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Mac Curtain BM, Qian W, Temperley HC, Simpkin AJ, Ng ZQ. Incisional hernias post cytoreductive surgery/peritonectomy and hyperthermic intraperitoneal chemotherapy: a systematic review and meta-analysis. Hernia 2023; 27:1067-1083. [PMID: 37653188 PMCID: PMC10533625 DOI: 10.1007/s10029-023-02859-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Cytoreductive surgery (CRS) is often combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal tumour deposits. Considering CRS, the evidence relating the large incisions, local chemotherapy and abdominal wall trauma to incisional hernias (IH) has not been synthesized. This systematic review and meta-analysis was conducted to examine the proportion of IH present in patients post CRS and the effect HIPEC had on these rates. METHODS PubMed, EMBASE, and Cochrane Central Registry of Trials were searched up to June 2023 to examine studies relating IH and CRS plus or minus HIPEC. The most up to date PRISMA guidelines were followed. Pertinent clinical information was synthesized in tabular form. A meta-analysis reporting the pooled proportions of IH post CRS plus or minus HIPEC, the odds of IH in HIPEC versus non-HIPEC CRS and the difference in follow-up time between groups was conducted. RESULTS Nine studies comprising 1416 patients were included. The pooled proportion of IH post CRS was 12% (95% confidence interval (CI) 8-16%) in HIPEC and 7% (95% CI 4-10%) in non-HIPEC patients and 11% (95% CI 7-14%) overall. Previously reported rates of IH in midline laparotomy range from 10 to 30%. The odds of IH in the HIPEC was 1.9 times higher compared to non-HIPEC cohorts however this was not statistically significant (odds ratio (OR) 1.9, 95% 0.7-5.2; p = 0.21). There was no significant difference in average follow-up times between HIPEC and non-HIPEC cohorts. CONCLUSIONS IH post CRS plus or minus HIPEC were in the expected range for midline laparotomies. IH in patients receiving HIPEC may occur at a greater proportion than in non-HIPEC patients, however, there were too few studies in our meta-analysis to determine this with statistical significance.
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Affiliation(s)
- B M Mac Curtain
- School of Medicine, University of Galway, Galway, Ireland.
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, WA, Australia.
| | - W Qian
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - H C Temperley
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - A J Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Z Q Ng
- Department of General Surgery, Royal Perth Hospital, Perth, WA, Australia
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de Sousa IVF, Lopes JM, Nogueiro JP, Costa TR, Barbosa LE, Aral MM. Histological tumor response predicts clinical outcome in patients with colorectal peritoneal metastasis treated with preoperative chemotherapy followed by cytoreduction and HIPEC. Pleura Peritoneum 2023; 8:37-44. [PMID: 37020471 PMCID: PMC10067549 DOI: 10.1515/pp-2022-0117] [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: 04/03/2022] [Accepted: 01/31/2023] [Indexed: 04/05/2023] Open
Abstract
Objectives Up to one quarter of the patients with colorectal cancer (CRC) develop peritoneal carcinomatosis (PM). The aims of this retrospective study were to characterize the histological response of the PM of CRC to preoperative chemotherapy and evaluate the potential prognostic value, in terms of survival. Methods This retrospective unicentric study evaluated a group of 30 patients treated between 2010 and 2020 at the São João University Hospital Center with preoperative chemotherapy, followed by cytoreduction surgery plus hyperthermic intraperitoneal chemotherapy. The evaluation of the histological response was done using two scores: the tumor regression grading (TRG) and the peritoneal regression grading score (PRGS). Results Mean post-procedure survival is higher in the PRGS 1–2 group (74.19 months) vs. the PRGS 3–4 group (25.27 months) (p=0.045), as well as in the TRG 1–2 group (74.58 months) vs. TRG 4–5 (25.27 months) (p=0.032). As for progression-free survival (PFS), the PRGS 1–2 group had a mean value of 58.03 months vs. PRGS 3–4 which had 11.67 months (p=0.002). Similar was observed with the TRG 1–2 group, which had a mean PFS of 61.68 months vs. TRG 4–5 with 11.67 months (p=0.003). Conclusions A better histological response to preoperative chemotherapy, represented as a lower PRGS and TRG value, is associated with longer post-procedure survival and progression-free survival in this group of patients. That is, these two scores have prognostic value.
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Affiliation(s)
| | - Joanne M.D. Lopes
- Faculty of Medicine of Porto University, Porto, Portugal
- Anatomic Pathology Department, São João University Hospital Center, Porto, Portugal
| | - Jorge P.M. Nogueiro
- Faculty of Medicine of Porto University, Porto, Portugal
- General Surgery Department, São João University Hospital Center, Porto, Portugal
| | - Teresa R. Costa
- General Surgery Department, Local Health Unit of Guarda, Guarda, Portugal
| | - Laura E.R. Barbosa
- Faculty of Medicine of Porto University, Porto, Portugal
- General Surgery Department, São João University Hospital Center, Porto, Portugal
| | - Marisa M.M. Aral
- Faculty of Medicine of Porto University, Porto, Portugal
- General Surgery Department, São João University Hospital Center, Porto, Portugal
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Račkauskas R, Baušys A, Jurgaitis J, Paškonis M, Strupas K. Initial Experience of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Baltic Country Center. J Clin Med 2022; 11:jcm11195554. [PMID: 36233421 PMCID: PMC9572244 DOI: 10.3390/jcm11195554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Peritoneal surface malignancies (PSMs) are a heterogenous group of primary and metastatic cancers affecting the peritoneum. They are associated with poor long-term outcomes. Many centers around the world adopt cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in routine clinical practice for these otherwise condemned patients despite a lack of high-level evidence from randomized control trials. This study aimed to investigate and present our 10-year experience with this controversial method, CRS and HIPEC, for PSM in a single tertiary center in a Baltic country. Methods: Patients who underwent CRS and HIPEC at Vilnius University Hospital Santaros Klinikos between 2011 and 2021 were included in this retrospective study. Overall survival was the primary study outcome. Secondary outcomes included postoperative morbidity and mortality, and local or systemic recurrence rates. Results: Sixty-nine patients who underwent CRS and HIPEC were included in the study. Most patients underwent treatment for peritoneal metastases from colorectal, ovarian, and appendiceal cancers. Six (8.7%) patients received CRS and HIPEC for primary peritoneal neoplasm—pseudomyxoma peritonei. The mean peritoneal carcinomatosis index score was 12 ± 7. Complete cytoreduction was achieved in 62 (89.9%) patients. The mean OS was 39 ± 29 months. The mean survival of patients with PSMs of different origin was as follows: 39 ± 25 (95% CI: 28–50) months for colorectal cancer, 44 ± 31 (95% CI: 30–58) months for ovarian cancer, 32 ± 21 (95% CI: 21–43) months for appendiceal cancer, 422 ± 1 (95% CI: 12–97) months for pseudomyxoma peritonei, and 7 months for gastric cancer. Conclusions: The current study demonstrated the results of the CRS and HIPEC program in a single Baltic country tertiary center. Patients who underwent CRS and HIPEC for PSMs achieved moderate survival rates with acceptable postoperative morbidity and mortality risk.
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Fayed M, Angappan S, Oyibo O, Valliani A. Role of Imaging Studies in Evaluating Patients Post Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Cureus 2021; 13:e20601. [PMID: 35103177 PMCID: PMC8782632 DOI: 10.7759/cureus.20601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 12/28/2022] Open
Abstract
A 77-year-old male presented to the ED with a new onset of acute abdominal pain, nausea, and vomiting. He had a previous surgical history of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for an appendiceal tumor. Despite the repeated reassuring abdominal examinations, CT abdomen showed high-grade bowel obstruction and perforation. He was urgently taken to the operating room and underwent resection of 70 cm segment of small ischemic bowel with primary anastomosis. His postoperative course was complicated with atrial fibrillation (AF) requiring cardioversion and medical therapy. Later, he was discharged home under stable conditions. Relying on abdominal signs, an abdominal exam in a patient with a previous history of extensive peritonectomy and post-HIPEC surgery is challenging due to the altered peritoneal anatomy. As a result, the abdominal examination findings can be benign and misleading. This can lead to delayed surgical intervention, thereby increasing morbidity and mortality significantly. Therefore, a detailed evaluation with a low threshold for abdominal imaging studies like abdominal X-rays and CT abdomen series is warranted in this subset of patients.
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Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy Experience in Peritoneal Carcinomatosis: Single-Center Analysis of 180 Cases. Int J Surg Oncol 2021; 2021:8851751. [PMID: 33976936 PMCID: PMC8087469 DOI: 10.1155/2021/8851751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/27/2022] Open
Abstract
Background In peritoneal carcinomatosis (PC), increased life span and disease-free survival times are shown in patients with hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) following cytoreductive surgery (SRC). In this study, our main objective was to present our experience of performing SRC and perioperative intraperitoneal chemotherapy (HIPEC and EPIC) on patients with PC, in light of the literature. Methods Demographic data, follow-up results, peritoneal carcinomatosis index (PCI), completeness of cytoreduction (CCR) score, and morbidity and mortality rates of 180 patients treated with SRC + HIPEC + EPIC for PC at the Department of Surgical Oncology at Sivas Cumhuriyet University between January 2008 and July 2020 were analyzed retrospectively. Results Distribution of 180 PC cases according to primary organs included 53 ovarian, 39 colorectal, 33 stomach, 25 primary peritoneum, 10 uterus, 10 tuba, five soft tissue, and five appendix originated carcinoma. The average PCI of the cases detected preoperatively was 21 (5-30). Completeness of cytoreduction scores of CCR-0 in 102 cases, CCR-1 in 67 cases, CCR-2 in eight cases, and CCR-3 in three cases was obtained. Median operation time was 300 (200-540) minutes. Perioperative morbidity rate was 47.0%, and perioperative mortality rate was 13.5%. Conclusion The peritonectomy procedure is a difficult, long-lasting, troublesome intervention, but it is the most important treatment option with acceptable morbidity and mortality rates in patients selected for PC treatment in experienced centers.
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Loughney L, McCaffrey N, Timon CM, Grundy J, McCarren A, Cahill R, Moyna N, Mulsow J. Physical, psychological and nutritional outcomes in a cohort of Irish patients with metastatic peritoneal malignancy scheduled for cytoreductive surgery (CRS) and heated intrapertioneal chemotherapy (HIPEC): An exploratory pilot study. PLoS One 2020; 15:e0242816. [PMID: 33296392 PMCID: PMC7725307 DOI: 10.1371/journal.pone.0242816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Background Treatment for peritoneal malignancy (PM) can include cytoreductive surgery (CRS) and heated intrapertioneal chemotherapy (HIPEC) and is associated with morbidity and mortality. Physical, psychological and nutritional outcomes are important pre-operatively. The aim of this pilot study was to investigate these outcomes in patients with PM before and after CRS-HIPEC. Methods Between June 2018 and November 2019, participants were recruited to a single-centre study. Primary outcome was cardiopulmonary exercise testing (CPET) variables oxygen uptake (VO2) at anaerobic threshold (AT) and at peak. Secondary outcome measures were upper and lower body strength, health related quality of life (HRQoL) and the surgical fear questionnaire. Exploratory outcomes included body mass index, nutrient intake and post-operative outcome. All participants were asked to undertake assessments pre CRS-HIPEC and 12 weeks following the procedure. Results Thirty-nine patients were screened, 38 were eligible and 16 were recruited. Ten female and 6 male, median (IQR) age 53 (42–63) years. Of the 16 patients recruited, 14 proceeded with CRS-HIPEC and 10 competed the follow up assessment at week 12. Pre-operative VO2 at AT and peak was 16.8 (13.7–18) ml.kg-1.min-1 and 22.2 (19.3–25.3) ml.kg-1.min-1, upper body strength was 25.9 (20.3–41.5) kg, lower body strength was 14 (10.4–20.3) sec, HRQoL (overall health status) was 72.5 (46.3–80) % whilst overall surgical fear was 39 (30.5–51). The VO2 at AT decreased significantly (p = 0.05) and HRQoL improved (p = 0.04) between pre and post- CRS-HIPEC. There were no significant differences for any of the other outcome measures. Conclusion This pilot study showed a significant decrease in VO2 at AT and an improvement in overall HRQoL at the 12 week follow up. The findings will inform a larger study design to investigate a prehabilitation and rehabilitation cancer survivorship programme.
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Affiliation(s)
- Lisa Loughney
- ExWell Medical, Dublin, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- The Royal College of Surgeons in Ireland, Dublin, Ireland
- * E-mail:
| | - Noel McCaffrey
- ExWell Medical, Dublin, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Claire M. Timon
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Joshua Grundy
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital Dublin, Dublin, Ireland
| | - Andrew McCarren
- Department of Computing, Dublin City University, Dublin, Ireland
| | - Ronan Cahill
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall Moyna
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Jurgen Mulsow
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital Dublin, Dublin, Ireland
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Gasser E, Kogler P, Lorenz A, Kafka-Ritsch R, Öfner D, Perathoner A. Do we still need CRS and HIPEC in colorectal cancer in times of modern chemotherapy and immunotherapy? MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2020; 13:430-433. [DOI: 10.1007/s12254-020-00647-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/18/2020] [Indexed: 08/30/2023]
Abstract
SummaryPeritoneal carcinomatosis from colorectal cancer is associated with a poor prognosis and is usually treated with systemic chemotherapy and immunotherapy alone. In patients with isolated peritoneal carcinomatosis (PC) without nonperitoneal metastases, however, cytoreductive surgery (CRS) has been shown to significantly improve outcome and to achieve even cure in selected patients in combination with systemic therapy. The additional use of a hyperthermic intraperitoneal chemotherapy (HIPEC) is primarily indicated to control microscopical residual tumor tissue in the peritoneal cavity after successful CRS. Another more recent option is the application of an adjuvant HIPEC to prevent peritoneal carcinomatosis in high risk patients with pT4 cancer or perforated cancer at the time of or after primary surgery. The aim of this short review is to highlight the corresponding available literature and assess the role of CRS and HIPEC in the context of modern chemotherapy and immunotherapy.
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Wang X, Li T. Postoperative pain pathophysiology and treatment strategies after CRS + HIPEC for peritoneal cancer. World J Surg Oncol 2020; 18:62. [PMID: 32234062 PMCID: PMC7110707 DOI: 10.1186/s12957-020-01842-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment choice for peritoneal cancer. However, patients commonly suffer from severe postoperative pain. The pathophysiology of postoperative pain is considered to be from both nociceptive and neuropathic origins. Main body The recent advances on the etiology of postoperative pain after CRS + HIPEC treatment were described, and the treatment strategy and outcomes were summarized. Conclusion Conventional analgesics could provide short-term symptomatic relief. Thoracic epidural analgesia combined with opioids administration could be an effective treatment choice. In addition, a transversus abdominis plane block could also be an alternative option, although further studies should be performed.
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Affiliation(s)
- Xiao Wang
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing, 100038, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing, 100038, China.
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Spectrum of Early Postoperative Multidetector Computed Tomography Findings Following Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy. J Comput Assist Tomogr 2020; 44:124-130. [PMID: 31939893 DOI: 10.1097/rct.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review and describe imaging findings on multidetector computed tomography in the early postoperative period after cytoreductive surgery with concomitant hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). METHODS This was a retrospective review of consecutive patients undergoing early (≤60 days) postoperative abdominopelvic multidetector computed tomography scans after CRS + HIPEC from 2014 to 2018 at a single institution. Two radiologists separately assessed bowel wall thickening, bowel wall enhancement, bowel dilation, ascites, and pleural effusion(s) and identified any other significant finding(s). RESULTS Thirty-two patients met the inclusion criteria. The majority of patients demonstrated bowel wall thickening (53%; n = 17) and ascites (72%; n = 23), whereas postoperative ileus (35%; n = 10), pleural effusion(s) (24%; n = 7), and bowel wall hyperenhancement (6%; n = 1) were less common. Significant findings included anastomotic leak/perforation (13%; n = 4), fistula (13%; n = 4), abscess (13%; n = 4), and bladder leak (6%; n = 2). CONCLUSIONS Multidetector computed tomography is an excellent imaging modality to identify common postoperative findings as well as complications following CRS + HIPEC.
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Epidemiology and risks for infection following cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. Support Care Cancer 2019; 28:2745-2752. [DOI: 10.1007/s00520-019-05093-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022]
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