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Neveu J, Tremblay E, Mercier F, Garneau S, Cormier B. Developing a hyperthermic intraperitoneal chemotherapy (HIPEC) gynecologic oncology program: a Canadian experience. Int J Gynecol Cancer 2023; 33:1957-1965. [PMID: 38011988 PMCID: PMC10803971 DOI: 10.1136/ijgc-2023-004788] [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: 08/17/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for epithelial ovarian cancer following cytoreductive surgery. The intraperitoneal spread of the disease makes the peritoneal cavity an ideal target for drug delivery. HIPEC has shown promising results in improving overall survival in epithelial ovarian cancer patients when performed during interval cytoreductive surgery. Recent studies have provided level 1 evidence supporting increased overall survival in stage III ovarian cancer patients treated with HIPEC during interval cytoreduction. Meta-analyses have further confirmed the survival improvement in women receiving HIPEC. Despite its inclusion in guidelines, many centers have been hesitant to implement HIPEC programs due to perceived obstacles, such as increased morbidity, cost, and resource requirements. Studies have shown that morbidity rates are acceptable in selected patients, and the addition of HIPEC to cytoreductive surgery is cost effective. Therefore, the main barrier to implementing HIPEC programs is related to resource requirements and logistics, but with proper preparation, these challenges can be overcome. Establishing a successful HIPEC program requires institutional support, a knowledgeable and dedicated team, adequate resources and equipment, and proper training and audit. This review aims to provide evidence based information to guide the development of successful HIPEC programs, including preoperative, anesthetic, and surgical considerations. It also reviews the different equipment and protocols for the perfusion and common postoperative events.
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Affiliation(s)
- Joannie Neveu
- Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
- H Bliss Murphy Cancer Center, Health Sciences Center General Hospital, St John's, Newfoundland and Labrador, Canada
| | - Elizabeth Tremblay
- Département d'obstétrique et gynécologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Département d'obstétrique et gynécologie, Université de Montréal, Montréal, Québec, Canada
| | - Frederic Mercier
- Département d'obstétrique et gynécologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Département de chirurgie, Université de Montréal, Montréal, Québec, Canada
| | - Sébastien Garneau
- Département d'obstétrique et gynécologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Département d'anesthésie, Université de Montréal, Montréal, Québec, Canada
| | - Beatrice Cormier
- Département d'obstétrique et gynécologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Département d'obstétrique et gynécologie, Université de Montréal, Montréal, Québec, Canada
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Sedighim S, Khan A, Li AY, Tajik F, Radhakrishnan VK, Eng O, Turaga K, Senthil M. Adoption of cytoreductive surgery in the management of peritoneal malignancies-Global trends. J Surg Oncol 2023; 128:1021-1031. [PMID: 37818906 DOI: 10.1002/jso.27448] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Cytoreductive surgery (CRS) has now been accepted as an integral component in the management of gastrointestinal and gynecological cancers with peritoneal metastases. Since the adoption of CRS is influenced by access to advanced medical facilities, trained multidisciplinary teams, and funding, there is wide variability in incorporation of CRS into routine clinical practice between high- versus low- and middle-income countries. This review highlights the global trends in the adoption of CRS for peritoneal malignancies with a specific focus on the establishment of CRS programs and barriers to incorporate CRS into routine clinical care in low- and middle-income countries.
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Affiliation(s)
- Shaina Sedighim
- Department of Surgery, University of California, Irvine, California, USA
| | - Aaqil Khan
- Department of Surgery, University of California, Irvine, California, USA
- School of Medicine, University of California, Irvine, California, USA
| | - Amy Y Li
- Division of Surgical Oncology, Department of Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Fatemeh Tajik
- Department of Surgery, University of California, Irvine, California, USA
| | | | - Oliver Eng
- Division of Surgical Oncology, Department of Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Kiran Turaga
- Division of Surgical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Maheswari Senthil
- Department of Surgery, University of California, Irvine, California, USA
- Division of Surgical Oncology, Department of Surgery, University of California Irvine Medical Center, Orange, California, USA
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Sun BJ, Daniel SK, Lee B. The Role of Prophylactic and Adjuvant Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Prevention of Peritoneal Metastases in Advanced Colorectal Cancer. J Clin Med 2023; 12:6443. [PMID: 37892582 PMCID: PMC10607874 DOI: 10.3390/jcm12206443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a locoregional therapy that may be combined with cytoreductive surgery (CRS) to treat patients with colorectal cancer and peritoneal metastases (PM). In recent years, three randomized controlled trials (RCTs) have investigated the role of prophylactic or adjuvant HIPEC in preventing the development of PM in patients with high-risk colorectal cancer: PROPHYLOCHIP and COLOPEC evaluated adjuvant HIPEC, and HIPECT4 studied concurrent HIPEC and CRS. Although PROPHYLOCHIP and COLOPEC were negative trials, a great deal may be learned from their methodology, outcome measures, and patient selection criteria. HIPECT4 is the first RCT to show a clinical benefit of HIPEC in high-risk T4 colorectal cancer, demonstrating improved locoregional disease control with the addition of HIPEC to CRS with no increase in the rate of complications. This review critically examines the strengths and limitations of each major trial and discusses their potential impact on the practice of HIPEC. Several additional ongoing clinical trials also seek to investigate the role of HIPEC in preventing PM in advanced colorectal cancer.
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Affiliation(s)
| | | | - Byrne Lee
- Section of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (B.J.S.); (S.K.D.)
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Das AK, Sharma A, Kothari N, Choudhary R. Refractory Hypotension and Rapid Onset AKI: Deadly Complication After Doxorubicin and Mitomycin-C HIPEC Therapy. Indian J Surg Oncol 2023; 14:189-191. [PMID: 37359929 PMCID: PMC10284760 DOI: 10.1007/s13193-022-01684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Akshaya Kumar Das
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, 342005 India
| | - Ankur Sharma
- Department of Trauma & Emergency (Anaesthesiology), All India Institute of Medical Sciences, Jodhpur, 342005 India
| | - Nikhil Kothari
- Department of Anesthesiology, All India Institute of Medical Sciences, Jodhpur, 342005 India
| | - Ramkaran Choudhary
- Department of Surgery, All India Institute of Medical Sciences, Jodhpur, 342005 India
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Goffredo P, Aguirre N, Mohamed M, Kleiman DA, Cercek A, Joshua Smith J, Paty PB, Weiser M, Garcia-Aguilar J, Nash GM. Incomplete cytoreductive surgery for appendiceal and colorectal peritoneal carcinomatosis: Characteristics and outcomes of an overlooked group. J Surg Oncol 2023; 127:1028-1034. [PMID: 36862078 PMCID: PMC10079630 DOI: 10.1002/jso.27223] [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: 02/03/2023] [Accepted: 02/18/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND OND OBJECTIVES Complete cytoreductive surgery (CRS) may prolong survival for selected patients with peritoneal carcinomatosis from colorectal cancer (CRC). However, there is a paucity of data on outcomes following incomplete procedures. METHODS Patients with incomplete CRS for well-differentiated (WD) and moderate/poorly-differentiated (M/PD) appendiceal cancer, right and left CRC were identified at a single tertiary center (2008-2021). RESULTS Of 109 patients, 10% were WD and 51% M/PD appendiceal cancers, and 16% right and 23% left CRC. There were no differences in gender, BMI (mean = 27), ASA score, previous abdominal surgery (72%), and extent of CRS. The PC Index differed between appendiceal and colorectal cancers (mean = 27 vs. 17, p < 0.01). Overall, the perioperative outcomes were similar among the groups, with 15% experiencing complications. Postoperatively, 61% received chemotherapy, and 51% required ≥1 subsequent procedure. The 1 and 3-year survival for the WD, M/PD, right and left CRC subgroups were 100%, 67%, 44%, 51%, and 88%, 17%, 12%, and 23%, respectively (p = 0.02). CONCLUSIONS Incomplete CRS was associated with significant morbidity and number of subsequent palliative procedures. Prognosis correlated with histologic subtype; WD appendiceal cancer patients having superior outcomes, while those with right sided CRC the worst survival. These data may help guiding expectations in the setting of incomplete procedures.
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Affiliation(s)
- Paolo Goffredo
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - Nicole Aguirre
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - Mostafa Mohamed
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - David A Kleiman
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - Andrea Cercek
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - Philip B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - Martin Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center New York, New York, New York, USA
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Beal EW, Chen JC, Kim A, Johnston FM, Abbott DE, Raoof M, Grotz TE, Fournier K, Dineen S, Veerapong J, Clarke C, Staley C, Patel SH, Lambert L, Cloyd JM. Is CRS-HIPEC Still Indicated in Patients With Extraperitoneal Disease? J Surg Res 2022; 277:269-278. [PMID: 35525209 DOI: 10.1016/j.jss.2022.04.007] [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: 12/16/2021] [Revised: 02/28/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with extraperitoneal disease (EPD) is controversial. METHODS Among patients with peritoneal metastases from appendiceal cancer (AC) and colorectal cancer (CRC) who underwent CRS-HIPEC, those with EPD (liver, lung, or retroperitoneal lymph nodes [RP LN]) were retrospectively compared to those without EPD. Overall (OS) and recurrence-free survival (RFS) analyses were performed before/after propensity score matching (PSM). RESULTS Among 1341 patients with AC (64%) or CRC (36%) who underwent CRS ± HIPEC, 134 (10%) had EPD whereas 1207 (90%) did not. EPD was located in the lungs (47%), RP LN (28%), liver (18%), or multiple (6%). Patients with EPD experienced worse median OS (34 versus 63 mo; P = 0.002) and RFS (12 versus 19 mo; P < 0.001). On a multivariable analysis, EPD was associated with worse RFS (P = 0.003), but not OS (P = 0.071). After PSM, the association of EPD with OS (P = 0.204) and RFS (P = 0.056) was no longer significant. In the multivariable analysis of the PSM cohort, EPD was not associated with OS (P = 0.157) or RFS (P = 0.110). CONCLUSIONS The findings of this large retrospective multi-institutional study suggest that EPD alone, while a negative prognostic indicator, should not be considered an absolute contraindication to CRS ± HIPEC for otherwise well-selected patients with peritoneal surface malignancies. Further research is needed to delineate whether location of EPD influences OS and RFS following CRS-HIPEC.
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Affiliation(s)
- Eliza W Beal
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | - J C Chen
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | - Alex Kim
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio
| | | | | | | | | | | | | | - Jula Veerapong
- University of California San Diego, San Diego, California
| | | | | | | | - Laura Lambert
- University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Jordan M Cloyd
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio.
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Song J, Choi N, Kang M, Ji SM, Kim DW, Kwon MA. Analgesic effects of ultrasound-guided four-quadrant transabdominal plane block in patients with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective, randomized, controlled study. Anesth Pain Med (Seoul) 2022; 17:75-86. [PMID: 35139610 PMCID: PMC8841264 DOI: 10.17085/apm.21094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Postoperative pain occurring after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is difficult to control because of extensive surgical injuries and long incisions. We assessed whether the addition of a four-quadrant transabdominal plane (4Q-TAP) block could help in analgesic control. Methods Seventy-two patients scheduled to undergo elective CRS with HIPEC and intravenous patient-controlled analgesia (IV PCA) were enrolled. The patients received 4Q-TAP blocks in a 10 ml mixture of 2% lidocaine and 0.75% ropivacaine per site (4Q-TAP group, n = 36) or normal saline (control group, n = 33). Oxycodone in the post-anesthesia care unit (PACU) and pethidine or tramadol in the ward were used as rescue analgesics. The primary outcome was less than 3 times of rescue analgesic administration (%) in the ward for 5 postoperative days. Secondary endpoints included oxycodone requirement in PACU, fentanyl doses of IV PCA, morphine milligram equivalent (MME) of total opioid use, hospital stay, and postoperative complications. Results During 5 postoperative days, there was no difference in pain scores and total rescue analgesic administration between two groups. However, the use of oxycodone in PACU (P = 0.011), fentanyl requirement in IV PCA (P = 0.029), and MME/kg of total opioid use (median, 2.35 vs. 3.21 mg/kg, P = 0.009) were significantly smaller in the 4Q-TAP group. Hospital stay and incidence of postoperative morbidity were similar in both groups. Conclusions The 4Q-TAP block enhanced multimodal analgesia and decreased opioid requirements in patients with CRS with HIPEC, but did not change postoperative recovery outcomes.
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Affiliation(s)
- Jaegyok Song
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
| | - Nayoung Choi
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
| | - Minji Kang
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
| | - Sung Mi Ji
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
| | - Dong-wook Kim
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Min A Kwon
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
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García-Fadrique A, Estevan Estevan R, Sabater Ortí L. Quality Standards for Surgery of Colorectal Peritoneal Metastasis After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2021; 29:188-202. [PMID: 34435297 DOI: 10.1245/s10434-021-10642-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The standardization of surgical outcomes throughout surgical procedures is mandatory. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) should provide proficient oncological and surgical outcomes. STUDY DESIGN The aim of this study was to identify clinically relevant quality indicators and their quality standard, and to determine their acceptable quality limit. A systematic review on cytoreductive results from 2000 to 2018 was performed focusing on clinical guidelines, consensus conferences, and publications. After the selection of quality indicators, a systematic review of indexed references was performed in order to calculate the quality standard for each indicator. STUDY SELECTION Unicentric/multicentric series, comparative studies, and clinical trials. Studies were to include outcomes after cytoreduction of colorectal origin and series with more than 50 patients. Quality indicators with at least 10 series were mandatory and objective measurements were also mandatory for inclusion. MAIN OUTCOME MEASUREMENTS Quality indicators selected were 1- to 5-year survival, overall disease-free survival, 1- to 5-year disease-free survival, complete surgical resection, duration of surgery, length of stay, overall morbimortality, major morbidity, re-intervention, postoperative hemorrhage, intestinal fistula, anastomotic leakage, wound infection, postoperative medical complications, overall recurrence, and failure to rescue. RESULTS The most relevant quality indicators and critical quality limits were overall disease-free survival and 5-year overall disease-free survival (14 months and <10 months, and 14% and <4%, respectively), completeness of surgical resection (89% and <80%, respectively), overall mortality (3% and >8%, respectively), overall morbidity (47% and >63%, respectively), failure to rescue (12% and <30%, respectively), reintervention (13 and <22%, respectively), anastomotic leakage (6% and <13%, respectively), and overall recurrence (60% and <74%, respectively). CONCLUSION This is the first study to assess quality standards in CRS + HIPEC for colorectal peritoneal metastases. The current data are of particular relevance for future studies to control the variability of this surgery.
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Affiliation(s)
| | | | - Luis Sabater Ortí
- Hospital Clínico Universitario, Department of Surgery, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
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Wu Q, Gu C, Wang Z. Comment on: Repeat Cytoreductive Surgery and Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Recurrences Is Safe and Efficacious. Ann Surg Oncol 2021; 28:813-814. [PMID: 33861404 DOI: 10.1245/s10434-021-09930-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.,State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Ryu JH, Koo CH. Anesthetic concerns during cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Korean J Anesthesiol 2021; 74:89-90. [PMID: 33743578 PMCID: PMC8024208 DOI: 10.4097/kja.21099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Trilling B, Brind'Amour A, Hamad R, Tremblay JF, Dubé P, Mitchell A, Sidéris L. Two-step cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei with high peritoneal carcinomatosis index. World J Surg Oncol 2021; 19:60. [PMID: 33622339 PMCID: PMC7903627 DOI: 10.1186/s12957-021-02171-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Complete cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the only curative treatment for pseudomyxoma peritonei (PMP) arising from the appendix. High peritoneal carcinomatosis index (PCI) is associated with an increased risk of surgical complications. The objective of this study was to present the results of a planned two-step surgical strategy to decrease postoperative morbidity and improve resectability of patients with very high PCI. METHODS All consecutive patients who underwent a planned two-step surgical approach for PMP between January 2012 and March 2020 were retrospectively included. This approach was offered for patients with low-grade PMP with PCI > 28 for which feasibility of a complete CRS in one operation was uncertain. The first surgery included a complete CRS of the inframesocolic compartment and omentectomy. HIPEC was delivered at the second surgery, after complete CRS of the supramesocolic compartment. Postoperative morbidity was assessed using the Clavien-Dindo classification and survival results were also collected. RESULTS Eight patients underwent the two-step approach. The median PCI was 33 (29-39) and the median time between the two procedures was 111 days (90-212 days). One patient was deemed unresectable at the second surgery. The rate of major morbidity was 0% for the first step and 25% for the second step, with no mortality. Median follow-up was 53.8 months (3-73 months). CONCLUSION A two-step surgical management for low-grade PMP patients with very high PCI is safe and feasible, with acceptable postoperative morbidity and no compromise on oncological outcomes.
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Affiliation(s)
- Bertrand Trilling
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Alexandre Brind'Amour
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Raphael Hamad
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Jean-Francois Tremblay
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Andrew Mitchell
- Department of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada
| | - Lucas Sidéris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada.
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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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Brind'Amour A, Dubé P, Tremblay JF, Soucisse ML, Mack L, Bouchard-Fortier A, McCart JA, Govindarajan A, Bischof D, Haase E, Giacomantonio C, Hebbard P, Younan R, MacNeill A, Boulanger-Gobeil C, Sidéris L. Canadian guidelines on the management of colorectal peritoneal metastases. Curr Oncol 2020; 27:e621-e631. [PMID: 33380878 PMCID: PMC7755452 DOI: 10.3747/co.27.6919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Modern management of colorectal cancer (crc) with peritoneal metastasis (pm) is based on a combination of cytoreductive surgery (crs), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (hipec). Although the role of hipec has recently been questioned with respect to results from the prodige 7 trial, the role and benefit of a complete crs were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, crc with pm is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with pm from crc should be referred to, or discussed with, a pm surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of pm from crc and to reflect on the new practice standards set by recent publications on the topic.
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Affiliation(s)
- A Brind'Amour
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, chu de Québec-Université Laval, Quebec City
| | - P Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - J F Tremblay
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - M L Soucisse
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - L Mack
- Department of Surgery, University of Calgary, Calgary, AB
| | | | - J A McCart
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - A Govindarajan
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - D Bischof
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - E Haase
- Department of Surgery, University of Alberta, Edmonton, AB
| | | | - P Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, MB
| | - R Younan
- Department of Surgery, University of Montreal, Montreal, QC
- Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - A MacNeill
- Department of Surgery, University of British Columbia, Vancouver, BC
| | | | - L Sidéris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
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14
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Survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A systematic review and discussion of latest controversies. Surgeon 2020; 19:310-320. [PMID: 33023847 DOI: 10.1016/j.surge.2020.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Peritoneal metastases confer the worst survival amongst all sites of metastatic colorectal cancer. The adoption of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has become an option for patients with isolated colorectal peritoneal metastases (CRPM). The aim of this study was to evaluate the outcomes following CRS and HIPEC for CRPM from published high volume cohort studies and to highlight the latest controversies and future directions of CRPM treatment. MATERIALS AND METHODS A systematic review was performed on published studies on the treatment outcomes of CRS and HIPEC for colorectal peritoneal metastases. RESULTS Twenty studies met the inclusion criteria for the systematic review. The median survival for all patients ranged from 14.6 to 60.1 months. The 5-year overall survival ranged from 23.4% to 52%. For patients with complete cytoreduction, the median survival was 25 to 49 months. Major morbidity and mortality ranged from 15.1% to 47.2% and 0% to 4.5%, respectively. CONCLUSION CRS and HIPEC for the treatment of CRPM is safe and current evidence suggests it improves both median and disease-free survival. However, the efficacy of intraperitoneal chemotherapy, in particular oxaliplatin, has recently come under scrutiny. Accordingly, higher quality evidence is urgently required to contribute to multidisciplinary and international consensus on CRPM treatment strategies.
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McBride KE, Steffens D, Solomon MJ, Koh C, Ansari N, Young CJ, Moran B. Cost-analysis of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal malignancy: An Australian perspective with global application. Eur J Surg Oncol 2020; 47:828-833. [PMID: 32972815 DOI: 10.1016/j.ejso.2020.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/13/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cost-effective cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of patients with peritoneal malignancy remains an ongoing financial challenge for healthcare systems, hospitals and patients. This study aims to describe the detailed in-hospital costs of CRS and HIPEC compared with an Australian Activity Based Funding (ABF) system, and to evaluate how the learning curve, disease entities and surgical outcomes influence in-hospital costs. METHODS A retrospective descriptive costing review of all CRS and HIPEC cases undertaken at a large public tertiary referral hospital in Sydney, Australia from April 2017 to June 2019. In-hospital cost variables included staff, critical care, diagnosis, operating theatre, and other costs. Univariate and multivariate analyses were conducted to investigate the differences between actual cost and the provision of funding, and potential factors associated with these costs. RESULTS Of the 118 CRS and HIPEC procedures included in the analyses, the median total cost was AU$130,804 (IQR: 105,744 to 153,972). Provision of funding via the ABF system was approximately one-third of the total CRS and HIPEC costs (p < 0.001). Surgical staff proficiency seems to reduce the total CRS and HIPEC costs. Surgical time, length of intensive care unit and hospital stay are the main predictors of total CRS and HIPEC costs. CONCLUSION Delivery of CRS and HIPEC is expensive with high variability. A standard ABF system grossly underestimates the specific CRS and HIPEC funding required with supplementation essential to sustaining this complex highly specialised service.
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Affiliation(s)
- Kate E McBride
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Solomon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Cherry Koh
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nabila Ansari
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher J Young
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Brendan Moran
- Peritoneal Malignancy Institute, Basingstoke, Basingstoke, United Kingdom
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Zajonz TS, Padberg W, Mann STW, Gehron J, Sander M, Mann V. Anesthetic Management During Pediatric Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Cisplatin in a Small Child: A Case Report and Systematic Literature Review. A A Pract 2020; 14:1-5. [PMID: 31651415 DOI: 10.1213/xaa.0000000000001122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) present a challenging task for anesthesia providers. Anesthesia management may be complicated by hyperthermia, fluid shifts, and distinct inflammatory response. Only a few reports dealing with the anesthesia management of pediatric CS and HIPEC have been published. We report a case of a 2-year-old child with a relapse of an alveolar rhabdomyosarcoma of the uterus and peritoneal carcinomatosis treated with CS and HIPEC. For children, careful temperature measurement, intraoperative prevention of hyperthermia, and sufficient volume management are important, as well as postoperative pediatric intensive care with experience CS and HIPEC patients.
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Affiliation(s)
- Thomas S Zajonz
- From the Department of Anesthesiology, Intensive Care and Pain Medicine
| | - Winfried Padberg
- Department of General, Visceral, Thoracic and Transplant Surgery, Justus Liebig University of Giessen, Giessen, Germany
| | - Sacha T W Mann
- Department of Orthopedic Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Johannes Gehron
- Department of Cardiovascular Surgery, Justus Liebig University of Giessen, Giessen, Germany
| | - Michael Sander
- From the Department of Anesthesiology, Intensive Care and Pain Medicine
| | - Valesco Mann
- From the Department of Anesthesiology, Intensive Care and Pain Medicine
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17
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Soucisse ML, Flood M, Sideris L, Dubé P, Heriot A. Letter comments on 'Indications for hyperthermic intraperitoneal chemotherapy (Hipec) with cytoreductive surgery: a systematic review'. Eur J Cancer 2020; 139:190-191. [PMID: 32811687 DOI: 10.1016/j.ejca.2020.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mikael L Soucisse
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada.
| | - Micheal Flood
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Lucas Sideris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
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18
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Auer RC, Sivajohanathan D, Biagi J, Conner J, Kennedy E, May T. Indications for hyperthermic intraperitoneal chemotherapy with cytoreductive surgery: a clinical practice guideline. ACTA ACUST UNITED AC 2020; 27:146-154. [PMID: 32669924 DOI: 10.3747/co.27.6033] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective The purpose of the present review was to provide evidence-based guidance about the provision of cytoreductive surgery (crs) with hyperthermic intraperitoneal chemotherapy (hipec) in the treatment of peritoneal cancers. Methods The guideline was developed by the Program in Evidence-Based Care together with the Surgical Oncology Program at Ontario Health (Cancer Care Ontario) through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews. Results Recommendation 1a: For patients with newly diagnosed stage iii primary epithelial ovarian or fallopian tube carcinoma, or primary peritoneal carcinoma, hipec should be considered for those with at least stable disease after neoadjuvant chemotherapy at the time that interval crs (if complete) or optimal cytoreduction is achieved. Recommendation 1b: There is insufficient evidence to recommend the addition of hipec when primary crs is performed for patients with newly diagnosed advanced primary epithelial ovarian or fallopian tube carcinoma, or primary peritoneal carcinoma, outside of a clinical trial. Recommendation 2: There is insufficient evidence to recommend hipec with crs in patients with recurrent ovarian cancer outside the context of a clinical trial. Recommendation 3: There is insufficient evidence to recommend hipec with crs in patients with peritoneal colorectal carcinomatosis outside the context of a clinical trial. Recommendation 4: There is insufficient evidence to recommend hipec with crs for the prevention of peritoneal carcinomatosis in colorectal cancer outside the context of a clinical trial; however, hipec using oxaliplatin is not recommended. Recommendation 5: There is insufficient evidence to recommend hipec with crs for the treatment of gastric peritoneal carcinomatosis outside the context of a clinical trial. Recommendation 6: There is insufficient evidence to recommend hipec with crs for the prevention of gastric peritoneal carcinomatosis outside the context of a clinical trial. Recommendation 7: There is insufficient evidence to recommend hipec with crs as a standard of care in patients with malignant peritoneal mesothelioma; however, patients should be referred to hipec specialty centres for assessment for treatment as part of an ongoing research protocol. Recommendation 8: There is insufficient evidence to recommend hipec with crs as a standard of care in patients with disseminated mucinous neoplasm in the appendix; however, patients should be referred to hipec specialty centres for assessment for treatment as part of an ongoing research protocol.
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Affiliation(s)
- R C Auer
- Departments of Surgery and of Biochemistry, Microbiology and Immunology, The Ottawa Hospital Research Institute, Ottawa, ON
| | - D Sivajohanathan
- Department of Oncology, McMaster University, and Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Hamilton, ON
| | - J Biagi
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON
| | - J Conner
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON
| | - E Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON
| | - T May
- Department of Oncology, University Health Network, Princess Margaret Hospital, Toronto, ON
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19
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Knapp GC, Mack LA. The challenge of creating evidence-based clinical practice guidelines for the use of hyperthermic intraperitoneal chemotherapy in the management of peritoneal malignancies. Curr Oncol 2020; 27:125-126. [PMID: 32669920 PMCID: PMC7339849 DOI: 10.3747/co.27.6679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The management of primary and secondary malignancies of the peritoneum continues to pose a challenge to modern, multidisciplinary cancer care.[...]
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Affiliation(s)
- G C Knapp
- University of Calgary, Division of Surgical Oncology, Calgary, AB
| | - L A Mack
- University of Calgary, Division of Surgical Oncology, Calgary, AB
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20
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Alyami M, Sgarbura O, Khomyakov V, Horvath P, Vizzielli G, So J, Torrent J, Delgadillo X, Martin D, Ceelen W, Reymond M, Pocard M, Hübner M. Standardizing training for Pressurized Intraperitoneal Aerosol Chemotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:2270-2275. [PMID: 32561205 DOI: 10.1016/j.ejso.2020.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND PIPAC is a novel mode of intraperitoneal drug delivery for patients with peritoneal cancer (PC). PIPAC is a safe treatment with promising oncological results. Therefore, a structured training program is needed to maintain high standards and to guarantee safe implementation. METHODS An international panel of PIPAC experts created by means of a consensus meeting a structured 2-day training course including essential theoretical content and practical exercises. For every module, learning objectives were defined and structured presentations were elaborated. This structured PIPAC training program was then tested in five courses. RESULTS The panel consisted of 12 experts from 11 different centres totalling a cumulative experience of 23 PIPAC courses and 1880 PIPAC procedures. The final program was approved by all members of the panel and includes 12 theoretical units (45 min each) and 6 practical units including dry-lab and live surgeries. The panel finalized and approved 21 structured presentations including the latest evidence on PIPAC and covering all mandatory topics. These were organized in 8 modules with clear learning objectives to be tested by 12 multiple-choice questions. Lastly, a structured quantifiable (Likert scale 1-5) course evaluation was created. The new course was successfully tested in five courses with 85 participants. Mean overall satisfaction with the content was rated at 4.79 (±0.5) with at 4.71 (±0.5) and at 4.61 (±0.7), respectively for course length and the balance between theory and practice. CONCLUSIONS The proposed PIPAC training program contains essential theoretical background and practical training enabling the participants to safely implement PIPAC.
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Affiliation(s)
- Mohammad Alyami
- Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran, Saudi Arabia.
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute in Montpellier, France
| | - Vladimir Khomyakov
- Moscow Research Oncological Institute n.a. P.A. Herzen, Thoracoabdominal, Moscow, Russian Federation
| | | | | | - Jimmy So
- National University Hospital, Singapore
| | - Juan Torrent
- QTI Comprehensive Cancer Center, Barcelona, Spain
| | | | - David Martin
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Switzerland
| | | | | | - Marc Pocard
- Université de Paris, UMR 1275 CAP Paris-Tech, F-75010, Paris, France; Service de Chirurgie Digestive et Cancérologie Hôpital Lariboisière, 2 rue Ambroise Paré, F-75010, Paris, France
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Switzerland
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21
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Jost E, Mack LA, Sideris L, Dube P, Temple W, Bouchard-Fortier A. Evaluation of repeat cytoreductive surgery and heated intraperitoneal chemotherapy for patients with recurrent peritoneal carcinomatosis from appendiceal and colorectal cancers: a multicentre Canadian study. Can J Surg 2020; 63:E71-E79. [PMID: 32080999 DOI: 10.1503/cjs.002519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Peritoneal recurrences after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for appendiceal and colorectal cancers are frequent. This study aimed to evaluate the safety, technical feasibility and perioperative and long-term outcomes of repeat CRS/HIPEC in patients with recurrent peritoneal carcinomatosis of colorectal and appendiceal origin. Methods Data were collected from patients treated from 2000 to 2016 for recurrent peritoneal carcinomatosis from appendiceal or colorectal cancer with CRS/HIPEC at 2 specialist centres. Data on demographics, procedure details, morbidity and survival were recorded. Analyses compared the iterations of CRS/HIPEC to assess the safety and effectiveness of repeat surgery. Results Of all patients who underwent CRS/HIPEC in the 2 centres, 37 patients underwent a repeat procedure. Operative time was similar for the first and second surgeries (412.1 v. 412.5 min, p = 0.74) but patients had a significantly lower peritoneal carcinoma index score with the second surgery (21.8 in the first iteration v. 9.53 in the second iteration, p < 0.001) and significantly less blood loss (1762 mL in the first iteration v. 790 mL in the second iteration, p = 0.001). There was a nonsignificant decrease in grade III–IV complications and there was no 30-day mortality associated with repeat procedures. For patients with colorectal cancer, median disease-free survival was 9.6 months and median overall survival was 40 months. For patients with appendiceal cancer, median disease-free survival was 15 months and overall survival was 64.4 months. Conclusion Repeat CRS/HIPEC procedures for recurrent appendiceal and colorectal peritoneal carcinomatosis are safe in well-selected patients, without increased morbidity or mortality, and they are associated with significant long-term survival, particularly for patients with appendiceal cancers. These results support the use of repeat CRS/HIPEC in these patients.
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Affiliation(s)
- Evan Jost
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Lloyd A. Mack
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Lucas Sideris
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Pierre Dube
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Walley Temple
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Antoine Bouchard-Fortier
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
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22
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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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23
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Solanki SL, Mukherjee S, Agarwal V, Thota RS, Balakrishnan K, Shah SB, Desai N, Garg R, Ambulkar RP, Bhorkar NM, Patro V, Sinukumar S, Venketeswaran MV, Joshi MP, Chikkalingegowda RH, Gottumukkala V, Owusu-Agyemang P, Saklani AP, Mehta SS, Seshadri RA, Bell JC, Bhatnagar S, Divatia JV. Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Indian J Anaesth 2019; 63:972-987. [PMID: 31879421 PMCID: PMC6921319 DOI: 10.4103/ija.ija_765_19] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/28/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023] Open
Abstract
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for primary peritoneal malignancies or peritoneal spread of malignant neoplasm is being done at many centres worldwide. Perioperative management is challenging with varied haemodynamic and temperature instabilities, and the literature is scarce in many aspects of its perioperative management. There is a need to have coalition of the existing evidence and experts' consensus opinion for better perioperative management. The purpose of this consensus practice guideline is to provide consensus for best practice pattern based on the best available evidence by the expert committee of the Society of Onco-Anaesthesia and Perioperative Care comprising perioperative physicians for better perioperative management of patients of CRS-HIPEC.
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Affiliation(s)
- Sohan Lal Solanki
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Address for correspondence: Dr. Sohan Lal Solanki, Department of Anaesthesiology, Critical Care and Pain, 2nd Floor, Main Building, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra, India. E-mail:
| | - Sudipta Mukherjee
- Department of Anaesthesiology, Critical Care Medicine and Pain, Tata Medical Center, Kolkata, West Bengal, India
| | - Vandana Agarwal
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Raghu S Thota
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kalpana Balakrishnan
- Department of Anaesthesia, Pain and Palliative Care, Cancer Institute, Chennai, Tamil Nadu, India
| | - Shagun Bhatia Shah
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Neha Desai
- Department of Anaesthesiology, Critical Care Medicine and Pain, Tata Medical Center, Kolkata, West Bengal, India
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Reshma P Ambulkar
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Viplab Patro
- Department of Anaesthesiology, Critical Care Medicine and Pain, Tata Medical Center, Kolkata, West Bengal, India
| | - Snita Sinukumar
- Surgical Oncology, Jehangir Hospital, Pune, Maharashtra, India
| | | | - Malini P Joshi
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pascal Owusu-Agyemang
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Avanish P Saklani
- Gastro-Intestinal Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sanket Sharad Mehta
- Department of Surgical Oncology, Saifee Hospital, Mumbai, Maharashtra, India
| | | | - John C Bell
- Anaesthetics and Intensive Care Medicine, Peritoneal Malignancy Institute, Hampshire Hospitals NHS FT, Basingstoke, United Kingdom
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Siddiqui J, Brown K, Zahid A, Young CJ. Current practices and barriers to referral for cytoreductive surgery and HIPEC among colorectal surgeons: A binational survey. Eur J Surg Oncol 2019; 46:166-172. [PMID: 31542240 DOI: 10.1016/j.ejso.2019.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/31/2019] [Accepted: 09/11/2019] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained traction for the management of peritoneal metastases. The number of specialist units globally offering CRS/HIPEC is increasing. The aim of this survey was to assess current practices and barriers to referral for CRS/HIPEC among colorectal surgeons in Australia and New Zealand (ANZ). MATERIALS AND METHODS An online questionnaire was emailed to members of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). The survey contained 3 sections: namely; demographics, referral patterns and clinical scenarios. Questions on referral patterns included number of peritoneal metastases patients seen per year and referred to a CRS/HIPEC unit, awareness of such a unit and distance from principle place of practice. Different pathologies referred were also explored, as well as investigations performed. Barriers to referral were also surveyed. RESULTS The response rate was 28% (83/296). Twenty-five percent received CRS training. Most surgeons (95%) were aware of a CRS/HIPEC unit and had referred to one previously. Thirty-nine percent would refer all patients. Provision of good service and/or relationship with CRS/HIPEC specialist were the main reasons for referring to the nearest unit, followed by accessibility. Major factors preventing referral included extent of peritoneal disease (48%), patient characteristics and comorbidities (44%) and lack of evidence (20%). The most common pathologies referred included colorectal and appendiceal peritoneal metastases and pseudomyxoma peritonei. CONCLUSION Colorectal specialist awareness of CRS/HIPEC units and accessibility is high. Strategies to improve referring physician/surgeon knowledge on patient selection and indications for CRS/HIPEC should be investigated and instituted to ensure all appropriate patients are referred to specialist units for discussion of suitability.
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Affiliation(s)
- Javariah Siddiqui
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kilian Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Christopher John Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
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Perumal V, Sivakumar PM, Zarrabi A, Muthupandian S, Vijayaraghavalu S, Sahoo K, Das A, Das S, Payyappilly SS, Das S. Near infra-red polymeric nanoparticle based optical imaging in Cancer diagnosis. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2019; 199:111630. [PMID: 31610429 DOI: 10.1016/j.jphotobiol.2019.111630] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/26/2019] [Accepted: 09/11/2019] [Indexed: 01/12/2023]
Abstract
Cancer disease is a foremost health concern and top basis of death in comparison with many diseases including cardiovascular disorders. During initial diagnosis (usually late diagnosis), a majority of cancer patients suffer from metastatic and advanced cancer stages which resulted in limited therapeutic modalities based interventions and effectiveness. Though considerable advancement has been made in combating the disease, continuous and intense efforts are ongoing for early diagnosis and development of therapies. Generally applied treatment options for cancer are surgery, chemotherapy and radiotherapy, which are restricted by failure to early diagnose, insufficient on-targeted drug delivery, systemic toxicity, and lack of real-time monitoring of therapeutic responses in cancer. Noninvasive imaging or minimally invasive imaging methodology is valuable in clinical diagnostic settings. Specifically, noninvasive optical imaging integrated with polymeric nanomaterial have been extensively investigated in the field of cancer diagnostics and therapy. Currently, optical imaging methods go together with polymer-based fluorescent nanoparticles in accomplishing the molecular level detection of tumor boundaries. NIR probe tagged polymeric nanoparticles have potential to provide an advantage in the early cancer detection, therapeutic monitoring and image guided surgery procedures. This article review the recent progress in state-of-the-art NIRF polymeric nanoparticles used for optical imaging particularly on cancer diagnosis.
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Affiliation(s)
- Venkatesan Perumal
- Rangel College of Pharmacy, Health Science Centre, Texas A&M University, TX, USA; Department of Biotechnology, IIT Kharagpur, west Bengal, India; College of Liberal Arts & Sciences, University of Colorado, Denver, CO 80204, USA.
| | | | - Ali Zarrabi
- Sabanci University Nanotechnology Research and Application Center (SUNUM), Tuzla 34956, Istanbul, Turkey
| | - Saravanan Muthupandian
- Department of Microbiology and Immunology, Division of Biomedical Sciences, School of Medicine, College of Health Sciences, Mekelle University, Mekelle 1871, Ethiopia
| | - Sivakumar Vijayaraghavalu
- Central Research Facility, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu 600116; Department of Biomedical Engineering, Cancer Nanomedicine Program, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Amlan Das
- Entomology Laboratory, Department of Zoology, University of Calcutta, 35 Ballygunj Circular Road, Kolkata, India
| | - Soumen Das
- Aviana Molecular Technologies, LLC, 3251 Progress Drive, Orlando, FL 32826, USA
| | - Sanal Sebastian Payyappilly
- International and Inter University Center for Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam, Kerala, India
| | - Subhasish Das
- Department of Biotechnology, IIT Kharagpur, west Bengal, India
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Barbato G, Tarantini A, Serra F, Cabry F, Farinetti A, Sorrentino L, Mattioli AV, Gelmini R. A novel surgical approach with peritonectomy to extranodal multisystemic histiocytic sarcoma: A case report and literature review. Int J Surg Case Rep 2019; 59:213-216. [PMID: 31181390 PMCID: PMC6556823 DOI: 10.1016/j.ijscr.2019.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/22/2019] [Accepted: 05/12/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Histiocytic sarcoma (HS) is a very rare malignant histiocytic derivation cancer. The extranodal multisystemic HS has an aggressive clinical course and poor Disease-Free Survival (DFS) and Overall Survival (OS). There are no shared and effective therapeutic protocols; our approach aims to improve the prognosis for advanced diseases. PRESENTATION OF THE CASE 53-year-old female patient admitted to hospital for intestinal obstruction in April 2016 with evidence of an ileal mass in the right iliac fossa and peritoneal metastases, undergoing urgent surgery of ileal resection, ileostomy and nodular peritoneal mass biopsy. Histological examination diagnosed HS. Staging exams excluded the involvement of other gastro-intestinal districts in the absence of concomitant lymphoproliferative disorders, and PET-CT revealed multiple abdominal and mediastinal nodes hyperplasia. The patient performed chemotherapy and, seeing the partial abdominal extranodal response, was performed cytoreductive surgery (CRS). Histological examination confirmed the diagnosis of HS with multiple peritoneal, ileal, colic and omental localisation. Adjuvant second-line chemotherapy treatment (4 DHAP cycles) was performed. Disease Free Survival at ten months from cytoreductive surgery, Overall Survival at 21 months from diagnosis. DISCUSSION Despite a multimodal therapy with surgery and chemotherapy, extranodal multisystemic HS has a poor prognosis. Up to now the role of surgery is limited to biopsies or complications treatment. Our results of DFS and OS show that cytoreductive surgery may be a valid therapeutic choice. CONCLUSION The surgical approach with major cytoreductive purposes could improve the prognosis in cases with prevalent abdominal extranodal localisation.
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Affiliation(s)
- Giuseppe Barbato
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy.
| | - Alessandro Tarantini
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy.
| | - Francesco Serra
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy.
| | - Francesca Cabry
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy.
| | - Alberto Farinetti
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy.
| | - Lorena Sorrentino
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy.
| | - Anna Vittoria Mattioli
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy.
| | - Roberta Gelmini
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy.
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Burnett A, Lecompte MEA, Trabulsi N, Dubé P, Gervais MK, Trilling B, Cloutier AS, Sideris L. Peritoneal carcinomatosis index predicts survival in colorectal patients undergoing HIPEC using oxaliplatin: a retrospective single-arm cohort study. World J Surg Oncol 2019; 17:83. [PMID: 31092250 PMCID: PMC6521370 DOI: 10.1186/s12957-019-1618-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract Background Peritoneal carcinomatosis (PC) from colorectal cancer is associated with poor prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for patients with colorectal peritoneal carcinomatosis. However, standardization of HIPEC protocols, including which chemotherapeutic agent to use, is lacking in the literature. Therefore, we sought to report survival outcomes from colorectal cancer patients undergoing CRS/oxaliplatin-based HIPEC at our institution over the last 10 years. Methods Colorectal PC patients treated with CRS/oxaliplatin-based HIPEC 2004–2015 were included. Demographic, clinical, and oncologic data were abstracted from the medical record. Overall (OS) and disease-free survival (DFS) were calculated using Kaplan–Meier analysis. Univariate/multivariate Cox regression analysis was done. Results Laparotomy was performed in 113 patients for colorectal PC; 91 completed a curative intent CRS/HIPEC. At 3 and 5 years, OS for the CRS/HIPEC cohort was 75% and 55%, and DFS was 50% and 25%, respectively. On multivariate analysis, incremental increases in peritoneal carcinomatosis index (PCI) were associated with worse OS (p = 0.0001) and DFS (p = 0.0001). Grade III/IV complications were also associated with worse OS. Conclusions A standardized regimen of CRS and oxaliplatin-based HIPEC for colorectal PC is effective with favorable OS and DFS and acceptable complication rates.
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Affiliation(s)
| | - Marie-Eve Aubé Lecompte
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Nora Trabulsi
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Pierre Dubé
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mai-Kim Gervais
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Bertrand Trilling
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Alexis-Simon Cloutier
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Lucas Sideris
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
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Narasimhan V, Pham T, Warrier S, Craig Lynch A, Michael M, Tie J, Ramsay R, Heriot A. Outcomes from cytoreduction and hyperthermic intraperitoneal chemotherapy for appendiceal epithelial neoplasms. ANZ J Surg 2019; 89:1035-1040. [PMID: 30685879 DOI: 10.1111/ans.14985] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Appendiceal epithelial neoplasms are rare cancers. Management of peritoneal disease from appendiceal neoplasms has historically been with debulking surgery. In recent decades, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard of care. Here, we report our single institution 10-year experience with CRS and HIPEC for appendiceal neoplasms. METHODS This is a retrospective review from 1 January 2008 to 1 June 2017 of all patients undergoing CRS and HIPEC for appendiceal neoplasms. Institutional ethics approval was granted for this project. RESULTS One hundred and seventy-two patients underwent 208 CRSs during this time. Overall, 83.72% of patients had one CRS and HIPEC procedure. Pseudomyxoma peritonei from a perforated appendiceal mucinous neoplasm accounted for 67.9% of cases. The median peritoneal carcinomatosis index (PCI) was 14, with complete cytoreduction achieved in 74.2% of patients. Fifty-four percent of patients had at least one complication, with one (0.5%) peri-operative mortality in our cohort. For the entire cohort, the median overall survival was 104 months and a 5-year survival of 75%. In those having a complete cytoreduction, 5-year survival was 90%, with a median disease free interval of 63 months. PCI and completeness of cytoreduction were independent predictors of overall survival. CONCLUSION Our results demonstrate that CRS and HIPEC for appendiceal neoplasms are safe and effective. Despite carrying some morbidity, it offers patients an excellent disease free and overall survival.
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Affiliation(s)
- Vignesh Narasimhan
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Toan Pham
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Satish Warrier
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Craig Lynch
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Michael
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Robert Ramsay
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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Sluiter NR, Tuynman JB. ASO Author Reflections: Toward Improved Selection of Patients for Cytoreduction and HIPEC: Identification of Prognostic Factors for Patients with Colorectal Peritoneal Metastases. Ann Surg Oncol 2018; 25:840-841. [PMID: 30302638 PMCID: PMC6329718 DOI: 10.1245/s10434-018-6842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Nina R Sluiter
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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31
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Jastrzębski T, Bębenek M. Peritoneal metastases of colorectal origin - cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The financial aspect. POLISH JOURNAL OF SURGERY 2018; 89:1-6. [PMID: 29335393 DOI: 10.5604/01.3001.0010.6733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The incidence of peritoneal carcinomatosis of colorectal cancer amounts to 5%-15% for synchronous metastases and as much as 40% in cases of local recurrence. Best results are obtained for cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment offers much better outcomes, leading to 5-year survival rates of as much as 30%-50%. The procedures require significant experience in abdominal surgery, are time-consuming (mean duration of the procedure ranging from 6 to 8 hours) and are burdened by complications that are due not only to the procedure itself but also to the intraperitoneal administration of the cytostatic drug at elevated temperature (41.5 °C). After the procedure, patients are required to be admitted to intensive care units due to potential complications associated with the extent and duration of the procedure as well as chemotherapy administered in hyperthermia. Postoperative management of these patients requires appropriate experience of the entire medical and nursing team. Cytoreductive surgeries combined with HIPEC as highly specialized medical procedures should be assessed for their potential long-term benefits and their costs should be appropriately calculated with consideration to realistic reimbursement rates. Realistic valuation and reimbursement covering the overall average cost of the procedure is recommended by the National Consultant in Surgical Oncology as well as the ESMO consensus guidelines.
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Affiliation(s)
| | - Marek Bębenek
- Department of Surgical Oncology, Lower Silesian Oncology Center, Wrocław
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Mas-Fuster MI, Ramon-Lopez A, Lacueva FJ, Arroyo A, Más-Serrano P, Nalda-Molina R. Population pharmacokinetics of oxaliplatin after intraperitoneal administration with hyperthermia in Wistar rats. Eur J Pharm Sci 2018; 119:22-30. [PMID: 29626594 DOI: 10.1016/j.ejps.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/20/2018] [Accepted: 04/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The evaluation of the efficacy and toxicity of hyperthermic intraoperative peritoneal chemotherapy presents some difficulties, due in part to the lack of information about the pharmacokinetic behavior of the drugs administered in this procedure. The aim of this study was to characterize the population pharmacokinetics of hyperthermic intraoperative peritoneal oxaliplatin in Wistar rats and to evaluate the effect of treatment-related covariates dose, instillation time and temperature on the pharmacokinetic parameters. METHODS Oxaliplatin peritoneal and plasma concentrations from 37 rats treated by either intravenous or intraperitoneal oxaliplatin administrations under different instillation times, temperatures and doses were analyzed according to a population pharmacokinetic approach using the software NONMEM V7.3®. RESULTS Intraperitoneal (n = 115) and plasma (n = 263) concentrations were successfully described according to a two-compartment model with first order absorption. No significant effect of dose, temperature and instillation time on pharmacokinetic parameters was found. However, an abrupt decrease in the elimination process was observed, reflected in the structural pharmacokinetic model through a modification in clearance. The typical parameters values and the interindividual variability (CV %) in clearance, central and peripheral volume of distribution were 3.25 mL/min (39.1%), 53.6 mL (37.8%) and 54.1 mL (77.3%), respectively. Clearance decreased to 0.151 mL/min (39.1%) when the instillation was still ongoing, at 31.4 min. One of the possible reasons behind the clearance decrease would be an alteration of renal function due to surgery and/or hyperthermia. CONCLUSIONS This study described the deterioration of the drug elimination process due to the procedure, and estimated the time at which this deterioration is most likely to occur. In addition, dose, instillation time and temperature had no influence in the PK parameters.
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Affiliation(s)
- M I Mas-Fuster
- Division of Pharmacy and Pharmaceutics, Department of Engineering, School of Pharmacy, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - A Ramon-Lopez
- Division of Pharmacy and Pharmaceutics, Department of Engineering, School of Pharmacy, Miguel Hernández University, San Juan de Alicante, Alicante, Spain; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.
| | - F J Lacueva
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
| | - A Arroyo
- Department of Pathology and Surgery, School of Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
| | - P Más-Serrano
- Division of Pharmacy and Pharmaceutics, Department of Engineering, School of Pharmacy, Miguel Hernández University, San Juan de Alicante, Alicante, Spain; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain; Clinical Pharmacokinetics Unit, Pharmacy Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - R Nalda-Molina
- Division of Pharmacy and Pharmaceutics, Department of Engineering, School of Pharmacy, Miguel Hernández University, San Juan de Alicante, Alicante, Spain; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.
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Sluiter NR, Rovers KP, Salhi Y, Vlek SL, Coupé VMH, Verheul HMW, Kazemier G, de Hingh IHJT, Tuynman JB. Metachronous Peritoneal Metastases After Adjuvant Chemotherapy are Associated with Poor Outcome After Cytoreduction and HIPEC. Ann Surg Oncol 2018; 25:2347-2356. [PMID: 29855834 PMCID: PMC6028868 DOI: 10.1245/s10434-018-6539-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) improve the survival of colorectal cancer (CRC) patients with peritoneal metastases. Patient selection is key since this treatment is associated with high morbidity. Patients with peritoneal recurrence within 1 year after previous adjuvant chemotherapy are thought to benefit less from HIPEC treatment; however, no published data are available to assist in clinical decision making. This study assessed whether peritoneal recurrence within 1 year after adjuvant chemotherapy was associated with survival after HIPEC treatment. METHODS Peritoneal recurrence within 1 year after adjuvant chemotherapy, as well as other potentially prognostic clinical and pathological variables, were tested in univariate and multivariate analysis for correlation with primary outcomes, i.e. overall survival (OS) and disease-free survival (DFS). Two prospectively collected databases from the VU University Medical Center Amsterdam and Catherina Hospital Eindhoven containing 345 CRC patients treated with the intent of HIPEC were utilized. RESULTS High Peritoneal Cancer Index (PCI) scores were associated with worse DFS [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00-1.08, p = 0.040] and OS (HR 1.11, 95% CI 1.07-1.15, p < 0.001) in multivariate analysis. Furthermore, patients with peritoneal recurrence within 1 year following adjuvant chemotherapy had worse DFS (HR 2.13, 95% CI 1.26-3.61, p = 0.005) and OS (HR 2.76, 95% CI 1.45-5.27, p = 0.002) than patients who did not receive adjuvant chemotherapy or patients with peritoneal recurrence after 1 year. CONCLUSION Peritoneal recurrence within 1 year after previous adjuvant chemotherapy, as well as high PCI scores, are associated with poor survival after cytoreduction and HIPEC. These factors should be considered in order to avoid high-morbidity treatment in patients who might not benefit from such treatment.
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Affiliation(s)
- Nina R Sluiter
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Koen P Rovers
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Youssra Salhi
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Stijn L Vlek
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Geert Kazemier
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jurriaan B Tuynman
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Adenocarcinoma of the Colon Disguised as Abdominal Wall Abscess: Case Report and Review of the Literature. Case Rep Surg 2018; 2018:1974627. [PMID: 29623229 PMCID: PMC5829352 DOI: 10.1155/2018/1974627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/01/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction Abdominal wall invasion by cancerous cells arising from the colon with an overlying secondary infection that presents as an abdominal wall abscess has been encountered previously, but such a symptom is rarely the first presentation of colon cancer. There are very few cases reported in the literature. Case Presentation In this case report, we present a case of a 66-year-old male presenting with abdominal wall abscess that was refractory to treatment. The patient later was found to have an abdominal wall invasion by an underlying colonic carcinoma. Conclusion The purpose of this review is to set forth the proper approach when encountering such cases and emphasize on the significance of keeping a high index of suspicion. We also highlight the need for utilizing proper diagnostic imaging modalities prior to invasive intervention.
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Wang W, Tan GHC, Skanthakumar T, Chia CS, Soo KC, Teo MCC. Exploring the trend in referrals for consideration of CRS and HIPEC to understand the attitudes of clinicians in the development of a national cancer centre programme in peritoneal disease. Int J Hyperthermia 2017; 34:551-558. [DOI: 10.1080/02656736.2017.1387939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Weining Wang
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | | | | | | | - Khee Chee Soo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
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Wu W, Yan S, Liao X, Xiao H, Fu Z, Chen L, Mou J, Yu H, Zhao L, Liu X. Curative versus palliative treatments for colorectal cancer with peritoneal carcinomatosis: a systematic review and meta-analysis. Oncotarget 2017; 8:113202-113212. [PMID: 29348899 PMCID: PMC5762584 DOI: 10.18632/oncotarget.21912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to provide an up-to-date summary of the current evidence that may be useful for updating guidelines. We comprehensively searched the published literatures and conferences for studies that compared curative with palliative treatments in colorectal cancer patients with peritoneal metastasis. The primary outcomes considered in this study were three- and five-year overall survival rates. We pooled data across studies and estimated summary effect sizes. Overall, patients who received curative treatments had improved three-year survival (hazard ratio (HR), 2.19 [95% CI, 1.83 to 2.62]) and five-year survival (HR, 2.22 [95% CI, 1.83 to 2.69]) compared with those who received palliative treatments. Patients who received curative treatments had an increased risk of treatment-related morbidity (odds ratio (OR), 2.90 [95% CI, 2.02 to 4.17]), but there was no significant difference in treatment-related mortality between patients who received curative treatments and those who received palliative treatments (OR, 1.46 [CI, 0.62 to 3.47]). Curative treatments improved overall survival in colorectal cancer patients with peritoneal metastasis and did not increase the risk of treatment-related mortality. Curative treatments were associated with a higher risk of treatment-related morbidity. These data highlight the importance for further investigation aimed at prevention of treatment-associated morbidity.
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Affiliation(s)
- Wenqiong Wu
- Department of Radiation Oncology, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Shipeng Yan
- Department of Cancer Prevention and Control, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Xianzhen Liao
- Department of Cancer Prevention and Control, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Haifang Xiao
- Department of Cancer Prevention and Control, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Zhongxi Fu
- Department of Chronic Diseases Prevention and Control, Centers for Disease Control and Prevention of Hunan, Changsha, Hunan Province, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Jinsong Mou
- Department of Epidemiology and Health Statistics, Changsha Medical University, Changsha, Hunan Province, China
| | - Haibo Yu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lian Zhao
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, Hunan Province, China
| | - Xiangguo Liu
- Department of Cancer Prevention and Control, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
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Lee L, Alie-Cusson F, Dubé P, Sideris L. Postoperative complications affect long-term outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. J Surg Oncol 2017; 116:236-243. [PMID: 28409831 DOI: 10.1002/jso.24632] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/09/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Morbidity after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) for colorectal peritoneal carcinomatosis (PC) may negatively affect survival. The objective was to determine the impact of postoperative complications (CX) on survival in patients undergoing CRS + HIPEC for colorectal PC. METHODS All patients undergoing laparotomy for planned CRS + HIPEC for colorectal PC at a single institution from 1999 to 2014 were included. Patients were divided into three groups: CRS + HIPEC without CX (+HIPEC-CX); CRS + HIPEC with postoperative complication (+HIPEC + CX); and aborted CRS and HIPEC due to unresectable disease (-HIPEC). Postoperative morbidity were defined as Clavien II+ complications. Kaplan-Meier survival analyses and multivariable Cox proportional hazard modeling were used to describe the disease-free (DFS) and overall survival (OS). RESULTS One hundred and twenty-two patients were included in the analysis (50 +HIPEC - CX, 40 +HIPEC + CX, 32-HIPEC). Overall complication rate was 42%. OS at 1-, 3-, and 5-years in patients undergoing successful CRS + HIPEC were 97%, 67%, and 45%. CX after successful CRS + HIPEC was independently associated with worsened OS (HR1.58, 95%CI, 1.19-1.97) but not DFS (HR1.11, 95%CI, 0.56-2.20). PCI also independently predicted worsened DFS (HR1.12, 95%CI, 1.06-1.18) and OS (HR1.08, 95%CI, 1.04-1.12). Patients with unresectable disease had significantly worse OS (HR6.50, 95%CI, 1.37-7.01). CONCLUSIONS CX after CRS + HIPEC significantly affect OS. Patient selection and perioperative care are of paramount importance in the management of CRS + HIPEC for colorectal PC.
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Affiliation(s)
- Lawrence Lee
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Fanny Alie-Cusson
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Lucas Sideris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
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Klaver CEL, Groenen H, Morton DG, Laurberg S, Bemelman WA, Tanis PJ. Recommendations and consensus on the treatment of peritoneal metastases of colorectal origin: a systematic review of national and international guidelines. Colorectal Dis 2017; 19:224-236. [PMID: 28008728 DOI: 10.1111/codi.13593] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/01/2016] [Indexed: 12/13/2022]
Abstract
AIM This systematic review aimed to provide an overview of (inter)national guidelines on the treatment of peritoneal metastases of colorectal cancer origin (PMCRC) and to determine the degree of consensus and available evidence with identification of topics for future research. METHOD A systematic search of MEDLINE, Embase, PubMed as well as Tripdatabase, National Guideline Clearinghouse, BMJ Best Practice and Guidelines International Network was performed to identify (inter)national guidelines and consensus statements from oncological or surgical societies on PMCRC. The quality of guidelines was assessed using the AGREE-II score. Topics followed by recommendations were extracted from the guidelines. The recommendations, highest level of supporting evidence and the degree of consensus were determined for each topic. RESULTS Twenty-one guidelines were included, in most (15) of which cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) was recommended in selected patients based on level 1b evidence. Substantial consensus was also reached on the benefit of multidisciplinary team discussion and the achievability of a (near) complete cytoreduction (CC0-1) without supporting evidence. Both evidence and consensus were lacking regarding other aspects including preoperative positron emission tomography/CT, second look surgery in high risk patients, the optimal patient selection for CRS/HIPEC, procedural aspects of HIPEC and (perioperative) systemic therapy. CONCLUSION In currently available guidelines, evidence and consensus on the treatment strategy for PMCRC are lacking. Updates of guidelines are ongoing and future (randomized) clinical trials should contribute to multidisciplinary and international consensus on treatment strategies for PMCRC.
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Affiliation(s)
- C E L Klaver
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H Groenen
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - D G Morton
- Academic Department of Surgery, University of Birmingham, Edgbaston, Birmingham, UK
| | - S Laurberg
- Department of Surgical Gastroenterology, Aarhus University, Aarhus C, Denmark
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Leung V, Huo YR, Liauw W, Morris DL. Oxaliplatin versus Mitomycin C for HIPEC in colorectal cancer peritoneal carcinomatosis. Eur J Surg Oncol 2016; 43:144-149. [PMID: 27780675 DOI: 10.1016/j.ejso.2016.09.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/17/2016] [Accepted: 09/21/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Compare long-term outcomes in colorectal cancer (CRC) patients with peritoneal carcinomatosis (PC) treated with peritonectomy/HIPEC using oxaliplatin versus MMC. BACKGROUND Peritonectomy and heated intraperitoneal chemotherapy (HIPEC) greatly improves patient survival in CRC PC. This procedure is not uniform across centres and the optimal choice of HIPEC chemotherapeutic is unclear. Oxaliplatin and Mitomycin C (MMC) are the most commonly used agents and comparative studies have reported varying results. METHOD 201 patients were retrospectively selected from the St George Hospital database, all of which had undergone peritonectomy/HIPEC for CRC PC. Oxaliplatin and MMC were used in 106 and 96 patients, respectively. Each patient's baseline characteristics, operative details, choice of chemotherapeutic agent and survival were noted. RESULTS The two groups did not differ significantly at baseline. Patients receiving oxaliplatin had significantly greater unadjusted median survival compared to MMC (56.0 ± 8.1 vs. 29.0 ± 3.4 months) which translated into a hazards ratio of 0.59 (95% CI 0.37-0.91, p = 0.017). Subgroup analysis further confirmed an advantage with oxaliplatin in females, moderate-well differentiated tumours, tumours without signet ring pathology and PCI 10-15. CONCLUSION Our study suggests oxaliplatin offers a survival advantage over MMC when used for HIPEC in CRC PC. Further studies to understand its efficacy, complications and ideal preparation are required. A Phase III randomised control trial comparing oxaliplatin and MMC would enhance decision-making.
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Affiliation(s)
- V Leung
- University of New South Wales, Kensington, Sydney, NSW, 2052, Australia.
| | - Y R Huo
- University of New South Wales, Kensington, Sydney, NSW, 2052, Australia.
| | - W Liauw
- Department of Surgery, St George Hospital, Gray St Kogarah, Sydney, NSW, 2217, Australia.
| | - D L Morris
- University of New South Wales, Kensington, Sydney, NSW, 2052, Australia; Department of Surgery, St George Hospital, Gray St Kogarah, Sydney, NSW, 2217, Australia.
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Ashvin R, Aditi B, Nikhilesh J. Preoperative Management of Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Indian J Surg Oncol 2016. [DOI: 10.1007/s13193-016-0517-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Vanounou T, Garfinkle R. Evaluation of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Origin in the Era of Value-Based Medicine. Ann Surg Oncol 2016; 23:2556-61. [PMID: 26957499 DOI: 10.1245/s10434-016-5096-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 11/18/2022]
Abstract
Peritoneal spread from colorectal cancer is second only to the liver as a site for metastasis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a well-established treatment option for patients with peritoneal carcinomatosis (PC) of colorectal origin. However, due to concerns regarding both its clinical benefit and high cost, its universal adoption as the standard of care for patients with limited peritoneal dissemination has been slow. The purpose of this review was to clarify the clinical utility and cost effectiveness of CRS-HIPEC in the treatment of colorectal PC using the framework of value-based medicine, which attempts to combine both benefit and cost into a single quantifiable metric. Our comprehensive review of the clinical outcomes and cost effectiveness of CRS-HIPEC demonstrate that it is a highly valuable oncologic therapy and a good use of healthcare resources.
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Affiliation(s)
- Tsafrir Vanounou
- Division of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
| | - Richard Garfinkle
- Division of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada.
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Bhatt A, Mehta S, Seshadri RA, Sethna K, Zaveri S, Rajan F, Mahajan V, Singh S, Raj EH, Sugarbaker PH. The Initial Indian Experience with Cytoreductive Surgery and HIPEC in the Treatment of Peritoneal Metastases. Indian J Surg Oncol 2016; 7:160-5. [PMID: 27065706 DOI: 10.1007/s13193-016-0500-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 01/28/2016] [Indexed: 12/24/2022] Open
Abstract
Worldwide, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been used for nearly 3 decades to treat peritoneal metastases (PM), improve quality of life, and prolong survival substantially in selected patients. In India, the use of the combined modality of treatment dates back a decade with majority of the efforts taking place within the last 5 years. The first PSOGI workshop (India) held in April 2015, at Bangalore, India offered an opportunity for Indian surgeons performing CRS and HIPEC to share their experience. To study the methodologies of CRS and HIPEC (hospital set up, equipment, training and surgical background) as well as the outcomes in terms of perioperative morbidity and mortality and short and long term survival of patients treated in India, Indian surgeons who had treated at least 10 patients with this combined modality were invited to present their experience. Data collection was retrospective. Analysis of the pooled data was carried out. Eight surgeons treated 384 patients with CRS and HIPEC over a period of 10 years. The commonest primary sites were ovary (as first line therapy n = 124), followed by appendix, including pseudomyxoma peritonei (n = 99), colorectum (n = 77), recurrent ovary (as second line therapy, n = 33), stomach (n = 15), primary peritoneal cancer (n = 10), peritoneal mesothelioma (n = 9) and rare tumors in 17 patients. The weighted mean PCI for all 384 patients was 18.25. 349/384 patients (90.88 %) had a complete cytoreduction (completeness of cytoreduction score of CC-0/1). Grade 3-5 complications developed in 108 patients (27.34 %) and 30 day mortality occurred in 28 (7.29 %) patients. This study showed that CRS and HIPEC can be performed with an acceptable morbidity and mortality in Indian patients. Most of the surgeons are on the learning curve and further improvement in these outcomes is expected over a period of time. Pooling of data related to both common and rare peritoneal cancers would be useful in knowing the disease behavior, response to treatment and outcomes in Indian patients. The 2015 PSOGI meeting provided a unique platform for data presentation with feedback from international experts in the field of peritoneal surface oncology. Future meetings are planned to expand the evaluation of Indian data and progress.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Fortis Hospital, 154/9 Bannerghatta road, Opposite IIM-Bangalore, Bangalore, -560076 India
| | - Sanket Mehta
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | | | - Kayomarz Sethna
- Department of General Sugery, Sion Hospital Mumbai, Mumbai, India
| | - Shabber Zaveri
- Department of Surgical Oncology, Manipal Hospital, Bangalore, India
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Centre, Coimbatore, India
| | - Vikas Mahajan
- Department of Surgical Oncology, Apollo Hospital, Chennai, India
| | - Shivendra Singh
- Department of GI Oncology, Rajiv Gandhi Cancer Centre, New Delhi, India
| | - E Hemanth Raj
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - Paul H Sugarbaker
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA
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