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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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Yadav P, Ambudkar SV, Rajendra Prasad N. Emerging nanotechnology-based therapeutics to combat multidrug-resistant cancer. J Nanobiotechnology 2022; 20:423. [PMID: 36153528 PMCID: PMC9509578 DOI: 10.1186/s12951-022-01626-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Cancer often develops multidrug resistance (MDR) when cancer cells become resistant to numerous structurally and functionally different chemotherapeutic agents. MDR is considered one of the principal reasons for the failure of many forms of clinical chemotherapy. Several factors are involved in the development of MDR including increased expression of efflux transporters, the tumor microenvironment, changes in molecular targets and the activity of cancer stem cells. Recently, researchers have designed and developed a number of small molecule inhibitors and derivatives of natural compounds to overcome various mechanisms of clinical MDR. Unfortunately, most of the chemosensitizing approaches have failed in clinical trials due to non-specific interactions and adverse side effects at pharmacologically effective concentrations. Nanomedicine approaches provide an efficient drug delivery platform to overcome the limitations of conventional chemotherapy and improve therapeutic effectiveness. Multifunctional nanomaterials have been found to facilitate drug delivery by improving bioavailability and pharmacokinetics, enhancing the therapeutic efficacy of chemotherapeutic drugs to overcome MDR. In this review article, we discuss the major factors contributing to MDR and the limitations of existing chemotherapy- and nanocarrier-based drug delivery systems to overcome clinical MDR mechanisms. We critically review recent nanotechnology-based approaches to combat tumor heterogeneity, drug efflux mechanisms, DNA repair and apoptotic machineries to overcome clinical MDR. Recent successful therapies of this nature include liposomal nanoformulations, cRGDY-PEG-Cy5.5-Carbon dots and Cds/ZnS core–shell quantum dots that have been employed for the effective treatment of various cancer sub-types including small cell lung, head and neck and breast cancers.
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Houlzé-Laroye C, Glehen O, Sgarbura O, Gayat E, Sourrouille I, Tuech JJ, Delhorme JB, Dumont F, Ceribelli C, Amroun K, Arvieux C, Moszkowicz D, Pirro N, Lefevre JH, Courvosier-Clement T, Paquette B, Mariani P, Pezet D, Sabbagh C, Tessier W, Celerier B, Guilloit JM, Taibi A, Quenet F, Bakrin N, Pocard M, Goéré D, Brigand C, Piessen G, Eveno C. Half of Postoperative Deaths After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Could be Preventable: A French Root Cause Analysis on 5562 Patients. Ann Surg 2021; 274:797-804. [PMID: 34334647 DOI: 10.1097/sla.0000000000005101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To perform a retrospective root-cause analysis of postoperative death after CRS and HIPEC procedures. BACKGROUND The combination of CRS and HIPEC is an effective therapeutic strategy to treat peritoneal surface malignancies, however it is associated with significant postoperative mortality. METHODS All patients treated with a combination of CRS and HIPEC between January 2009 and December 2018 in 22 French centers and died in the hospital, were retrospectively analyzed. Perioperative data of the 101 patients were collected by a local senior surgeon with a sole junior surgeon. Three independent experts investigated the typical root cause of death and provided conclusions on whether postoperative death was preventable (PREV group) or not (NON-PREV group). A typical root cause of preventable postoperative death was classified on a cause-and-effect diagram. RESULTS Of the 5562 CRS+HIPEC procedures performed, 101 in-hospital deaths (1.8%) were identified, of which a total of 18 patients of 70 years old and above and 20 patients with ASA score of 3. Etiology of peritoneal disease was mainly colorectal. A total of 54 patients (53%) were classified in the PREV group and 47 patients (47%) in the NON-PREV group. The results of the study show that in the PREV group, WHO performance status 1-2 was more frequent and the Median Peritoneal Cancer Index was higher compared with those of the NON-PREV group. The cause of death in the PREV group was classified as: (i) preoperatively for debatable indication (59%), (ii) intraoperatively (30%) and (iii) postoperatively in 17 patients (31%). A multifactorial cause of death was found in 11 patients (20%). CONCLUSION More than half of the postoperative deaths after combined CRS and HIPEC may be preventable, mainly by following guidelines regarding preoperative selection of the patients and adequate intraoperative decisions.
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Affiliation(s)
- Constance Houlzé-Laroye
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000 Lille, France
| | - Olivier Glehen
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute Montpellier, University of Montpellier 208 Avenue des Apothicaires, Montpellier, Cedex 05, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, F-34298, France
| | - Etienne Gayat
- INSERM UMR-S 942, Université de Paris, Paris, France; Department of Anaesthesiology and Critical Care Medicine, Lariboisière University Hospital, DMU PARABOL, AP-HP.Nord, Paris, France
| | - Isabelle Sourrouille
- Department of Visceral and Oncological Surgery, Gustave Roussy, Cancer Campus, Villejuif Cedex, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Jean-Baptiste Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University, Strasbourg, France
| | - Frédéric Dumont
- Department of Surgical Oncology, ICO René Gauducheau Cancer Center, Saint-Herblain, France
| | - Cécilia Ceribelli
- Department of Digestive Surgery, Institut de Cancérologie de Lorraine, 54519 Vandoeuvre-les-Nancy
| | - Koceila Amroun
- Department of General, Digestive and Endocrine Surgery, Robert-Debré Hospital, Université de Reims Champagne-Ardenne, 51100 Reims, France
| | - Catherine Arvieux
- Department of Digestive Surgery, Grenoble-Alpes University Hospital, Grenoble, France
| | - David Moszkowicz
- Université de Paris; Department of Digestive Surgery, Louis-Mourier Hospital, DMU ESPRIT - GHU AP-HP. Nord - University of Paris; Colombes, France
| | - Nicolas Pirro
- Department of Digestive Surgery, Timône University Hospital, Marseille, France
| | - Jérémie H Lefevre
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | | | - Brice Paquette
- Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Pascale Mariani
- Department of Surgical Oncology, Curie Institute, Paris, France
| | - Denis Pezet
- Department of Digestive Surgery, CHU Clermont Ferrand, 1 rue Lucie et Raymond Aubrac, Clermont-Ferrand, France
| | - Charles Sabbagh
- Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
| | - Williams Tessier
- Department of digestive and oncological Surgery, Oscar Lambret Center, Lille, France
| | - Bertrand Celerier
- Department of Colorectal Surgery, CHU Bordeaux, Haut-Leveque Hospital, University of Bordeaux, Pessac, France
| | - Jean-Marc Guilloit
- Department of Surgical Oncology, François Baclesse Institute, 3 avenue du general Harris, Caen, France
| | - Abdelkader Taibi
- Endocrine, General and Digestive Surgery Department, CHU of Limoges, Limoges, France
| | - François Quenet
- Department of Surgical Oncology, Cancer Institute Montpellier, University of Montpellier 208 Avenue des Apothicaires, Montpellier, Cedex 05, France
| | - Naoual Bakrin
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - Marc Pocard
- Service de chirurgie digestive hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, AP-HP, Paris, France
- Université de Paris, UMR INSERM 1275 CAP Paris-Tech, F-75010 Paris, France
| | - Diane Goéré
- Department of Digestive and Oncological Surgery, Saint-Louis University Hospital, Paris, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University, Strasbourg, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000 Lille, France
- UMR-S1277 - CANTHER laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies," Lille, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000 Lille, France
- UMR-S1277 - CANTHER laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies," Lille, France
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Twelve-Year Single Center Experience Shows Safe Implementation of Developed Peritoneal Surface Malignancy Treatment Protocols for Gastrointestinal and Gynecological Primary Tumors. Cancers (Basel) 2021; 13:cancers13102471. [PMID: 34069475 PMCID: PMC8159136 DOI: 10.3390/cancers13102471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The treatment of peritoneal surface malignancies (PSM) has dramatically evolved during the past two decades. Indications, treatment protocols, surgical techniques and the application of HIPEC in the prophylactic setting were evaluated in the surgical community. Nevertheless, the current results of the PRODIGE-7 trial disfavored the application of HIPEC for PSM of colorectal cancer and raised uncertainty among surgeons. On the other hand, cytoreductive surgery and HIPEC represent state-of-the-art therapy for peritoneal mesothelioma (except the sarcomatoid-subtype) and pseudomyxoma peritonei. Comparing the literature is cumbersome due to the variety of HIPEC protocols and differences in indication settings. This article aims to provide an insight into the impact of different HIPEC protocols, different indication settings and the implementation of pre-HIPEC laparoscopy on patients’ morbidity rates and outcomes and serves as guidance for surgeons dealing with these patients in order to guarantee high-quality treatment. Abstract (1) Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy provide survival benefits to selected patients. We aimed to report our experience and the evolution of our peritoneal surface malignancy program. (2) Methods: From June 2005 to June 2017, 399 patients who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy at the Tübingen University Hospital were analyzed from a prospectively collected database. (3) Results: Peritoneal metastasis from colorectal cancer was the leading indication (group 1: 28%; group 2: 32%). The median PCI was 15.5 (range, 1–39) in group 1 and 11 (range, 1–39) in group 2 (p = 0.002). Regarding the completeness of cytoreduction (CC), a score of 0 was achieved in 63% vs. 69% for group 1 and 2, respectively (p = 0.010). Median overall survival rates for patients in group 1 and 2 for colon cancer, ovarian cancer, gastric cancer and appendix cancer were 34 and 25 months; 45 months and not reached; 30 and 16 months; 39 months and not reached, respectively. The occurrence of grade-III and -IV complications slightly differed between groups (14.5% vs. 15.6%). No 30-day mortality occurred. (4) Conclusions: Specialized centers are able to provide low-morbidity cytoreductive surgery and hyperthermic intraperitoneal chemotherapy without mortality. Strict patient selection during the time period significantly improved CC scores.
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Horvath P, Yurttas C. Reply to: "Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Definitively Does Not Deserve Its Bad Reputation". Ann Surg Oncol 2021; 28:5450-5451. [PMID: 33638041 PMCID: PMC8349317 DOI: 10.1245/s10434-021-09743-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Philipp Horvath
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Tübingen, Germany. .,National Center for Pleura and Peritoneum, University of Tübingen, 72076, Tübingen, Germany.
| | - Can Yurttas
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Tübingen, Germany.,National Center for Pleura and Peritoneum, University of Tübingen, 72076, Tübingen, Germany
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Noiret B, Piessen G, Eveno C. Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Definitively Does not Deserve Its Bad Reputation. Ann Surg Oncol 2021; 28:5448-5449. [PMID: 33611746 DOI: 10.1245/s10434-021-09741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 11/18/2022]
Affiliation(s)
- B Noiret
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France.,UMR-S1277 - CANTHER Laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies", Lille, France
| | - C Eveno
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France. .,UMR-S1277 - CANTHER Laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies", Lille, France.
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