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Yan G, Zhang K, Yan L, Zhang Y. Efficacy and safety of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in patients with pancreatic cancer peritoneal metastasis. World J Surg Oncol 2024; 22:212. [PMID: 39218891 PMCID: PMC11367765 DOI: 10.1186/s12957-024-03464-9] [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: 05/29/2024] [Accepted: 07/08/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES Pancreatic cancer with peritoneal metastasis presents a challenging prognosis, with limited effective treatment options available. This study aims to evaluate the efficacy and safety of combining cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment strategy for this patient group. METHODS A retrospective analysis was conducted on patients with peritoneal metastasis of pancreatic cancer who underwent CRS + HIPEC treatment at Beijing Shijitan Hospital from March 2017 to December 2023. The study focused on assessing clinical features, the incidence of sever adverse events (SAEs), and overall survival (OS). RESULTS A total of 10 patients were enrolled in this study. The median OS was 24.2 months, suggesting an improvement over traditional therapies. While SAEs were noted, including two cases of severe complications necessitating additional surgical interventions, no perioperative fatalities were recorded. The overall survival time for patients with CC0/1 was not significantly different from that of patients with CC2/3, and no prognostic predictors were identified. CONCLUSIONS The combination of CRS and HIPEC appears to be a viable and promising treatment modality for patients with peritoneal metastasis of pancreatic cancer, offering an improved survival rate with manageable safety concerns. Further research is needed to refine patient selection criteria and to explore the long-term benefits of this approach.
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Affiliation(s)
- Guojun Yan
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, China
| | - Kai Zhang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, China
| | - Lijun Yan
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, China
| | - Yanbin Zhang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, China.
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Yan G, Zhang K, Yan L, Zhang Y. Long-term survival outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastasis of hepatocellular carcinoma patients. World J Surg Oncol 2024; 22:144. [PMID: 38822337 PMCID: PMC11140955 DOI: 10.1186/s12957-024-03426-1] [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: 03/25/2024] [Accepted: 05/24/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma with peritoneal metastasis (HCC-PM) has a poor outlook. Traditional treatments have limited effect on survival. The safety and efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) have been shown in other peritoneal cancers. This study evaluates the role of CRS + HIPEC in HCC-PM. METHODS A retrospective analysis of HCC-PM patients treated with CRS + HIPEC at Beijing Shijitan Hospital from March 2017 to December 2023 was conducted, assessing clinical features, severe adverse events (SAEs), and overall survival (OS) rates. RESULTS The study population comprised 10 HCC-PM patients who underwent CRS + HIPEC. The median peritoneal cancer index (PCI) was 25, and complete cytoreduction (CC0 ~ 1) was achieved in half of the patients. Three patients experienced SAEs within 30 days postoperatively. The 1-year, 3-year, and 5-year OS rates were recorded as 89.0%, 89.0%, and 21.0% respectively, with a median OS1 of 107.8 months and OS2 of 49.9 months. The median progression-free survival (PFS) was 5.0 months. CONCLUSION The application of CRS + HIPEC offers significant benefits to patients with HCC-PM. A selected group of patients may achieve prolonged PFS. Incorporating CRS + HIPEC into the treatment paradigm can thus be considered a strategic therapeutic option for patients with HCC-PM.
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Affiliation(s)
- Guojun Yan
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, China
| | - Kai Zhang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, China
| | - Lijun Yan
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, China
| | - Yanbin Zhang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, 100038, China.
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Wu JX, Hua R, Luo XJ, Xie F, Yao L. Effects of cytoreductive surgery combined with hyperthermic perfusion chemotherapy on prognosis of patients with advanced gallbladder cancer. World J Gastrointest Surg 2023; 15:2413-2422. [PMID: 38111760 PMCID: PMC10725543 DOI: 10.4240/wjgs.v15.i11.2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Gallbladder cancer (GC) is a common malignant tumor and one of the leading causes of cancer-related death worldwide. It is typically highly invasive, difficult to detect in the early stages, and has poor treatment outcomes, resulting in high mortality rates. The available treatment options for GC are relatively limited. One emerging treatment modality is hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC involves delivering heated chemotherapy directly into the abdominal cavity. It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions, aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity. AIM To determine the effects of cytoreductive surgery (CRS) combined with HIPEC on the short-term prognosis of patients with advanced GC. METHODS Data from 80 patients treated at the Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed. The control group comprised 44 patients treated with CRS, and the research group comprised 36 patients treated with CRS combined with HIPEC. Then, the survival time and prognostic factors of the two groups were compared, as well as liver and kidney function indices before and six days after surgery. Adverse reactions and complications were recorded in both groups. RESULTS The baseline data of the research and control groups were similar (P > 0.05). Six days after surgery, the alanine aminotransferase, aspartate aminotransferase, total bilirubin, and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups (P < 0.05). However, the values did not differ between the two groups six days postoperatively (P > 0.05). Similarly, the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups (P < 0.05), but they did not differ between the groups six days postoperatively (P > 0.05). Furthermore, the research group had fewer postoperative adverse reactions than the control group (P = 0.027). Finally, a multivariate Cox analysis identified the tumor stage, distant metastasis, and the treatment plan as independent factors affecting prognosis (P < 0.05). The three-year survival rate in the study group was higher than that in the control group (P = 0.002). CONCLUSION CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.
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Affiliation(s)
- Jin-Xiu Wu
- Department of Hepatobiliary-Pancreatic Surgery, Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Rong Hua
- Department of Biliary-Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Xiang-Ji Luo
- Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Secondary Military Medical University, Shanghai 200438, China
| | - Feng Xie
- Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Secondary Military Medical University, Shanghai 200438, China
| | - Li Yao
- Department of Hepatobiliary-Pancreatic Surgery, Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
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Huang F, Shamavonian R, Morris DL. Cytoreductive Surgery and HIPEC for Regionally Advanced Gallbladder Cancer: a Case Report. Indian J Surg Oncol 2023; 14:127-130. [PMID: 37359942 PMCID: PMC10284756 DOI: 10.1007/s13193-022-01634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/23/2022] [Indexed: 02/07/2023] Open
Abstract
Gallbladder cancer is a rare cancer, associated with an extremely poor prognosis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is not commonly performed in gallbladder cancer; however, case series have shown prolonged survival time with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gallbladder cancer and no increase in morbidity compared to cytoreductive surgery without hyperthermic intraperitoneal chemotherapy. We present a case of gallbladder cancer with peritoneal metastases in a 60-year-old male who was successfully treated with complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and survived for 4 years following diagnosis.
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Affiliation(s)
- Fay Huang
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, University of New South Wales, Level 3, Clinical Sciences (Pitney) Building, Kogarah, NSW 2217 Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Raphael Shamavonian
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, University of New South Wales, Level 3, Clinical Sciences (Pitney) Building, Kogarah, NSW 2217 Australia
- School of Medicine, University of Notre Dame, Sydney, NSW Australia
| | - David L. Morris
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, University of New South Wales, Level 3, Clinical Sciences (Pitney) Building, Kogarah, NSW 2217 Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW Australia
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Ströhlein MA, Seefeldt S, Lange J, Bulian DR, Heiss MM. [Treatment options for peritoneal metastases from hepato-pancreato-biliary tumors and neuroendocrine tumors]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:1139-1143. [PMID: 35997962 DOI: 10.1007/s00104-022-01695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Peritoneal metastasis (PM) in gastroenteropancreatic neuroendocrine tumors (GEP-NET) and hepato-pancreato-biliary (HPB) tumors has a low incidence and has rarely been studied as a stand-alone condition. The clinical relevance of PM in HPB tumors and GEP-NET arises from the fact that PM significantly worsens the prognosis of the underlying tumors. In GEP-NET, the particular situation is that PM has a negative prognostic impact compared to patients without metastases, which is not evident compared to patients with metastases in other locations. Complete surgical cytoreduction (CRS) is a curative treatment option for patients with PM in GEP-NET. Complete surgical resection should always be strived for, although patients may benefit from incomplete resection (70-90%) or resection of the primary tumor alone. Additional hyperthermic chemoperfusion (HIPEC) is currently not recommended. For nonresectable GEP-NET, systemic treatment is available that is oriented to the studies for generally metastasized GEP-NET. For PM in carcinomas of the bile duct and pancreatic carcinomas, there are no valid data or indications for CRS and HIPEC. In contrast, case series for PM in hepatocellular carcinoma (HCC) after CRS or CRS/HIPEC show good survival outcomes that justify a surgical approach under the condition of a complete resection. Patients with PM in GEP-NET and HCC should therefore be referred to a center for peritoneal tumor surgery to evaluate the option of complete CRS and use it as a curative option.
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Affiliation(s)
- Michael A Ströhlein
- Klinik für Viszeral‑, Tumor‑, Transplantations- und Gefäßchirurgie, Klinikum Köln-Merheim, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
| | - Simone Seefeldt
- Klinik für Viszeral‑, Tumor‑, Transplantations- und Gefäßchirurgie, Klinikum Köln-Merheim, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - Jonas Lange
- Klinik für Viszeral‑, Tumor‑, Transplantations- und Gefäßchirurgie, Klinikum Köln-Merheim, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - Dirk R Bulian
- Klinik für Viszeral‑, Tumor‑, Transplantations- und Gefäßchirurgie, Klinikum Köln-Merheim, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - Markus M Heiss
- Klinik für Viszeral‑, Tumor‑, Transplantations- und Gefäßchirurgie, Klinikum Köln-Merheim, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
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A Unique Presentation of Metastatic Gallbladder Carcinoma. Case Rep Surg 2021; 2021:6455540. [PMID: 34956686 PMCID: PMC8702359 DOI: 10.1155/2021/6455540] [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: 04/14/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Gallbladder carcinoma can be challenging to diagnose and treat and usually leads to poor outcome, due to its aggressive nature and the nonspecific clinical presentation at early stage. We describe an interesting case of a 60-year-old female who presented with stage 3 appendiceal carcinoma after appendectomy was performed outside hospital. Further imaging workup demonstrated enlarged ovarian cysts and porcelain gallbladder. Upon exploration, she was found to have carcinomatosis and we proceeded with cytoreductive surgery (CRS) and hyperthermic intraperitoneal therapy (HIPEC). Final pathology demonstrated carcinoma from gallbladder primary.
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Feng F, Gao Q, Wu Y, Liu C, Yu Y, Li B, Chu K, Yi B, Cheng Q, Jiang X. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy vs. cytoreductive surgery alone for intrahepatic cholangiocarcinoma with peritoneal metastases: A retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2363-2368. [PMID: 34119376 DOI: 10.1016/j.ejso.2021.05.014] [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: 02/04/2021] [Revised: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has survival benefits in patients with intraperitoneal malignant lesions, but there is no study specific to intrahepatic cholangiocarcinoma (ICC). PURPOSE To compare the prognosis of patients with advanced ICC undergoing CRS + HIPEC compared with CRS alone. METHODS This study was a retrospective cohort study of patients with advanced ICC treated at the Shanghai Eastern Hepatobiliary Surgery Hospital between 01/2014 and 12/2018. The patients were divided into either CRS + HIPEC or CRS group based on the treatment they received. Overall survival (OS), complications, hospital stay, biochemical indicators, tumor markers, and number of HIPEC were examined. RESULTS There were 51 and 61 patients in the CRS + HIPEC and CRS groups, respectively. There were no differences between the groups regarding preoperative CA19-9 levels (421 ± 381 vs. 523 ± 543 U/mL, P = 0.208). The hospital stay was longer in the CRS + HIPEC group (22.2 ± 10.0 vs. 18.6 ± 7.6 days, P = 0.033). The occurrence of overall complications was similar in the two groups (37.2% vs. 34.4%, P = 0.756). The postoperative CA19-9 levels were lower in the CRS + HIPEC group compared with the CRS group (196 ± 320 vs. 337 ± 396 U/mL, P = 0.044). The median OS was longer in the CRS + HIPEC group than in the CRS group (25.53 vs. 11.17 months, P < 0.001). Compared with the CRS group, the CRS + HIPEC group showed a higher occurrence of leukopenia (7.8% vs. 0, P = 0.040) but a lower occurrence of total bilirubin elevation (15.7% vs. 37.7%, P = 0.032). CONCLUSION CRS + HIPEC could be a treatment option for patients with advanced ICC, with improved OS and similar complications and adverse events compared with CRS alone.
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Affiliation(s)
- Feiling Feng
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China
| | - Qingxiang Gao
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China
| | - Yue Wu
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China
| | - Chen Liu
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China
| | - Yong Yu
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China
| | - Bin Li
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China
| | - Kaijian Chu
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China
| | - Bin Yi
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China
| | - Qingbao Cheng
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China.
| | - Xiaoqing Jiang
- Department of Biliary Tract I, Eastern Hepatobiliary Surgery Hospital, No.225, Changhai Road, Yangpu District, Shanghai, 200433, PR China.
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Brind'Amour A, Webb M, Parapini M, Sidéris L, Segedi M, Chung SW, Chartier-Plante S, Dubé P, Scudamore CH, Kim PTW. The role of intraperitoneal chemotherapy in the surgical management of pancreatic ductal adenocarcinoma: a systematic review. Clin Exp Metastasis 2021; 38:187-196. [PMID: 33486670 DOI: 10.1007/s10585-021-10074-2] [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: 12/12/2020] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis, particularly for patients with metastatic disease. Treatment for oligometastatic presentation has been reported in recent literature, but the role of intraperitoneal chemotherapy for patients with peritoneal metastases (PM) remains unclear. We performed a systematic literature search of the PubMed, Cochrane and Embase databases in order to identify clinical trials and case-series reporting on the safety and efficacy of intraperitoneal chemotherapy in patients with PDAC-derived PM. Eight publications reporting on 85 patients were identified, using three different therapeutic strategies. First, 37 patients received cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for PDAC with PM. Grade 3 and 4 complications occurred in 37.8% of patients, without perioperative mortality. Median disease-free survival and overall survival (OS) rates varied from 4 to 36 months and 4 to 62 months, respectively. Secondly, 40 patients with resectable PDAC without PM received prophylactic HIPEC following pancreatic resection, with postoperative morbidity and mortality rates of 30% and 5%, and 5-year OS rates of 23-24%. Finally, eight patients with PDAC-derived peritoneal disease were converted to resectable disease after receiving neoadjuvant intraperitoneal chemotherapy and operated on with curative intent, achieving a median OS of 27.8 months. In conclusion, CRS with HIPEC for PDAC-derived PM appears to be safe, conferring the same postoperative morbidity and mortality as reported on non-pancreatic malignancies. In highly selected patients, it could be considered for short-term disease control. However, long-term survival remains poor. The addition of prophylactic HIPEC for resectable PDAC cannot be recommended.
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Affiliation(s)
- Alexandre Brind'Amour
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada. .,Department of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada. .,Gordon & Leslie Diamond Health Care Centre, 2775 Laurel Street, 5th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Mitchell Webb
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Marina Parapini
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Lucas Sidéris
- Department of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.,Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Maja Segedi
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Stephen W Chung
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Pierre Dubé
- Department of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.,Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Charles H Scudamore
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Peter T W Kim
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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