careful selection of patients to identify surgical candidates with favorable prognostic indicators is important.