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Srinivas Rao S, Ghosh S, Vardar BU, Pandey A, Uma Baskaran N, Panwar SS, Catalano OA, Shenoy-Bhangle AS, Harisinghani MG, Brink JA, Kambadakone AR. Imaging in malignant peritoneal neoplasms. Abdom Radiol (NY) 2024:10.1007/s00261-024-04595-z. [PMID: 39368001 DOI: 10.1007/s00261-024-04595-z] [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: 08/21/2024] [Revised: 09/13/2024] [Accepted: 09/14/2024] [Indexed: 10/07/2024]
Abstract
Peritoneal malignancies encompass a diverse range of tumors originating within the peritoneum, including primary tumors such as mesothelioma and primary serous peritoneal carcinoma or secondary tumors resulting from the spread of cancers from gastrointestinal, gynecological, and extra-abdominal sources. The traditional approach of palliative care for these malignancies is being replaced by a multimodal strategies that integrates surgery with systemic or intraperitoneal chemotherapy. Notably, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has shown significant improvements in survival rates. Imaging is crucial in the multidisciplinary management of these tumors, aiding in diagnosis, staging, restaging, and monitoring therapy response. It is also vital for appropriate patient selection, using the acronym "PAUSE", which involves assessing tumor burden via the peritoneal carcinomatosis index, evaluating patients pre- and post-therapy, detecting complications following therapy, and predicting treatment outcomes. This review explores the imaging manifestations of peritoneal malignancies, distinguishing them from various mimics, and underscores the importance of imaging modalities such as CT, MRI, PET/CT, and PET/MRI in effective decision-making and management.
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Solsky I, Patel A, Leonard G, Russell G, Perry K, Votanopoulos KI, Shen P, Levine EA. Distance Traveled and Disparities in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2024; 31:1035-1048. [PMID: 37980711 DOI: 10.1245/s10434-023-14469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/05/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The impact of distance traveled on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) outcomes needs further investigation. METHODS This retrospective study reviewed a prospectively managed single-center CRS/HIPEC 1992-2022 database. Zip codes were used to calculate distance traveled and to obtain data on income and education via census data. Patients were separated into three groups based on distance traveled in miles (local: ≤50 miles, regional: 51-99 miles, distant: ≥100 miles). Descriptive statistics, Kaplan-Meier method, and Cox regression were performed. RESULTS The 1614 patients in the study traveled a median distance of 109.5 miles (interquartile range [IQR], 53.36-202.29 miles), with 23% traveling locally, 23.9% traveling regionally, and 53% traveling distantly. Those traveling distantly or regionally tended to be more white (distant: 87.8%, regional: 87.2%, local: 83.2%), affluent (distant: $61,944, regional: $65,014, local: $54,390), educated (% without high school diploma: distant: 10.6%, regional: 11.5%, local: 13.0%), less often uninsured (distant: 2.3%, regional: 4.6%, local: 5.2%) or with Medicaid (distant: 3.3%, regional: 1.3%, local: 9.7%). They more often had higher Peritoneal Carcinomatosis Index (PCI) scores (distant: 15.4, regional: 15.8, local: 12.7) and R2 resections (distant: 50.3%, regional: 52.2%, local: 40.5%). Median survival did not differ between the groups, and distance traveled was not a predictor of survival. CONCLUSION More than 50% of the patients traveled farther than 100 miles for treatment. Although regionalization of CRS/HIPEC may be appropriate given the lack of survival difference based on distance traveled, those who traveled further had fewer health care disparities but higher PCI scores and more R2 resections, which raises concerns about access to care for the underserved, time to treatment, and surgical quality.
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Affiliation(s)
- Ian Solsky
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Ana Patel
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Grey Leonard
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Gregory Russell
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathleen Perry
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | | - Perry Shen
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Edward A Levine
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
- Division of Surgical Oncology, Department of General Surgery, Medical Center Boulevard, Winston-Salem, NC, USA.
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Nikiforchin A, Sardi A, King MC, Baron E, Lopez-Ramirez F, Falla-Zuniga LF, Barakat P, Iugai S, Pawlikowski K, Nieroda C, Campbell K, Ryu H, Diaz-Montes T, Gushchin V. Collaborative expertise of gynecological and surgical oncologists in managing advanced epithelial ovarian cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107948. [PMID: 38183864 DOI: 10.1016/j.ejso.2023.107948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Most patients with epithelial ovarian cancer (EOC) present with significant peritoneal spread. We assessed collaborative efforts of surgical and gynecological oncologists with expertise in cytoreductive surgery (CRS) in the management of advanced EOC. METHODS Using a prospective single-center database (2014-2022), we described the operative and oncologic outcomes of stage IIIC-IVA primary and recurrent EOC perioperatively managed jointly by gynecological and surgical oncologists both specializing in CRS and presented components of this collaboration. RESULTS Of 199 identified patients, 132 (66 %) had primary and 53 (27 %) had recurrent EOC. Due to inoperable disease, 14 (7 %) cases were aborted and excluded from analysis. Median peritoneal cancer index (PCI) in primary and recurrent patients was 21 (IQR: 11-28) and 21 (IQR: 6-31). Upper abdominal surgery was required in 95 % (n = 125) of primary and 89 % (n = 47) of recurrent patients. Bowel resections were performed in 83 % (n = 110) and 72 % (n = 38), respectively. Complete cytoreduction (CC-0/1) with no disease or residual lesions <2.5 mm was achieved in 95 % (n = 125) of primary and 91 % (n = 48) of recurrent patients. Ninety-day Clavien-Dindo grade III-IV morbidity was 12 % (n = 16) and 21 % (n = 11), respectively. Median follow-up was 44 (95%CI: 33-55) months. Median overall survival in primary and recurrent EOC was 68 (95%CI: 45-91) and 50 (95%CI: 16-84) months. Median progression-free survival was 26 (95%CI: 22-30) and 14 (95%CI: 7-21) months, respectively. CONCLUSIONS Perioperative collaboration between surgical and gynecological oncologists specializing in CRS allows safe performance of complete cytoreduction in the majority of patients with primary and recurrent EOC, despite high tumor burden.
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Affiliation(s)
- Andrei Nikiforchin
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Armando Sardi
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA.
| | - Mary Caitlin King
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Ekaterina Baron
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Felipe Lopez-Ramirez
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Luis Felipe Falla-Zuniga
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Philipp Barakat
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Sergei Iugai
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Kathleen Pawlikowski
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Carol Nieroda
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Kurtis Campbell
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Hyung Ryu
- Gynecological Oncology, The Lya Segall Ovarian Cancer Institute, Mercy Medical Center, 227 St. Paul Place, 6th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Teresa Diaz-Montes
- Gynecological Oncology, The Lya Segall Ovarian Cancer Institute, Mercy Medical Center, 227 St. Paul Place, 6th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Vadim Gushchin
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
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Kopetskyi V, Antoniv M, Yarema R, Maksymovskyi V, Chetverikova-Ovchinnik V, Kryzhevskyi V, Volodko N, Gushchin V, Nikiforchin A. Building an Efficient Peritoneal Surface Malignancies Program Despite the Lower-Middle-Income Barriers: Ukraine Experience. JCO Glob Oncol 2024; 10:e2300432. [PMID: 38330272 DOI: 10.1200/go.23.00432] [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: 11/16/2023] [Revised: 11/26/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) programs are often limited to centers in developed countries because of extensive requirements. We aimed to analyze efficacy and challenges of CRS/HIPEC centers in lower-middle-income settings in the Ukraine example. METHODS A multicenter descriptive study was conducted using data sets (2008-2022) from Kyiv, Lviv, and Odesa centers. Patients with appendiceal neoplasm (AN); colorectal cancer (CRC); malignant peritoneal mesothelioma (MPM); and epithelial ovarian, fallopian tube, and primary peritoneal cancer (EOC) treated with CRS ± HIPEC were included. Overall survival (OS) was analyzed for N ≥ 20 cohorts using the Kaplan-Meier method. RESULTS We included 596 patients. At Kyiv and Lviv centers, 37 and 28 patients with AN had completeness of cytoreduction (CC-0/1) rates of 84% and 71%, respectively. Thirty-day major morbidity stood at 24% and 18%, respectively. Median OS was not reached (NR) at both centers. Nineteen patients with CRC from Kyiv, 11 from Lviv, and 156 from Odesa had CC-0/1 rates of 84%, 91%, and 86%, respectively. Thirty-day major complications occurred in 16%, 18%, and 8%, respectively. Median OS in the Odesa cohort was 35 (95% CI, 32 to 38) months. Among 15 Kyiv, five Lviv, and six Odesa patients with MPM, CC-0/1 rates were 67%, 80%, and 100%, respectively, while major complications occurred in 13%, 0%, and 17%, respectively. OS was not analyzed because of small MPM cohorts. At Kyiv, Lviv, and Odesa centers, 91, 40, and 89 patients, respectively, had primary EOC. CC-0/1 rates were 79%, 100%, and 80%, and 30-day major morbidity rates were 23%, 5%, and 6%, respectively. Median OS was NR, 71 (95% CI, 32 to 110), and 67 (95% CI, 61 to 73) months, respectively. CONCLUSION CRS/HIPEC programs in lower-middle-income environment can achieve safety and survival that meet global standards. Our discussion highlights common obstacles in such settings and proposes effective overcoming strategies.
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Affiliation(s)
- Viacheslav Kopetskyi
- Department of Hepatopancreatobiliary Surgery, National Cancer Institute, Kyiv, Ukraine
| | - Marta Antoniv
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | - Roman Yarema
- Department of Oncology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | | | | | - Vitalii Kryzhevskyi
- Department of Hepatopancreatobiliary Surgery, National Cancer Institute, Kyiv, Ukraine
| | - Nataliya Volodko
- Department of Oncology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD
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Nikiforchin A, Sardi A, King MC, Baron E, Lopez-Ramirez F, Falla-Zuniga LF, Barakat P, Iugai S, Pawlikowski K, Nieroda C, Gushchin V. Patterns of Recurrence in Appendix Cancer After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2023; 30:7848-7857. [PMID: 37633853 DOI: 10.1245/s10434-023-14145-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND It is thought that low-grade (LG) appendiceal cancer (AC) demonstrates predominantly intraperitoneal recurrence (IPR) after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), whereas high-grade (HG) tumors progress both intra- and extraperitoneally (EPR). However, evidence supporting this conception is lacking; therefore, we assessed recurrence in various AC histologies. METHODS A retrospective, cohort study was conducted by using a single-center database (1998-2022). Recurrence patterns (IPR, EPR, combined) were identified for LG, HG, high-grade with signet ring cells (SRC), and goblet cell carcinoma (GCC). RESULTS We included 432 complete (CC-0/1) CRS/HIPECs: 200 LG, 114 HG, 72 SRC, and 46 GCC. Median follow-up was 78 (95% confidence interval [CI] 70-86) months. Overall, 34% (n = 148) of patients recurred. IPR was the most common (LG 16%, HG 27%, SRC 36%, GCC 26%) with median time to recurrence (MTR) of 21 (IQR: 12-40) months. EPR (liver, lung, pleura, lymph nodes, or bones) occurred in LG 3%, HG 9%, SRC 22%, and GCC 7%. MTR was 11 (IQR: 4-16) months. Combined pattern occurred in LG 0%, HG 8%, SRC 7%, and GCC 0%. MTR was 13 (IQR: 7-18) months. Iterative surgery was performed in 53% IPR, 18% EPR, and 51% combined. Median post-recurrence survival was longer after IPR compared with EPR and combined recurrence: 36 (95% CI 25-47) versus 13 (95% CI 7-19) and 18 (95% CI 6-30) months (p < 0.01). CONCLUSIONS After complete CRS/HIPEC, IPR was the predominant pattern in all AC histologies and occurred later. Post-recurrence survival after IPR was longer. Knowing AC recurrence patterns can help to understand its biology and plan follow-up and post-relapse management.
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Affiliation(s)
- Andrei Nikiforchin
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
| | - Mary Caitlin King
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Ekaterina Baron
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Felipe Lopez-Ramirez
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | | | - Philipp Barakat
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Sergei Iugai
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Kathleen Pawlikowski
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Carol Nieroda
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
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Ramos Bernadó MI, Crusellas Maña O, Martín-Baranera M, Barrios Sánchez P. Morbimortality after 1321 consecutive CRS + HIPEC procedures: seeking excellence in surgery for peritoneal surface malignancy. Clin Transl Oncol 2023; 25:2911-2921. [PMID: 37085638 DOI: 10.1007/s12094-023-03155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) treatment has classically presented a percentage of associated complications that have limited its expansion. The aim of this study is to describe the morbimortality results obtained from a referral center implemented with the support of a governmental health agency and directed by a surgical team experienced in CRS for Peritoneal Surface Malignancies (PSM). METHODS Data from the Peritoneal Carcinomatosis Program of Catalonia (PCPC) prospective database, including patients who underwent CRS + HIPEC between September 2006 and January 2021, were analyzed. RESULTS A total of 1151 consecutive patients underwent 1321 CRS + HIPEC procedures. Colonic origin of peritoneal metastasis was the most frequent (47.3%). Median PCI was 7 and most patients had CC0-1 (96.1%). Multivisceral resection was performed in 44% of all patients, 57% required digestive anastomosis. Median hospital stay was 11 days (range 6-144 days). High-grade complications occurred in 20% of all patient, most of them surgical complications. Anastomotic leak occurred in 0.6% of all cases. The overall in-stay and 30-day mortality rate was 0.4%. The low-rate of complications and the high rate of complete CRS were achieved from the beginning of the PCPC. Median overall survival was 54.7 months, with a 5-year survival rate of 47.5%. CONCLUSIONS Implementation of a CRS + HIPEC referral program for the treatment of PSM with preferably an experienced surgical team enables acceptable rates of severe morbidity (20%) and mortality (< 1%).
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Affiliation(s)
| | - Oriol Crusellas Maña
- Department of Surgery, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Montserrat Martín-Baranera
- Department of Clinical Epidemiology, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
- Epidemiology and Preventive Medicine, Autonomous University of Barcelona School of Medicine, Barcelona, Spain
| | - Pedro Barrios Sánchez
- Department of Surgery, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
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Baron E, Sardi A, King MC, Nikiforchin A, Lopez-Ramirez F, Nieroda C, Gushchin V, Ledakis P. Adjuvant chemotherapy for high-grade appendiceal cancer after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:179-187. [PMID: 36253240 DOI: 10.1016/j.ejso.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/29/2022] [Accepted: 08/21/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION There are no available data on the efficacy of adjuvant chemotherapy (ACT) in stage IVA/B high-grade mucinous appendiceal cancer treated with CRS/HIPEC. We evaluated the association between ACT and survival in this cohort. MATERIALS AND METHODS A single-institution retrospective cohort study using a prospective database was conducted. Stage IVA/B high-grade mucinous appendiceal cancer patients who underwent CRS/HIPEC with CC-0/1 were included. Survival was compared between ACT and no chemotherapy (NoCT) patients. Subgroup analysis was performed with adjustment for confounding variables. RESULTS We identified 180 patients: 77 ACT and 103 NoCT. ACT regimens included 5-FU/capecitabine (13%), oxaliplatin-based (63%), and irinotecan-based (21%), combined with bevacizumab in 27% of cases. Median number of cycles was 9 (IQR: 6-12). Median overall survival (OS) did not significantly differ between ACT and NoCT (53 vs 75 months, p = 0.566). Multivariable Cox regression showed no OS benefit for ACT vs NoCT in patients with neoadjuvant chemotherapy (HR 1.14; 95%CI: 0.38-3.39) or without it (HR 1.33; 95%CI: 0.69-2.57), with signet ring cell (HR 0.89; 95%CI: 0.38-2.06) or other histologies (HR 1.11; 95%CI: 0.50-2.46), positive lymph nodes (HR 1.60; 95%CI: 0.74-3.49), or peritoneal cancer index ≥20 (HR 1.08; 95%CI: 0.55-2.11) after adjusting for other factors. CONCLUSIONS In our cohort, colon-type ACT was not associated with better OS in stage IVA/B mucinous appendiceal cancer after CRS/HIPEC, even after adjusting for confounders. This may be due to different tumor biology than colon cancer or small sample size. Prospective collaborative studies are needed.
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Affiliation(s)
- Ekaterina Baron
- Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Armando Sardi
- Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA.
| | - Mary Caitlin King
- Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Andrei Nikiforchin
- Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Felipe Lopez-Ramirez
- Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Carol Nieroda
- Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Vadim Gushchin
- Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Panayotis Ledakis
- Medical Oncology & Hematology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA
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Complications and Mortality Rate of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: Italian Peritoneal Surface Malignancies Oncoteam Results Analysis. Cancers (Basel) 2022; 14:cancers14235824. [PMID: 36497306 PMCID: PMC9741330 DOI: 10.3390/cancers14235824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy may significantly improve survival for selected patients with peritoneal surface malignancies, but it has always been criticized due to the high incidence of postoperative morbidity and mortality. METHODS Data were collected from nine Italian centers with peritoneal surface malignancies expertise within a collaborative group of the Italian Society of Surgical Oncology. Complications and mortality rates were recorded, and multivariate Cox analysis was used to identify risk factors. RESULTS The study included 2576 patients. The procedure was mostly performed for ovarian (27.4%) and colon cancer (22.4%). The median peritoneal cancer index was 13. Overall postoperative morbidity and mortality rates were 34% and 1.6%. A total of 232 (9%) patients required surgical reoperation. Multivariate regression logistic analysis identified the type of perfusion (p ≤ 0.0001), body mass index (p ≤ 0.0001), number of resections (p ≤ 0.0001) and colorectal resections (p ≤ 0.0001) as the strongest predictors of complications, whereas the number of resections (p ≤ 0.0001) and age (p = 0.01) were the strongest predictors of mortality. CONCLUSIONS Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is a valuable option of treatment for selected patients with peritoneal carcinomatosis providing low postoperative morbidity and mortality rates, if performed in high-volume specialized centers.
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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal metastasis of non-primary origin. Langenbecks Arch Surg 2021; 406:2817-2825. [PMID: 34686891 DOI: 10.1007/s00423-021-02354-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/10/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The objective of this study was to analyze the role of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy that has developed in the treatment of patients with peritoneal metastasis of non-primary origin. METHODS Patients who underwent treatment for secondary gastrointestinal and ovarian malignancies over a 20-year period were reviewed. Survival curves were estimated by the Kaplan-Meier product limit method and the log-rank test was used to assess differences between subgroups. RESULTS The study included 293 patients. The most common histology was ovarian cancer (56.3%). Median PCI was 16 and CC0-1 resection was obtained in 88.1% of cases. Grade III and IV complications occurred in 12 patients (4.1%) and 47 patients (16%), respectively. The 30- and 60-day mortality rate was 1.3% (4 patients) and 2.4% (7 patients). Five-year OS was 21.7%, 73.6%, 42.1%, and 0 for colorectal, appendiceal, ovarian, and gastric cancer (p = < 0.0001), respectively, whereas 5-year DFS was 12.4%, 48.4%, 24.3%, and 0 (p = < 0.0001), respectively. Survival outcomes were significantly higher for CC0 in each subgroup of patients. CONCLUSION Despite being a complex procedure, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should be considered a safe treatment with acceptable postoperative morbidity and mortality rates, if performed in high-volume centers. Good survival outcomes have been increasingly obtained in selected patients with peritoneal metastasis of non-primary origin.
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Nikiforchin A, Gushchin V, Sittig M, Baron E, Lopez-Ramirez F, Nieroda C, Sardi A. Outcomes Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy with and without Diaphragmatic Resection in Patients with Peritoneal Metastases. Ann Surg Oncol 2021; 29:873-882. [PMID: 34546479 DOI: 10.1245/s10434-021-10669-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Diaphragmatic resection (DR) is often required during cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) to achieve complete cytoreduction (CC). While CC provides the best survival, requiring a DR may indicate unfavorable tumor biology. We assessed how DR during CRS/HIPEC affects outcomes. METHODS A retrospective cohort study was conducted using a prospective single-center database from October 1994-May 2020. Peritoneal surface malignancy patients who underwent CRS/HIPEC with CC-0/1/2 were assigned to DR and NoDR groups. Survival was measured using the Kaplan-Meier method. Subgroup analysis was performed for patients with peritoneal cancer index (PCI) ≥ 20 to eliminate confounding of more extensive disease in DR. RESULTS Of 824 CRS/HIPECs, 774 were included: 134 DR and 640 NoDR. PCI was significantly higher in DR: 29 versus 21, p < 0.001. CC-0/1 rate was 89% in DR and 95% in NoDR (p = 0.003). Neither 100-day morbidity nor mortality differed between the groups (p = 0.355 and p = 1.000). Median follow-up was 64 months. Median overall survival (OS) was significantly lower in DR (32 vs. 96 months, p < 0.001). Subgroup analysis by tumor type in patients with PCI ≥ 20 showed significantly shorter OS in DR than NoDR in appendiceal (40 vs. 196 months, p < 0.001) and colorectal (14 vs. 23 months, p = 0.003), but not in ovarian tumors (32 vs. 42 months, p = 0.893), whereas median PCI did not differ among subgroups. CONCLUSIONS DR during CRS/HIPEC does not increase morbidity and mortality. It is associated with worse survival in appendiceal and colorectal tumors, even after adjusting for tumor burden but does not appear to impact ovarian cancer survival.
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Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Felipe Lopez-Ramirez
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Carol Nieroda
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA.
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Nikiforchin A, Sittig M, Gushchin V, Sardi A. ASO Author Reflections: What to Expect After You Resect Diaphragm During CRS/HIPEC. Ann Surg Oncol 2021; 29:883-884. [PMID: 34537898 DOI: 10.1245/s10434-021-10824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
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Nikiforchin A, Gushchin V, King MC, Baron E, Lopez-Ramirez F, Sardi A. Cytoreductive Surgery with Hyperthermic Intrathoracic Chemotherapy for Patients with Intrapleural Dissemination of Peritoneal Surface Malignancies. Ann Surg Oncol 2021; 28:9126-9135. [PMID: 34263367 DOI: 10.1245/s10434-021-10298-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/24/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Peritoneal surface malignancies (PSM) can disseminate into the pleural cavity, increasing morbidity and mortality. While cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) improves outcomes for PSM with intra-abdominal spread, the optimal approach for patients with pleural dissemination from PSM remains unclear. It seems reasonable to apply peritoneal carcinomatosis management principles to patients with pleural lesions using CRS and hyperthermic intrathoracic chemotherapy (HITHOC). METHODS We conducted a descriptive study to evaluate outcomes of PSM patients who underwent CRS/HITHOC for pleural dissemination using a high-volume PSM center's prospective database from October 1994-June 2020. CRS/HITHOC was performed via either diaphragmatic window during CRS/HIPEC (CRS/HIPEC+HITHOC) or thoracotomy as a separate procedure (CRS/HITHOC). RESULTS Of 852 completed CRS/HIPECs, 18 HITHOCs in 15 patients were identified: 10 CRS/HIPEC+HITHOCs, and 8 CRS/HITHOCs. CRS/HIPEC+HITHOC primary tumors included: 4 appendix, 4 ovary, 1 colon, and 1 unknown. All (n = 8) CRS/HITHOC patients had recurrent appendiceal neoplasms. Complete cytoreduction was achieved in 90% of CRS/HIPEC+HITHOCs and 75% of CRS/HITHOCs. Major complications occurred in 20% of CRS/HIPEC+HITHOCs and 13% of CRS/HITHOCs with no 30-day mortality in either group. After median follow-up of 22 months, overall survival at 1, 3, and 5 years was 93.3%, 67.9%, and 67.9%, while 1-, 3-, and 5-year progression-free survival was 70.9%, 20.3%, and 20.3%. Intrapleural recurrence occurred in 1 CRS/HIPEC+HITHOC and 2 CRS/HITHOC patients. CONCLUSIONS CRS/HITHOC performed via diaphragm or thoracotomy at high-volume centers is a safe option for PSM with pleural dissemination. Further comparative studies with longer follow-up are needed to evaluate survival by tumor type.
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Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Mary Caitlin King
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Felipe Lopez-Ramirez
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
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