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Esquivel J, Petrelli N, Spellman J, Bennett J, Chirla S, Khatri J, Masters G. Consensus statement and clinical pathway for the management of colon cancer with peritoneal metastases in the state of Delaware. Surg Oncol 2023; 51:101895. [PMID: 36682944 DOI: 10.1016/j.suronc.2022.101895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Increasing data suggests that the combination of modern systemic therapies and Cytoreductive surgery with or without Hyperthermic Intraperitoneal Chemotherapy (HIPEC) may improve the outcome of patients with colon cancer with peritoneal metastases. Patient selection and sequence of treatments remains ill-defined. MATERIALS AND METHODS A working group, the State of Delaware Peritoneal Surface Malignancies Task Force (DE-PSM-TF), was created including representatives from medical and surgical oncology from the acute care hospitals in Delaware. An extensive review of all available literature was carried out. Virtual meetings were held, and interpretation and discussion of the data was conducted. RESULTS A clinical pathway that includes a multidisciplinary evaluation at the time of diagnosis of colon cancer with peritoneal metastases and reflects a consensus from the Task Force on 7 key points that suggest the management of these patients based on the severity of their peritoneal metastases and incorporates all currently available therapies was created. The sequence of therapies of this multimodality treatment was determined by the Peritoneal Surface Disease Severity Score (PSDSS) (Fig. 1). CONCLUSION The current pathway represents a comprehensive, team effort that should improve the outcome of patients with Colon Cancer with peritoneal metastases in the state of Delaware by having multidisciplinary discussions at the time of diagnosis, selecting the best order of sequence of currently available therapies in order to maximize benefits and minimize morbidity.
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Affiliation(s)
| | - Nicholas Petrelli
- Helen F Graham Cancer Center & Research Institute, Christiana Care, USA
| | | | - Joseph Bennett
- Helen F Graham Cancer Center & Research Institute, Christiana Care, USA
| | | | - Jamil Khatri
- Helen F Graham Cancer Center & Research Institute, Christiana Care, USA
| | - Gregory Masters
- Helen F Graham Cancer Center & Research Institute, Christiana Care, USA
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Seyfried N, Yurttas C, Burkard M, Oswald B, Tolios A, Herster F, Kauer J, Jäger T, Königsrainer I, Thiel K, Quante M, Rammensee HG, Venturelli S, Schwab M, Königsrainer A, Beckert S, Löffler MW. Prolonged Exposure to Oxaliplatin during HIPEC Improves Effectiveness in a Preclinical Micrometastasis Model. Cancers (Basel) 2022; 14:cancers14051158. [PMID: 35267468 PMCID: PMC8909393 DOI: 10.3390/cancers14051158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/01/2022] [Accepted: 02/12/2022] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Absence of survival benefits when adding hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin to cytoreductive surgery in peritoneal metastasis from colorectal cancer has recently been shown in the randomized controlled PRODIGE 7 trial. We therefore aimed to investigate the effects of this treatment modality in a preclinical micrometastasis model. Cancer cells were incubated with either patient samples obtained during HIPEC procedures or with defined oxaliplatin-containing solutions prepared according to clinically established HIPEC protocols. Our results demonstrate a limited effectiveness of short-term HIPEC in simulations with oxaliplatin to eliminate micrometastases, although we used platinum-sensitive cell lines for our model. Since these results are in line with findings from current research, our studies might offer further convincing evidence and potential explanations for HIPEC futility observed in clinical application. Abstract Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) was considered a promising treatment for patients with peritoneal metastasis from colorectal cancer. However, the recently published randomized controlled PRODIGE 7 trial failed to demonstrate survival benefits through the addition of short-term oxaliplatin-based HIPEC. Constituting a complex multifactorial treatment, we investigated HIPEC in a preclinical model concerning the elimination of minimal tumor residues, thereby aiming to better understand the size of effects and respective clinical trial results. Patient samples of peritoneal perfusates obtained during HIPEC treatments and oxaliplatin-containing solutions at clinically relevant dosages, conforming with established HIPEC protocols, were assessed regarding their ability to eliminate modelled ~100 µm thickness cancer cell layers. Impedance-based real-time cell analysis and classical end-point assays were used. Flow cytometry was employed to determine the effect of different HIPEC drug solvents on tumor cell properties. Effectiveness of peritoneal perfusate patient samples and defined oxaliplatin-containing solutions proved limited but reproducible. HIPEC simulations for 30 min reduced the normalized cell index below 50% with peritoneal perfusates from merely 3 out of 9 patients within 72 h, indicating full-thickness cytotoxic effects. Instead, prolonging HIPEC to 1 h enhanced these effects and comprised 7 patients’ samples, while continuous drug exposure invariably resulted in complete cell death. Further, frequently used drug diluents caused approximately 25% cell size reduction within 30 min. Prolonging oxaliplatin exposure improved effectiveness of HIPEC to eliminate micrometastases in our preclinical model. Accordingly, insufficient penetration depth, short exposure time, and the physicochemical impact of drug solvents may constitute critical factors.
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Affiliation(s)
- Nick Seyfried
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; (N.S.); (I.K.); (K.T.); (M.Q.); (A.K.); (S.B.); (M.W.L.)
- Interfaculty Institute for Cell Biology, Department of Immunology, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany; (B.O.); (F.H.); (J.K.); (H.-G.R.)
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Can Yurttas
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; (N.S.); (I.K.); (K.T.); (M.Q.); (A.K.); (S.B.); (M.W.L.)
- Correspondence:
| | - Markus Burkard
- Institute of Nutritional Sciences, Department of Nutritional Biochemistry, University of Hohenheim, Garbenstr. 30, 70599 Stuttgart, Germany; (M.B.); (S.V.)
| | - Benedikt Oswald
- Interfaculty Institute for Cell Biology, Department of Immunology, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany; (B.O.); (F.H.); (J.K.); (H.-G.R.)
| | - Alexander Tolios
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Schwarzspanierstraße 17A, 1090 Vienna, Austria
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Artificial Intelligence, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Franziska Herster
- Interfaculty Institute for Cell Biology, Department of Immunology, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany; (B.O.); (F.H.); (J.K.); (H.-G.R.)
- Robert Bosch Center for Tumor Diseases (RBCT), Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Joseph Kauer
- Interfaculty Institute for Cell Biology, Department of Immunology, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany; (B.O.); (F.H.); (J.K.); (H.-G.R.)
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, 72076 Tübingen, Germany;
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
- Department of Hematology, Oncology, and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria;
| | - Ingmar Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; (N.S.); (I.K.); (K.T.); (M.Q.); (A.K.); (S.B.); (M.W.L.)
- Department of General, Visceral and Thoracic Surgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Karolin Thiel
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; (N.S.); (I.K.); (K.T.); (M.Q.); (A.K.); (S.B.); (M.W.L.)
| | - Markus Quante
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; (N.S.); (I.K.); (K.T.); (M.Q.); (A.K.); (S.B.); (M.W.L.)
| | - Hans-Georg Rammensee
- Interfaculty Institute for Cell Biology, Department of Immunology, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany; (B.O.); (F.H.); (J.K.); (H.-G.R.)
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC2180) ‘Image-Guided and Functionally Instructed Tumor Therapies’, University of Tübingen, 72076 Tübingen, Germany
| | - Sascha Venturelli
- Institute of Nutritional Sciences, Department of Nutritional Biochemistry, University of Hohenheim, Garbenstr. 30, 70599 Stuttgart, Germany; (M.B.); (S.V.)
- Department of Vegetative and Clinical Physiology, Institute of Physiology, University of Tübingen, Wilhelmstr. 56, 72074 Tübingen, Germany
| | - Matthias Schwab
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC2180) ‘Image-Guided and Functionally Instructed Tumor Therapies’, University of Tübingen, 72076 Tübingen, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, Auf der Morgenstelle 8, 72076 Tübingen, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Auerbachstr. 112, 70376 Stuttgart, Germany
- Departments of Pharmacy and Biochemistry, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; (N.S.); (I.K.); (K.T.); (M.Q.); (A.K.); (S.B.); (M.W.L.)
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC2180) ‘Image-Guided and Functionally Instructed Tumor Therapies’, University of Tübingen, 72076 Tübingen, Germany
| | - Stefan Beckert
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; (N.S.); (I.K.); (K.T.); (M.Q.); (A.K.); (S.B.); (M.W.L.)
- Department of General and Visceral Surgery, Schwarzwald-Baar Hospital, Klinikstr. 11, 78052 Villingen-Schwenningen, Germany
| | - Markus W. Löffler
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; (N.S.); (I.K.); (K.T.); (M.Q.); (A.K.); (S.B.); (M.W.L.)
- Interfaculty Institute for Cell Biology, Department of Immunology, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany; (B.O.); (F.H.); (J.K.); (H.-G.R.)
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC2180) ‘Image-Guided and Functionally Instructed Tumor Therapies’, University of Tübingen, 72076 Tübingen, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, Auf der Morgenstelle 8, 72076 Tübingen, Germany
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3
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Wong LCK, Li Z, Fan Q, Tan JWS, Tan QX, Wong JSM, Ong CAJ, Chia CS. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal sarcomatosis-A systematic review and meta-analysis. Eur J Surg Oncol 2021; 48:640-648. [PMID: 34716035 DOI: 10.1016/j.ejso.2021.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) play an important role in the treatment of various peritoneal surface malignancies, but its efficacy in peritoneal sarcomatosis (PS) remains unknown. Hence, we performed a systematic review and meta-analysis to investigate outcomes of CRS-HIPEC in PS, in accordance with PRISMA guidelines. 16 studies with a total of 320 patients were included in the meta-analysis. Pooled mean length of hospital stay after CRS-HIPEC was 16.0 days (95% CI: 12.2-19.8) and rate of serious complications was 17.4% (95% CI: 9.8-26.3). The median DFS was 12.0 months (95% CI: 8.0-16.0) and the 5-year DFS was 21.8% (95% CI: 13.2-31.7). Overall pooled median OS was 29.3 months (95% CI: 23.8-34.8), with a 5-year OS of 35.3% (95% CI: 26.3-44.8). Subgroup analysis showed that patients with CC-0 cytoreduction had a higher median OS of 34.6 months (95% CI: 23.2-45.9). Median OS for patients with a primary tumour histology of leiomyosarcoma and liposarcoma was 33.5 months (95% CI: 15.9-51.1) and 39.1 months (95% CI: 20.8-57.5) respectively. The site of recurrence was locoregional in 57.3% (95% CI: 38.9-74.8), distant in 17.3% (95% CI: 3.9-35.6), and both in 17.4% (95% CI: 5.8-32.2). In conclusion, our results suggest that CRS-HIPEC may improve outcomes in a select group of PS patients.
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Affiliation(s)
- Louis Choon Kit Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Zhenyue Li
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Qiao Fan
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Joey Wee-Shan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Qiu Xuan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Institute of Molecular and Cell Biology, A∗STAR Research Entities, Singapore; SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore.
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4
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Stewart JH, Blazer DG, Calderon MJG, Carter TM, Eckhoff A, Al Efishat MA, Fernando DG, Foster JM, Hayes-Jordan A, Johnston FM, Lautz TB, Levine EA, Maduekwe UN, Mangieri CW, Moaven O, Mogal H, Shen P, Votanopoulos KI. The Evolving Management of Peritoneal Surface Malignancies. Curr Probl Surg 2020; 58:100860. [PMID: 33832580 DOI: 10.1016/j.cpsurg.2020.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/04/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Dan G Blazer
- Division of Surgical Oncology, Duke University Medical Center, Durham, NC
| | | | | | | | | | | | - Jason M Foster
- Fred and Pamela Buffet Cancer Center, University of Nebraska, Omaha, NE
| | | | - Fabian M Johnston
- Complex General Surgical Oncology Program, Johns Hopkins University, Baltimore, MD
| | - Timothy B Lautz
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ugwuji N Maduekwe
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Perry Shen
- Wake Forest University School of Medicine, Winston-Salem, NC
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5
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Roh SJ, Park SC, Choi J, Lee JS, Lee DW, Hong CW, Han KS, Park HC, Sohn DK, Oh JH. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Mitomycin C Used for Colorectal Peritoneal Carcinomatosis. Ann Coloproctol 2020; 36:22-29. [PMID: 32146785 PMCID: PMC7069674 DOI: 10.3393/ac.2019.04.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose This study aimed to assess the evaluation of clinical outcomes and consequences of complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the peritoneal carcinomatosis (PC) from colorectal cancer. Methods A total 26 patients underwent CRS and HIPEC for PC from colorectal cancer between March 2009 and April 2018. All the patients underwent CRS with the purpose of complete or near-complete cytoreduction. Intraoperative HIPEC was performed simultaneously after the CRS. Mitomycin C was used as chemotherapeutic agent for HIPEC. Results Median disease-free survival was 27.8 months (range, 13.4–42.2 months). Median overall survival was 56.0 months (range, 28.6–83.5 months). The mean peritoneal cancer index (PCI) was 8.73 ± 5.54. The distributions thereof were as follows: PCI <10, 69.23%; PCI 10–19, 23.08%; and PCI ≥20, 7.69%. The completeness of cytoreduction was 96.2% of patients showed CC-0, with 3.8% achieved CC-1. The mean operation time was 8.5 hours, and the mean postoperative hospital stay was 21.6 days. The overall rate of early postoperative complications was 88.5%; the rate of late complications was 34.6%. In the early period, most complications were grades I–II complications (65.4%), compared to grades III–V (23.1%). All late complications, occurring in 7.7% of patients, were grades III–V. There was no treatment-related mortality. Conclusion Although the complication rate was approximately 88%, but the rate of severe complication rate was low. In selective patients with peritoneal recurrence, more aggressive strategies for management, such as CRS with HIPEC, were able to be considered under the acceptable general condition and life-expectancy.
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Affiliation(s)
- Seung Jae Roh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jaehee Choi
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Joon Sang Lee
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dong Woon Lee
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyoung Chul Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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6
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Webb C, Day R, Velazco CS, Pockaj BA, Gray RJ, Stucky CC, Young-Fadok T, Wasif N. Implementation of an Enhanced Recovery After Surgery (ERAS) Program is Associated with Improved Outcomes in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2019; 27:303-312. [PMID: 31605328 DOI: 10.1245/s10434-019-07900-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with increased postoperative complications and a prolonged length of stay (LOS). We report on our experience following implementation of an Enhanced Recovery After Surgery (ERAS) program for CRS and HIPEC. METHODS Patients were divided into pre- and post-ERAS groups. Modifications in the ERAS group included routine use of transversus abdominis plane blocks, intra- and postoperative fluid restriction, and minimizing the use of narcotics, drains, and nasogastric tubes. RESULTS Of a total of 130 procedures, 49 (38%) were in the pre-ERAS group and 81 (62%) were in the ERAS group. Mean LOS was reduced from 10.3 ± 8.9 days to 6.9 ± 5.0 days (p = 0.007) and the rate of grade III/IV complications was reduced from 24 to 15% (p = 0.243) following ERAS implementation. The ERAS group received less intravenous fluid during hospitalization (19.2 ± 18.7 L vs. 32.8 ± 32.5 L, p = 0.003) and used less opioids than the pre-ERAS group (median of 159.7 mg of oral morphine equivalents vs. 272.6 mg). There were no significant changes in the rates of 30-day readmission or acute kidney injury between the two groups (p = non-significant). On multivariable analyses, ERAS was significantly associated with a reduction in LOS (- 2.89 days, 95% CI - 4.84 to - 0.94) and complication rates (odds ratio 0.22, 95% CI 0.08-0.57). CONCLUSIONS Implementation of an ERAS program for CRS and HIPEC is associated with a reduction in overall intravenous fluids, postoperative narcotic use, complication rates, and LOS.
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Affiliation(s)
- Christopher Webb
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Ryan Day
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Cristine S Velazco
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Barbara A Pockaj
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Richard J Gray
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Chee-Chee Stucky
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Tonia Young-Fadok
- Department of Surgery, Division of Colorectal Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Nabil Wasif
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
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7
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Leigh NL, Solomon D, Feingold D, Magge DR, Golas BJ, Sarpel U, Labow DM. Improved Survival with Experience: A 10-Year Learning Curve in Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery. Ann Surg Oncol 2019; 27:222-231. [DOI: 10.1245/s10434-019-07518-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Indexed: 12/21/2022]
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8
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Alzahrani NA, Valle SJ, Fisher OM, Sugarbaker PH, Yonemura Y, Glehen O, Goere D, Honore C, Brigand C, de Hingh I, Verwaal VJ, Deraco M, Baratti D, Kusamura S, Pocard M, Piso P, Maerz L, Marchal F, Moran B, Levine EA, Dumont F, Pezet D, Abboud K, Kozman MA, Liauw W, Morris DL. Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional experience. J Surg Oncol 2018; 119:336-346. [PMID: 30554404 DOI: 10.1002/jso.25277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The aims of this multi-institutional study were to assess the feasibility of iterative cytoreductive surgery (iCRS)/hyperthermic intraperitoneal chemotherapy, iCRS in colorectal peritoneal carcinomatosis (CRPC), evaluate survival, recurrence, morbidity and mortality outcomes, and identify prognostic factors for overall survival. METHODS Patients with CRPC that underwent an iCRS, with or without intraperitoneal chemotherapy, from June 1993 to July 2016 at 13 institutions were retrospectively analyzed from prospectively maintained databases. RESULTS The study comprised of 231 patients, including 126 females (54.5%) with a mean age at iCRS of 51.3 years. The iterative high-grade (3/4) morbidity and mortality rates were 23.4% and 1.7%, respectively. The median recurrence-free survival was 15.0 and 10.1 months after initial and iCRS, respectively. The median and 5-year survivals were 49.1 months and 43% and 26.4 months and 26% from the initial and iCRS, respectively. Independent negative predictors of survival from the initial CRS included peritoneal carcinomatosis index (PCI) > 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI > 10 ( P = 0.03 for PCI 11-20; P < 0.001 for PCI > 20), high-grade complications ( P = 0.012), and incomplete cytoreduction ( P < 0.001). CONCLUSION iCRS can provide long-term survival benefits to highly selected colorectal peritoneal carcinomatosis patients with comparable mortality and morbidity rates to the initial CRS procedure. Careful patient selection is necessary to improve overall outcomes.
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Affiliation(s)
- Nayef A Alzahrani
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia.,College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sarah J Valle
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Oliver M Fisher
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Paul H Sugarbaker
- MedStar Washington Hospital Center, Peritoneal Surface Oncology Unit, Washington, DC
| | - Yutaka Yonemura
- Peritoneal Metastasis Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Olivier Glehen
- Surgical Oncology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Dianne Goere
- Institute Gustave Roussy Cancer Campus, Department of Digestive and Oncology Surgery, Paris, France
| | - Charles Honore
- Institute Gustave Roussy Cancer Campus, Department of Digestive and Oncology Surgery, Paris, France
| | - Cecile Brigand
- General & Digestive Surgery, CHRU Hautepierre, Strasbourg, France
| | - Ignace de Hingh
- Catharina Hospital, Department of Surgery, Eindhoven, Netherlands
| | - Vic J Verwaal
- Catharina Hospital, Department of Surgery, Eindhoven, Netherlands.,Department of Surgical Oncology, Aarhus University Hospital, Denmark
| | - Marcello Deraco
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Dario Baratti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Shigeki Kusamura
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Mark Pocard
- Surgical Oncology Department, St. Louis Hospital Lariboisiere, Paris, France
| | - Pompiliu Piso
- Department of Surgical Oncology, Hospital Barmherzige Brueder Regensburg, Germany
| | - Loreen Maerz
- Department of Surgical Oncology, Hospital Barmherzige Brueder Regensburg, Germany
| | - Frederic Marchal
- Department of Surgical Oncology, Institute of Cancer, Vandoeeuvre Les Nancy, France
| | - Brendan Moran
- Peritoneal Malignancy Department, Basingstoke North Hampshire Hospital, Basingstoke, UK
| | - Edward A Levine
- Wake Forest Baptist Health, Surgical Oncology, Winston-Salem, North Carolina
| | - Frédéric Dumont
- Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - Denis Pezet
- Department of Digestive Surgery, CHU Estaing, Clermont Ferrand, France
| | - Karine Abboud
- Department of General Surgery, CHU Nord, Saint Etienne, France
| | - Mathew A Kozman
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Winston Liauw
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW, Australia
| | - David L Morris
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
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9
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Guerrero WL, Munene G, Dickson PV, Darby D, Davidoff AM, Martin MG, Glazer ES, Shibata D, Deneve JL. Early experience with cytoreduction and hyperthermic intraperitoneal chemotherapy at a newly developed center for peritoneal malignancy. J Gastrointest Oncol 2018; 9:338-347. [PMID: 29755773 DOI: 10.21037/jgo.2018.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has improved outcomes for patients with peritoneal carcinomatosis (PC). We present our experience from a newly developed peritoneal surface malignancy program. Methods An IRB approved retrospective review was performed for the first 50 patients treated with CRS/HIPEC with clinicopathologic data described. Results Patients treated with CRS/HIPEC were Caucasian (64%), female (66%) with a median age of 53 years (range, 11-73 years). Primary pathology included: appendix (40%, n=20), ovary (20%, n=10), colon (14%, n=7), desmoplastic small round cell tumor (14%, n=7) or other (12%, n=6). The median peritoneal cancer index (PCI) score was 15.5 (range, 1-39) and 92% underwent complete cytoreduction (CCR 0/1). Median hospital length of stay was 9.0 days (range, 6-35 days). Eight patients (16%) suffered major morbidity with 2 (4%) 30-day mortalities. Conclusions Short-term outcomes observed after CRS/HIPEC in a newly developed center for PC are consistent with published higher volume center experiences.
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Affiliation(s)
- Whitney L Guerrero
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gitonga Munene
- Western Michigan University, Homer Stryker School of Medicine, West Michigan Cancer Center, Kalamazoo, MI, USA
| | - Paxton V Dickson
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dina Darby
- University of Tennessee Medical Practice, Surgical Oncology, Methodist Healthcare, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Pediatric Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Evan S Glazer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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10
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Park EJ, Baik SH, Hur H, Min BS, Kang J, Han YD, Cho MS, Lee KY, Kim NK. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for appendiceal and colorectal cancer with peritoneal carcinomatosis: Clinical outcomes at 2 tertiary referral centers in Korea. Medicine (Baltimore) 2017; 96:e6632. [PMID: 28538365 PMCID: PMC5457845 DOI: 10.1097/md.0000000000006632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is regarded as effective surgical treatments in patients with peritoneal metastasis. This study aimed to evaluate the clinical outcomes of CRS and HIPEC in patients with appendiceal or colorectal cancer with peritoneal carcinomatosis.A total of 66 patients who underwent CRS with HIPEC for appendiceal or colorectal cancer with peritoneal metastasis at 2 tertiary referral centers in Korea were evaluated between July 2014 and March 2016. The perioperative outcomes and postoperative complications were evaluated prospectively.The mean peritoneal cancer index (PCI) was 15.3 ± 10.5. The distributions thereof were as follows: PCI < 10, 33.3%; PCI 10-19, 36.4%; and PCI≥20, 30.3%. Regarding completeness of cytoreduction (CC), 59.1% of patients achieved CC-0, with 18.2% showing CC-1 and 22.7% showing CC-2. The mean operation time was 9.4 hours, and the mean hospital stay was 20.2 days. The overall rate of short-term complications was 74.2%; the rate of long-term complications was 10.6%. In the short-term period, most complications were grades I-II complications (62.1%), compared to grades III-V (12.1%). All long-term complications, occurring in 10.6% of patients, were grades III-V.In this study, CRS with HIPEC was deemed feasible and safe for treating stage IV appendiceal or colorectal cancer with peritoneal carcinomatosis in Koreans.
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11
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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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12
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Cytoreductive surgery and heated intraperitoneal chemotherapy for peritoneal carcinomatosis secondary to mucinous adenocarcinoma of the appendix. Int Surg 2016; 100:21-8. [PMID: 25594636 DOI: 10.9738/intsurg-d-14-00089.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a radical but effective treatment option for select peritoneal malignancies. We sought to determine our early experience with this method for peritoneal carcinomatosis secondary to mucinous adenocarcinomas of appendiceal origin. As such, we performed a retrospective clinical study of 30 consecutive patients undergoing CRS with planned HIPEC at the Princess Alexandra Hospital, between June 2009 to December 2012, with mucinous adenocarcinomas of the appendix. CRS was performed in 30 patients, 13 received HIPEC intraoperatively and 17 received early postoperative intra-peritoneal chemotherapy (EPIC) in addition. Mean age was 52.3 years and median hospital stay was 26 days (range 12-190 days). Peritoneal cancer index scores were 0-10 in 6.7% of patients, 11-20 in 20% of patients and >20 in 73.3% of patients. Complete cytoreduction was achieved overall in 21 patients. In total, 106 complications were observed in 28 patients. Ten were grade 3-A, five were grade 3-B and one grade-5 secondary to a fatal PE on day 97. In patients who received HIPEC, there was no difference in disease-free survival (P = 0.098) or overall survival (P = 0.645) between those who received EPIC versus those who did not. This study demonstrates that satisfactory outcomes with regards to morbidity and survival can be achieved with CRS and HIPEC, at a single-centre institution with growing expertise in the technique. Our results are comparable with outcomes previously described in the international literature.
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13
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Wu Z, Li Z, Ji J. Morbidity and mortality of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in advanced gastric cancer. Transl Gastroenterol Hepatol 2016; 1:63. [PMID: 28138629 DOI: 10.21037/tgh.2016.07.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/14/2016] [Indexed: 12/29/2022] Open
Abstract
Gastric cancer (GC) is one of the leading cancer causes of death worldwide with high incidence of mortality. With limited available data from the previous literature, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) seems to provide substantial survival benefits to the advanced GC patients, especially in those with peritoneal carcinomatosis (PC). However, it is also considered as a high morbid approach. This review summarizes the current evidence regarding the perioperative safety of CRS-HIPEC in advanced GC patients. According to the currently available evidence, CRS-HIPEC causes surgery-related morbidity including abscess, fistula, and anastomotic leak, and chemotherapy-related morbidities such as leucopenia, anemia, thrombopenia, and heart, liver or renal toxicity. The incidence of the morbidity and mortality approximate 20% and 4.8% respectively, which are comparable to a major gastrointestinal surgery. Repeated evidence demonstrates that incidence of morbidity or mortality is significantly influenced by the institutional experience. Centers undertaking this treatment strategy must aim to minimize morbidity and mortality by learning from the experienced units and carefully selecting candidate patients. Patients with advanced age or greater disease burden seem to be at greater risks and thus application of CRS-HIPEC on them must be based on an extensive evaluation and multi-disciplinary team (MDT) discussion.
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Affiliation(s)
- Zhouqiao Wu
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ziyu Li
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
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14
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Huang Y, Alzahrani NA, Chua TC, Liauw W, Morris DL. Impacts of peritoneal cancer index on the survival outcomes of patients with colorectal peritoneal carcinomatosis. Int J Surg 2016; 32:65-70. [DOI: 10.1016/j.ijsu.2016.06.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/11/2016] [Accepted: 06/15/2016] [Indexed: 01/31/2023]
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15
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Huang Y, Alzahrani NA, Chua TC, Huo YR, Liauw W, Morris DL. Impacts of Preoperative Serum Albumin Level on Outcomes of Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy. Ann Surg Oncol 2016; 23:2411-2418. [DOI: 10.1245/s10434-016-5172-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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16
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Kuijpers AM, Hauptmann M, Aalbers AG, Nienhuijs SW, de Hingh IH, Wiezer MJ, van Ramshorst B, van Ginkel RJ, Havenga K, Verwaal VJ. Cytoreduction and hyperthermic intraperitoneal chemotherapy: The learning curve reassessed. Eur J Surg Oncol 2015; 42:244-50. [PMID: 26375923 DOI: 10.1016/j.ejso.2015.08.162] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 07/20/2015] [Accepted: 08/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND CytoReductive Surgery and Hyperthermic IntraPEritoneal Chemotherapy (CRS-HIPEC) is now the preferred treatment of many peritoneal surface malignancies. In this retrospective study we aimed to analyze how several performance indicators changed during the first 100 CRS-HIPEC procedures in hospitals which recently introduced this treatment, and compare those with an experienced institution. METHODS The first consecutive 100 CRS-HIPEC procedures of three institutions were compared to those of the pioneer hospital. The training provided by the pioneer hospital consisted of hands-on training during the first ten procedures; hereafter guidance was available on consult basis. Operation characteristics, morbidity and completeness of cytoreduction were evaluated by case sequence. Locally-estimated-scatter-plot smoothing was used to evaluate the learning curve. RESULTS From four institutions 372 cases were included. A macroscopic complete cytoreduction was reached in 66% of the cases in the pioneer hospital and in 86% in the new hospitals (p < 0.001). Complete cytoreduction rates were higher at start off in the new institutions compared with the experienced institution and increased significantly in the first 100 procedures. The new hospitals started with lower morbidity than the experienced hospital, which did not significantly decrease during the study period. CONCLUSION New institutions that were trained and mentored by an experienced CRS-HIPEC hospital performed better from the beginning with regard to complete cytoreduction and morbidity rate with than the experienced center. An improvement in complete cytoreduction rate during the first 100 procedures was observed in the new institutions.
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Affiliation(s)
- A M Kuijpers
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - M Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A G Aalbers
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - I H de Hingh
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - M J Wiezer
- Department of Surgery, Sint Antonius Hospital Nieuwegein, The Netherlands
| | - B van Ramshorst
- Department of Surgery, Sint Antonius Hospital Nieuwegein, The Netherlands
| | - R J van Ginkel
- Department of Surgery, University Medical Center Groningen, The Netherlands
| | - K Havenga
- Department of Surgery, University Medical Center Groningen, The Netherlands
| | - V J Verwaal
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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17
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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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18
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Abstract
Until recently, a diagnosis of peritoneal carcinomatosis was uniformly accompanied by a grim prognosis that was typically measured in weeks to months. Consequently, the management of carcinomatosis revolves largely around palliation of symptoms such as bowel obstruction, nausea, pain, fatigue, and cachexia. A prior lack of effective treatment options created the nihilistic view that currently exists and persists despite improvements in the efficacy of systemic therapy and the evolution of multimodality approaches including surgery and intraperitoneal chemotherapy. This article reviews the evolution and current state of treatment options for patients with peritoneal carcinomatosis. In addition, it highlights recent advances in understanding the molecular biology of carcinomatosis and the focus of current and future clinical trials. Finally, this article provides practical management options for the palliation of common complications of carcinomatosis. It is hoped that the reader will recognize that carcinomatosis is no longer an imminent death sentence and that through continued research and therapeutic innovation, clinicians can make an even greater impact on this form of metastatic cancer.
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Affiliation(s)
- Laura A Lambert
- Associate Professor, Division of Surgical Oncology, Division of Palliative Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
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19
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Polanco PM, Ding Y, Knox JM, Ramalingam L, Jones H, Hogg ME, Zureikat AH, Holtzman MP, Pingpank J, Ahrendt S, Zeh HJ, Bartlett DL, Choudry HA. Institutional Learning Curve of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion for Peritoneal Malignancies. Ann Surg Oncol 2014; 22:1673-9. [DOI: 10.1245/s10434-014-4111-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Indexed: 12/29/2022]
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20
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Kusamura S, Moran BJ, Sugarbaker PH, Levine EA, Elias D, Baratti D, Morris DL, Sardi A, Glehen O, Deraco M, Gilly FN, Barrios P, Quenet F, Loggie BW, Gómez Portilla A, de Hingh IHJT, Ceelen WP, Pelz JOW, Piso P, González-Moreno S, Van Der Speeten K, Chua TC, Yan TD, Liauw W. Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. Br J Surg 2014; 101:1758-65. [DOI: 10.1002/bjs.9674] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 08/19/2014] [Accepted: 09/17/2014] [Indexed: 12/18/2022]
Abstract
Abstract
Background
The learning curves for cytoreductive surgery with intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei (PMP) were explored between international centres/surgeons to identify institutional or other factors that might affect performance.
Methods
Data from patients with PMP treated with the combined procedure across 33 international centres between 1993 and 2012 were analysed retrospectively. A risk-adjusted sequential probability ratio test was conducted after defining the target outcome as early oncological failure (disease progression within 2 years of treatment), an acceptable risk for the target outcome (odds ratio) of 2, and type I/II error rates of 5 per cent. The risk prediction model was elaborated and patients were evaluated sequentially for each centre/surgeon. The learning curve was considered to be overcome and proficiency achieved when the odds ratio for early oncological failure became smaller than 2.
Results
Rates of optimal cytoreduction, severe postoperative morbidity and early oncological failure were 84·4, 25·7 and 29·0 per cent respectively. The median annual centre volume was 17 (range 6–66) peritoneal malignancies. Only eight of the 33 centres and six of 47 surgeons achieved proficiency after a median of 100 (range 78–284) and 96 (86–284) procedures respectively. The most important institutional factor affecting surgical performance was centre volume.
Conclusion
The learning curve is extremely long, so centralization and/or networking of centres is necessary to assure quality of services. One centre for every 10–15 million inhabitants would be ideal.
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Affiliation(s)
- S Kusamura
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - B J Moran
- Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
| | - P H Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - E A Levine
- Surgical Oncology Service, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - D Elias
- Department of Surgical Oncology, Institut Gustave Roussy, Cancer Centre, Villejuif
- RENAPE: Centre Expert National de Référence des Cancers Rares du Péritoine, Unité de Recherche Clinique, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Pierre Bénite, France
| | - D Baratti
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - D L Morris
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, New South Wales, Sydney, Australia
| | - A Sardi
- Division of Surgery, Department of Surgical Oncology, Institute for Cancer Care, Mercy Medical Center, Baltimore, Maryland, USA
| | - O Glehen
- RENAPE: Centre Expert National de Référence des Cancers Rares du Péritoine, Unité de Recherche Clinique, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Pierre Bénite, France
- Department of Digestive Surgery, CHU de Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - M Deraco
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - F N Gilly
- Department of Digestive Surgery, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Hospices Civils de Lyon, and RENAPE, Unité de Recherche Clinique, CHU de Lyon Sud, Pierre-Benite, France
| | - P Barrios
- Department of Oncological Surgery, Hospital Sant Joan Despí, Moises Broggi, Peritoneal Surface Malignancy Catalonian's Programme, Sant Joan Despí, Barcelona, Spain
| | - F Quenet
- Centre Régional de Lutte du Cancer Val d'Aurell, Montpellier, and RENAPE, CHU de Lyon Sud, Pierre-Benite, France
| | - B W Loggie
- Division of Surgical Oncology, Creighton University Medical Center, Omaha, New England, USA
| | - A Gómez Portilla
- Department of General Surgery and Digestive Diseases, Hospital Santiago Apostol, Vitoria, Spain
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - W P Ceelen
- Department of Gastrointestinal Surgery, University Hospital, Ghent, Belgium
| | - J O W Pelz
- Department of General, Visceral and Paediatric Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - P Piso
- Department of Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - S González-Moreno
- Peritoneal Surface Oncology Programme, Department of Surgical Oncology, M. D. Anderson Cancer Center Madrid, Madrid, Spain
| | - K Van Der Speeten
- Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - T C Chua
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - T D Yan
- Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - W Liauw
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
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Ahmed S, Stewart JH, Shen P, Votanopoulos KI, Levine EA. Outcomes with cytoreductive surgery and HIPEC for peritoneal metastasis. J Surg Oncol 2014; 110:575-84. [DOI: 10.1002/jso.23749] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/16/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Shuja Ahmed
- Surgical Oncology Service; Department of General Surgery; Wake Forest Baptist Medical Center; Winston Salem North Carolina
| | - John H. Stewart
- Surgical Oncology Service; Department of General Surgery; Wake Forest Baptist Medical Center; Winston Salem North Carolina
| | - Perry Shen
- Surgical Oncology Service; Department of General Surgery; Wake Forest Baptist Medical Center; Winston Salem North Carolina
| | - Konstantinos I. Votanopoulos
- Surgical Oncology Service; Department of General Surgery; Wake Forest Baptist Medical Center; Winston Salem North Carolina
| | - Edward A. Levine
- Surgical Oncology Service; Department of General Surgery; Wake Forest Baptist Medical Center; Winston Salem North Carolina
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Abstract
Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) is a treatment option for peritoneal surface malignancy. Despite the survival benefits, this treatment was previously associated with a high morbidity and mortality rates, and the perception of the poor perioperative outcomes associated with this regimen remains. Careful patient selection with an optimal level of postoperative care must be advocated to avoid undesirable complications of this treatment.However, for this treatment to be accepted as standard of care, teams undertaking this treatment strategy must aim to minimize morbidity and mortality by learning from the experience of established centers and using the "global learning curve". The HIPEC Registry and accreditation of centers will improve the quality of the treatment.
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Sardi A, Gushchin V, Sugarbaker PH. Conference Scene: Second Annual Workshop of the Mid-Atlantic Chapter of the American Society of Peritoneal Surface Malignancy. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Second Annual Workshop of the Mid-Atlantic Chapter of the American Society of Peritoneal Surface Malignancy, Mercy Medical Center, Baltimore, MD, USA, 20–21 June 2013 The annual workshop is dedicated to the regional advancement and coordination of efforts to control the peritoneal surface component of gastrointestinal and gynecologic malignancy. It was attended by surgeons, medical oncologists, radiologists, gastroenterologists and nurses involved in clinical and laboratory research efforts to optimally manage peritoneal metastases and peritoneal mesothelioma. During the first day of the 2-day meeting, presentations were coordinated with live video transmission from the operating room at Mercy Medical Center (MD, USA). The live surgery, didactic speeches and patient presentations were displayed for open discussion in real-time. Twenty regional and global opinion leaders spoke and interacted regarding clinical and research information relevant to the rapidly developing multidisciplinary subspecialty of peritoneal surface oncology.
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Affiliation(s)
- Armando Sardi
- The Institute for Cancer Care, Surgical Oncology at Mercy, Baltimore, MD, USA
| | - Vadim Gushchin
- The Institute for Cancer Care, Surgical Oncology at Mercy, Baltimore, MD, USA
| | - Paul H Sugarbaker
- Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, Washington, DC, USA
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Pelz JOW. Peritoneal Carcinomatosis: Registry and Centers in Germany. VISZERALMEDIZIN 2013. [DOI: 10.1159/000354259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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McConnell YJ, Mack LA, Francis WP, Ho T, Temple WJ. HIPEC + EPIC versus HIPEC-alone: differences in major complications following cytoreduction surgery for peritoneal malignancy. J Surg Oncol 2012; 107:591-6. [PMID: 23129533 DOI: 10.1002/jso.23276] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 09/17/2012] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Peritoneal metastases (PM) can be treated with cytoreduction surgery (CRS) with intraoperative heated intraperitoneal chemotherapy (HIPEC) plus or minus early postoperative intraperitoneal chemotherapy (EPIC). HIPEC + EPIC may be associated with more complications than HIPEC alone. METHODS A prospective database of consecutive patients undergoing CRS + HIPEC ± EPIC at the University of Calgary between February 2000 and May 2011 was reviewed. Patient, tumor, and perioperative variables included peritoneal cancer index (PCI), completeness of cytoreduction (CCR) score, HIPEC ± EPIC type, and grade III/IV complications. RESULTS 198 patients had a CCR score of 0/1 and received: (1) HIPEC mitomycin C + EPIC 5-fluorouracil for 5 days (n = 85; February 2000-January 2008); or (2) HIPEC oxaliplatin with IV 5-fluorouracil + no EPIC (n = 113; February 2008-May 2011). Clinicodemographics were similar except PCI was higher in the HIPEC-alone group (mean PCI 22 vs. 17; P = 0.02). The rate of grade III/IV complications was higher in the HIPEC + EPIC group (44.7% vs. 31.0%; P = 0.05). On multivariate logistic regression only HIPEC + EPIC and PCI > 26 were associated with an increased rate of complications. CONCLUSION In patients with PM, the use of EPIC, in combination with CRS and HIPEC, is associated with an increased rate of complications. Surgeons should consider using HIPEC only (without EPIC).
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Affiliation(s)
- Yarrow J McConnell
- Department of Surgery and Oncology, University of Calgary, Calgary, Alberta, Canada.
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GarcÍA-Matus R, HernÁNdez-HernÁNdez CA, Leyva-GarcÍA O, Vásquez-Ciriaco S, Flores-Ayala G, Navarro-Hernández Q, Pérez-Bustamante G, Valencia-Mijares NM, Esquivel J. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Peritoneal Carcinomatosis: Initial Experience in Oaxaca, Mexico. Am Surg 2012. [DOI: 10.1177/000313481207800932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multi-modality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at “Hospital Regional de Alta Especialidad de Oaxaca,” Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.
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Konstantinidis IT, Young C, Tsikitis VL, Lee E, Jie T, Ong ES. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion: The University of Arizona early experience. World J Gastrointest Surg 2012; 4:135-40. [PMID: 22816027 PMCID: PMC3400041 DOI: 10.4240/wjgs.v4.i6.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 06/22/2012] [Accepted: 06/24/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety and effectiveness of our new cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) program.
METHODS: Retrospective review of patients with gastrointestinal malignancies who were suitable candidates for CRS and HIPEC between 12/1/2009 and 10/1/2010. All clinicopathologic data were reviewed with a special focus on the surgical outcome and the postoperative morbidity and mortality.
RESULTS: Fourteen patients were identified. Median age was 64 years; seven were female. The primary tumors were: colonic (29%), appendiceal (36%), peritoneal mesothelioma (14%), gastric (7%), adenocarcinoma of unknown primary (7%), and gastrointestinal stromal tumor (7%). Eleven patients (79%) received CRS/HIPEC, three for palliation. Three patients that did not undergo CRS/HIPEC had an average peritoneal cancer index (PCI) of 25. The eight patients that underwent curative CRS/HIPEC had an average PCI of 10 and a completeness of cytoreduction score of 0 (87.5%) or 1 (12.5%). Postoperative morbidity was 36%; the worst adverse event was Grade 3 ileus. Mortality rate was 0%.
CONCLUSION: CRS with HIPEC is safe and feasible at tertiary institutions with fledgling programs. PCI is an accurate predictor of surgical outcomes.
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Affiliation(s)
- Ioannis T Konstantinidis
- Ioannis T Konstantinidis, Christine Young, Vassiliki L Tsikitis, Tun Jie, Evan S Ong, Department of Surgery, The University of Arizona College of Medicine, 1501 N. Campbell Av. PO Box 245131, Tucson, AZ 85724-5131, United States
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Chua TC, Esquivel J, Pelz JOW, Morris DL. Summary of current therapeutic options for peritoneal metastases from colorectal cancer. J Surg Oncol 2012; 107:566-73. [PMID: 22688776 DOI: 10.1002/jso.23189] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/15/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peritoneal metastases remain an under addressed problem for which this review serves to investigate the efficacy of systemic chemotherapy and radical surgical treatments in this disease entity. METHODS The literature between 1995 and June 2009 was surveyed systematically through a review of published studies on the treatment outcomes of metastatic colorectal cancer to the peritoneum on the Medline and PubMed databases. RESULTS A total of 2,492 patients from 19 studies were reviewed. One thousand and eighty-four patients treated with complete cytoreductive surgery (CCS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and 1,408 patients were treated with palliative surgery and/or systemic chemotherapy. For CCS HIPEC, the overall survival ranged between 20 and 63 (median 33) months, and 5-year survival ranged between 17% and 51% (median 40%). For palliative surgery and/or systemic chemotherapy, the overall survival ranged between 5 and 24 (median 12.5) months, and 5-year survival ranged between 13% and 22% (median 13%). CONCLUSION Systemic therapies have not proved effective and randomised clinical trials have not sufficiently addressed patient subpopulations with metastatic disease of this entity. Current evidence have demonstrated the efficacy associated with CCS HIPEC for which should now be embraced as the standard of care.
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Affiliation(s)
- Terence C Chua
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
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Brücher BLDM, Piso P, Verwaal V, Esquivel J, Derraco M, Yonemura Y, Gonzalez-Moreno S, Pelz J, Königsrainer A, Ströhlein M, Levine EA, Morris D, Bartlett D, Glehen O, Garofalo A, Nissan A. Peritoneal carcinomatosis: cytoreductive surgery and HIPEC--overview and basics. Cancer Invest 2012; 30:209-24. [PMID: 22360361 DOI: 10.3109/07357907.2012.654871] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tumor involvement of the peritoneum-peritoneal carcinomatosis-is a heterogeneous form of cancer that had been generally regarded as a sign of systemic tumor disease and as a terminal condition. The multimodal treatment approach for patients with peritoneal carcinomatosis, which had been conceived and developed, consists of what is known as cytoreductive surgery, followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Depending on the tumor mass as assessed intraoperatively and the histopathological differentiation, patients who undergo cytoreductive surgery and HIPEC have a significant survival benefit. Mean increases in the survival period ranging from six months to up to four years have now been reported. In view of the substantial logistic effort and the extent of the surgery involved, this treatment approach represents a major challenge both for patients and for surgical oncologists, as well as for the members of the overall interdisciplinary structure required, which includes oncology, anesthesiology and intensive care, psycho-oncology, and patient management. The surgical procedures alone may take 8-14 hr. The present paper provides an overview of the basis for the approach and the use of specialized classifications and quantitative prognostic indicators.
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Affiliation(s)
- Björn L D M Brücher
- Surgical Oncology, Department of Surgery, Tübingen Comprehensive Cancer Center, University of Tübingen, Germany.
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Multidimensional analysis of the learning curve for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal surface malignancies. Ann Surg 2012; 255:348-56. [PMID: 22202584 DOI: 10.1097/sla.0b013e3182436c28] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the learning curve of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in treating peritoneal surface malignancies (PSM). SUMMARY AND BACKGROUND CRS and HIPEC to treat PSM is a complex procedure with a significant morbidity. A long-lasting training program is required to acquire expertise in this type of operation. METHODS We performed CRS using peritonectomy procedures. HIPEC through the closed abdomen technique employed cisplatin and mitomycin-C or cisplatin and doxorubicin. Risk-adjusted sequential probability ratio test was used to assess the learning curve on a series of 420 cases of PSM on the basis of rates of incomplete cytoreduction and G3-5 morbidity (NCI-CTCAE v3). We determined control limits setting the type I/II error rates and unacceptable odds ratios (ORs) for the outcomes being studied. We performed the risk adjustment using logistic regression model. RESULTS Rates of incomplete cytoreduction, G3-5 morbidity, and postoperative mortality rates were 10.2%, 28.5%, and 2.1%, respectively. The risk-adjusted sequential probability ratio test curve crossed the lower control limit at the 137 th and 149 th case, respectively, for incomplete cytoreduction and G3-5 morbidity. At those points, the actual ORs are lower than the prespecified ORs for outcomes being studied. Therefore, we estimated that approximately 140 cases are necessary to ensure surgical proficiency in CRS and HIPEC. CONCLUSIONS CRS and HIPEC to treat PSM has a steep learning curve requiring 140 procedures to acquire expertise.
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Goslin B, Sevak S, Siripong A, Onesti J, Wright GP, Melnik M, Chung M. Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital. Am J Surg 2012; 203:383-6; discussion 387. [PMID: 22226143 DOI: 10.1016/j.amjsurg.2011.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 09/20/2011] [Accepted: 09/20/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most cytoreduction with hyperthermic intraperitoneal chemotherapy procedures are performed at academic tertiary referral centers with numerous surgical oncology faculty. The objective of this study was to review the postoperative morbidity and mortality data of our institution, a large community hospital. METHODS This was a retrospective cohort study of patients who underwent cytoreduction with hyperthermic intraperitoneal chemotherapy at a single institution. Two surgical oncologists performed all the procedures between May 2005 and June 2011. RESULTS We retrospectively analyzed 57 patients. The most common pathology being treated was pseudomyxoma peritonei (34 of 57; 59.6%), followed by colorectal cancer (9 of 57; 15.8%). Other types of cancer included peritoneal mesothelioma and gastric adenocarcinoma. The average surgery time was 6.9 hours. Approximately 51% of patients suffered grade 3 or 4 morbidity and there were no perioperative mortalities. CONCLUSIONS Cytoreduction with hyperthermic intraperitoneal chemotherapy can be performed at our institution with comparable outcomes as academic referral centers.
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Affiliation(s)
- Brent Goslin
- Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency, Grand Rapids, MI 49503, USA.
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Cytoreductive surgery with intraperitoneal chemotherapy to treat pseudomyxoma peritonei at nonspecialized hospitals. Surg Today 2011; 41:1219-23. [PMID: 21874418 DOI: 10.1007/s00595-010-4495-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 08/09/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE It has been reported that complete cytoreduction using peritonectomy combined with intraperitoneal chemotherapy improves the prognosis of patients with pseudomyxoma peritonei (PMP); however, this treatment strategy remains controversial, especially at nonspecialized institutes, because of its high morbidity rate. METHODS We reviewed the clinical records of 15 consecutive patients with PMP, treated in nonspecialized hospitals and observed by one of us between 1999 and 2010. Cytoreductive surgery was done using peritonectomy procedures with intraperitoneal chemotherapy and was performed with curative intent, |in accordance with Sugarbaker. RESULTS All patients had mucinous tumors disseminated in the peritoneal cavity. Complete cytoreduction was achieved in 12 patients. Morbidity was 40% (6/15) and mortality was 0% (0/15). After a median follow-up period of 43 months, the 12 patients who underwent complete cytoreduction were disease-free with good quality of life, and 1 of the 3 patients who underwent incomplete cytoreduction was alive with disease. CONCLUSIONS These findings suggest that peritonectomy with intraperitoneal chemotherapy for PMP can provide prognostic benefit, even at nonspecialized hospitals. Considering the treatment risk, it should ideally be performed at a referral center, or at least by an experienced surgeon.
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Mohamed F, Cecil T, Moran B, Sugarbaker P. A new standard of care for the management of peritoneal surface malignancy. ACTA ACUST UNITED AC 2011; 18:e84-96. [PMID: 21505593 DOI: 10.3747/co.v18i2.663] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer dissemination to peritoneal surfaces was, in the past, a lethal condition with a limited survival. Clinical and pharmacologic research have shown that options for both treatment and prevention are now reality. The diseases most commonly treated include peritoneal dissemination from appendiceal malignancy, colorectal malignancy, and peritoneal mesothelioma. Selection factors are important to minimize the number of treated patients who will experience short-term benefit. Treatments involve cytoreductive surgery and perioperative chemotherapy. The intraperitoneal chemotherapy in the operating room is used with heat. Although this combined approach has been criticized, the informed oncologist will seek to identify those patients that may benefit from this more optimistic concept of peritoneal dissemination of cancer.
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Affiliation(s)
- F Mohamed
- Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, U.K
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Gill RS, Al-Adra DP, Nagendran J, Campbell S, Shi X, Haase E, Schiller D. Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: A systematic review of survival, mortality, and morbidity. J Surg Oncol 2011; 104:692-8. [DOI: 10.1002/jso.22017] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 06/09/2011] [Indexed: 12/17/2022]
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Freeman L, Rahmani EY, Burgess RCF, Al-Haddad M, Selzer DJ, Sherman S, Constable P. Evaluation of the learning curve for natural orifice transluminal endoscopic surgery: bilateral ovariectomy in dogs. Vet Surg 2011; 40:140-50. [PMID: 21223315 DOI: 10.1111/j.1532-950x.2010.00779.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Study the learning curve for canine Natural Orifice Transluminal Endoscopic Surgery (NOTES) ovariectomy by evaluating operative times and complications. STUDY DESIGN Preclinical research study. ANIMALS Adult female dogs (n=20). METHODS NOTES ovariectomy procedures were performed as follows: Feasibility Group 1 (n=5), Feasibility Group 2 (n=5), and Early Clinical Group 3 (n=10). Six steps of the procedure were identified, timed separately, and the overall time was recorded from introduction to removal of the endoscope. Complications were recorded. Repeated measures analysis of variance using ranked data compared the effect of group (3 levels) on the time for each step. Nonlinear regression using an exponential model with nonzero asymptote was used to model the operative time-procedure number relationship. RESULTS Overall median operative time was significantly longer for Group 1 (195 minutes; range, 160-265 minutes) than Group 2 (108 minutes; range, 81-148 minutes; P=.048) and Group 3 (77 minutes; range, 41-136 minutes; P=.0008). The estimated asymptotic operative time was 71 minutes (95% confidence interval, 41-100 minutes); this time was reached after 10 procedures. Gastric cleansing and removing the left ovary took significantly longer in Group 1 than in Group 2 or 3. Operative complications included incomplete ovarian excision, dropping an ovary during retrieval, and conversion to an open procedure. No intraoperative complications occurred in Group 3. CONCLUSION NOTES procedures result in longer operative times in the early part of the learning curve and require considerable experience before reaching proficiency.
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Affiliation(s)
- Lynetta Freeman
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA.
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Munene G, Mack LA, Temple WJ. Systematic Review on the Efficacy of Multimodal Treatment of Sarcomatosis with Cytoreduction and Intraperitoneal Chemotherapy. Ann Surg Oncol 2010; 18:207-13. [DOI: 10.1245/s10434-010-1229-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Indexed: 01/31/2023]
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