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Chen V, Jones M, Cohen L, Yang W, Bedi J, Mohan HM, Apte SS, Larach JT, Flood M, Heriot A, Kong J, Warrier S. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in small bowel adenocarcinoma with peritoneal metastasis: a systematic review. Pleura Peritoneum 2022; 7:159-167. [PMID: 36560970 PMCID: PMC9742456 DOI: 10.1515/pp-2022-0121] [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: 05/20/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Small bowel adenocarcinoma (SBA) with peritoneal metastasis (PM) is rare and despite treatment with systemic chemotherapy, the prognosis is poor. However, there is emerging evidence that cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) may offer a survival benefit over systemic therapy alone. This systematic review will assess the effectiveness of CRS-HIPEC for SBA-PM. Content Three databases were searched from inception to 11/10/21. Clinical outcomes were extracted and analysed. Summary A total of 164 cases of SBA-PM undergoing CRS-HIPEC were identified in 12 studies. The majority of patients had neoadjuvant chemotherapy (87/164, 53%) and complete cytoreduction (143/164, 87%) prior to HIPEC. The median overall survival was 9-32 months and 5-year survival ranged from 25 to 40%. Clavien-Dindo grade III/IV morbidity ranged between 19.1 and 50%, while overall mortality was low with only 3 treatment-related deaths. Outlook CRS-HIPEC has the potential to improve the overall survival in a highly selected group of SBA-PM patients, with 5-year survival rates comparable to those reported in colorectal peritoneal metastases. However, the expected survival benefits need to be balanced against the intrinsic risk of morbidity and mortality associated with the procedure. Further multicentre studies are required to assess the safety and feasibility of CRS-HIPEC in SBA-PM to guide best practice management for this rare disease.
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Affiliation(s)
- Vicky Chen
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Morgan Jones
- Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
| | - Lauren Cohen
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Wilson Yang
- Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
| | - Jasman Bedi
- Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
| | - Helen M. Mohan
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sameer S. Apte
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - José Tomas Larach
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael Flood
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joseph Kong
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
| | - Satish Warrier
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
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Farina M, Falbo F, Biancucci A, Lucandri G, Pende V, Mazzocchi P, Cascini F, Lembo A, Santoro E. Small bowel adenocarcinoma: natural history of recurrence after surgical resection. J Surg Case Rep 2022; 2022:rjac451. [PMID: 36324758 PMCID: PMC9613117 DOI: 10.1093/jscr/rjac451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022] Open
Abstract
Small bowel adenocarcinomas (SBA) are a rare entity associated with a poor prognosis and an advanced stage of disease at diagnosis. Surgical resection is considered the gold standard of treatment for stage I-III, while stage IV disease approach is still debated. We present a case of a young woman affected by a duodenojejunal junction SBA treated with surgical resection and FOLFOX adjuvant chemotherapy. The patient later underwent a palliative duodenojejunal bypass for peritoneal carcinomatosis.
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Affiliation(s)
- Massimo Farina
- UOC Chirurgia Generale ad Indirizzo Oncologico, Direttore Prof. Emanuele Santoro, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - Francesco Falbo
- Correspondence address. UOC Chirurgia Generale ad Indirizzo Oncologico, Direttore Prof. Emanuele Santoro, Azienda Ospedaliera San Giovanni Addolorata, Via dell'Amba Aradam 9, 00184 Roma, Italy. E-mail:
| | - Andrea Biancucci
- UOC Chirurgia Generale ad Indirizzo Oncologico, Direttore Prof. Emanuele Santoro, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - Giorgio Lucandri
- UOC Chirurgia Generale ad Indirizzo Oncologico, Direttore Prof. Emanuele Santoro, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - Vito Pende
- UOC Chirurgia Generale ad Indirizzo Oncologico, Direttore Prof. Emanuele Santoro, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - Paolo Mazzocchi
- UOC Chirurgia Generale ad Indirizzo Oncologico, Direttore Prof. Emanuele Santoro, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - Francescopaolo Cascini
- UOC Chirurgia Generale ad Indirizzo Oncologico, Direttore Prof. Emanuele Santoro, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - Alessandro Lembo
- Direttore UO Oncologia Medica, Casa di Cura Marco Polo, Rome, Italy
| | - Emanuele Santoro
- UOC Chirurgia Generale ad Indirizzo Oncologico, Direttore Prof. Emanuele Santoro, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
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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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Deo S, Ray M, Bansal B, Bhoriwal S, Bhatnagar S, Garg R, Gupta N, Sharma A, Kumar L, Thulkar S, Dhamija E, Mathur S, Das P. Feasibility and outcomes of cytoreductive surgery and HIPEC for peritoneal surface malignancies in low- and middle-income countries: a single-center experience of 232 cases. World J Surg Oncol 2021; 19:164. [PMID: 34090452 PMCID: PMC8180169 DOI: 10.1186/s12957-021-02276-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has recently emerged as a viable management option for peritoneal surface malignancy (PSM). CRS and HIPEC is a complex, multidisciplinary and resource-intensive surgical procedure. It has a steep learning curve and is associated with significant morbidity and mortality. The expertise is mostly limited to few dedicated high-volume centers located in developed countries. We present a single institutional experience of 232 cases of CRS and HIPEC performed at a tertiary care cancer center in a low- and middle-income country (LMIC). METHODS A multidisciplinary PSM program was initiated in 2015 at a high-volume public-sector tertiary care cancer center in North India catering largely to patients belonging to low- and middle-income groups. Perioperative protocols were developed, and a prospective structured database was created to capture data. All patients undergoing CRS and HIPEC between January 2015 and December 2020 were identified, and the data was retrospectively analyzed for clinical spectrum, surgical details, and perioperative morbidity and mortality. RESULTS Two hundred and thirty-two patients underwent CRS and HIPEC during the study period. Epithelial ovarian carcinoma (56.5%) was the most common malignancy treated, followed by pseudomyxoma peritonei (18.5%), colorectal carcinoma (13.4%), and malignant mesothelioma (5.6%). Optimal CRS could be achieved in 94.4% of patients. Cisplatin and mitomycin were the most common drugs used for HIPEC. A total of 28.0% of patients had morbidity including deep vein thrombosis, subacute intestinal obstruction, sepsis, burst abdomen, lymphocele, urinoma, acute renal failure, and enterocutaneous fistula. The overall treatment-related mortality was 3.5%. CONCLUSIONS Results of the current study indicate that it is feasible to establish a successful CRS and HIPEC program for PSM in government-funded hospitals in LMIC facing resource constraints. The most common indication for CRS and HIPEC were carcinoma of the ovary followed by pseudomyxoma peritonei and colorectal carcinoma. Overall morbidity and mortality in the current series are comparable to global standards, reported from high-income countries. A protocol-based multidisciplinary team approach, optimal patient selection, and surgical expertise can help achieve optimal outcomes in government-funded hospitals in LMIC.
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Affiliation(s)
- Suryanarayana Deo
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110029, India.
| | - Mukurdipi Ray
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110029, India
| | - Babul Bansal
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110029, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110029, India
| | - Sushma Bhatnagar
- Department of Onco-anesthesia & Palliative Medicine, BRA-IRCH, AIIMS, New Delhi, India
| | - Rakesh Garg
- Department of Onco-anesthesia & Palliative Medicine, BRA-IRCH, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-anesthesia & Palliative Medicine, BRA-IRCH, AIIMS, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, BRA-IRCH, AIIMS, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, BRA-IRCH, AIIMS, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, BRA-IRCH, AIIMS, New Delhi, India
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