We reviewed outcomes following cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with appendiceal or colorectal neoplasms and evaluated key prognostic indicators for treatment.
Methods
All patients who underwent cytoreductive surgery/HIPEC for appendiceal and colorectal neoplasms were identified from an IRB-approved database. Patient demographics, operative reports, and postoperative outcomes were reviewed.
Results
110 patients [median age 54.5 (18-79) years, 55% male] were included. Primary tumor location was colorectal (58; 52.7%) and appendiceal (52; 47.3%). 28.2%, .9%, and 12.7% had right, left, and sigmoid tumors, respectively; 11.8% had rectal tumors. 12/13 rectal cancer patients underwent preoperative radiotherapy. Mean Peritoneal Cancer Index was 9.6 ± 7.7; complete cytoreduction was achieved in 90.9%. 53.6% developed postoperative complications. Reoperation, perioperative mortality, and 30-day readmission rates were 1.8%, .09%, and 13.6%, respectively. Recurrence at a median of 11.1 months was 48.2%; overall survival at 1 and 2 years was 84% and 56.8%, respectively; disease-free survival was 60.8% and 33.7%, respectively, at a median follow-up of 16.8 (0-86.8) months. Univariate analysis of preoperative chemotherapy, primary malignancy location, primary tumor perforated or obstructive, postoperative bleeding complication, and pathology of adenocarcinoma, mucinous adenocarcinoma and negative lymph nodes were identified as possible predictive factors of survival. Multivariate logistic regression analysis showed that preoperative chemotherapy (P < .001), perforated tumor (P = .003), and postoperative intra-abdominal bleeding (P < .001) were independent prognostic indicators for survival.
Conclusions
Cytoreductive surgery/HIPEC for colorectal and appendiceal neoplasms has low mortality and high completeness of cytoreduction score. Preoperative chemotherapy, primary tumor perforation, and postoperative bleeding are adverse risk factors for survival.
SugarbakerPHVan der SpeetenK. Surgical technology and pharmacology of hyperthermic perioperative chemotherapy. J Gastrointest Oncol. 2016;7(1):29-44.
2.
SugarbakerPH. Total pelvic exenterative surgery in patients with peritoneal metastases from appendiceal neoplasms. A case series of 2 patients. Int J Surg Case Rep. 2019;65:279-283.
3.
SprattJSAdcockRASherrillWMuskovinMMcKeownJ. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res. 1980;40(2):256-260.
4.
SugarbakerPH. Surgical treatment of peritoneal carcinomatosis: 1988 du pont lecture. Can J Surg. 1989;32(3):164-170.
5.
SamartzisKThomakosNLiontosMKolliaDMalakasisAHaidopoulosD, et al.Is it the right moment to include hyperthermic intraperitoneal chemotherapy as standard in ovarian cancer management? A reappraisal. J Buon. 2018;23(7):19-23.
6.
GoéréDPassotGGelliM, et al.Complete cytoreductive surgery plus HIPEC for peritoneal metastases from unusual cancer sites of origin: results from a worldwide analysis issue of the peritoneal surface oncology group international (PSOGI). Int J Hyperther. 2017;33(5):520-527.
7.
KoemansWJvan der KaaijRTBootH, et al.Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy versus palliative systemic chemotherapy in stomach cancer patients with peritoneal dissemination, the study protocol of a multicentre randomised controlled trial (PERISCOPE II). BMC Cancer. 2019;19(1):420.
8.
ConfuortoGGiulianoMEGrimaldiAVivianoC. Peritoneal carcinomatosis from colorectal cancer: HIPEC?Surg Oncol. 2007;16(3):149-152.
9.
ChuDZLangNPThompsonCOsteenPKWestbrookKC. Peritoneal carcinomatosis in non gynecologic malignancy. Cancer. 1989;63:364-367.
10.
SadeghiBArvieuxCGlehenO, et al.Peritoneal carcinomatosis from non-gynecologic malignancies: Results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88(2):358-363.
11.
Cortes-GuiralDEliasDCascales-CamposPA, et al.Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis: Does it really save lives?World J Gastroenterol. 2017;23(3):377-381.
12.
CaoCYanTDBlackDMorrisDL. A systematic review and meta-analysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2009;16(8):2152-2165.
13.
EliasDGoéréDDumontF, et al.Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases. Eur J Cancer. 2014;50(2):332-340.
14.
LosGMutsaersPHvan der VijghWJBaldewGSde GraafPWMcVieJG. Direct diffusion of cis-diamminedichloroplatinum(II) in intraperitoneal rat tumors after intraperitoneal chemotherapy: A comparison with systemic chemotherapy. Cancer Res. 1989;49(12):3380-3384.
15.
van de VaartPJvan der VangeNZoetmulderFA, et al.Intraperitoneal cisplatin with regional hyperthermia in advanced ovarian cancer: Pharmacokinetics and cisplatin-DNA adduct formation in patients and ovarian cancer cell lines. Eur J Cancer. 1998;34(1):148-154.
16.
EliasDDetrozBDebaeneB, et al.Treatment of peritoneal carcinomatosis by intraperitoneal chemo-hyperthermia: Reliable and unreliable concepts. Hepato-Gastroenterology. 1994;41(3):207-213.
17.
CiavaldiniA. Mise au point. Topique. 2006;96(3):159-160.
18.
SugarbakerPHChangDKosloweP. Prognostic features for peritoneal carcinomatosis in colorectal and appendiceal cancer patients when treated by cytoreductive surgery and intraperitoneal chemotherapy. Cancer Treat Res. 1996;81:89-104.
19.
GlehenOGillyFNBoutitieF, et al.Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: A multi-institutional study of 1,290 patients. Cancer. 2010;116(24):5608-5618.
20.
AzizOJaradatIChakrabartyB, et al.Predicting survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendix adenocarcinoma. Dis Colon Rectum. 2018;61(7):795-802.
21.
YanTDLinksMFransiSJacquesTBlackDSaundersV, et al.Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy--a journey to becoming a Nationally Funded Peritonectomy Center. Ann Surg Oncol. 2007;14(8):2270-2280.
22.
CotteEPassotGGillyFNGlehenO. Selection of patients and staging of peritoneal surface malignancies. World J Gastrointest Oncol. 2010;2(1):31-35.
23.
MuronoKKawaiKHataK, et al.Regimens of intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer. Anticancer Res. 2018;38(1):15-22.
24.
RamponeBSchiavoneBMartinoAConfuortoG. Current role of hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis from colorectal cancer. World J Gastroenterol. 2010;16(11):1299-1302.
25.
FrankoJShiQMeyersJP, et al.Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: An analysis of individual patient data from prospective randomised trials from the analysis and research in cancers of the digestive system (ARCAD) database. Lancet Oncol. 2016;17(12):1709-1719.
26.
BartlettEKMeiseCRosesREFrakerDLKelzRRKarakousisGC. Morbidity and mortality of cytoreduction with intraperitoneal chemotherapy: Outcomes from the ACS NSQIP database. Ann Surg Oncol. 2014;21(5):1494-1500.
27.
EsquivelJSticcaRSugarbakerP, et al.Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: A consensus statement.. Ann Surg Oncol. 2007;14(1):128-133.
28.
ChouliarasKLevineEAFinoNShenPVotanopoulosKI. Prognostic factors and significance of gastrointestinal leak after cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2017;24(4):890-897.
29.
YanTDBlackDSavadyRSugarbakerPH. Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol. 2006;24(24):4011-4019.
30.
FrankoJIbrahimZGusaniNJHoltzmanMPBartlettDLZehHJ. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer. 2010;116(16):3756-3762.
31.
VerwaalVJvan RuthSde BreeEvan SloothenGWvan TinterenHBootH, et al.Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21(20):3737-3743.
32.
Arjona-SanchezARufian-PeñaSSanchez-HidalgoJMCasado-AdamACosano-AlvarezABriceño-DelgadoJ. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (HIPEC) by minimally invasive approach, an initial experience. World J Surg. 2018;42(10):3120-3124.
33.
Moreno DjadouTPohKSYellinekSDaSilvaGWexnerSD. Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastrointestinal cancer : A case series and review of the literature. Am J Clin Oncol. 2021. in press.
34.
EliasDViganòLOrsiFScorsettiMComitoTLerutJ, et al.New perspectives in the treatment of colorectal metastases. Liver Cancer. 2016;6(1):90-98.
35.
EliasDGillyFBoutitieF, et al.Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: Retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28(1):63-68.
36.
ZanonCClaraRBortoliniM, et al.Chemohyperthermia for advanced abdominal malignancies: A new procedure with closed abdomen and previously performed anastomosis. Int J Hyperther. 2001;17(5):456-464.
37.
HamiltonTDTaylorELCannellAJMcCartJAGovindarajanA. Impact of major complications on patients’ quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23(9):2946-2952.
38.
LeeLAlie-CussonFDubéPSiderisL. Postoperative complications affect long-term outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. J Surg Oncol. 2017;116(2):236-243.
39.
CavaliereFDe SimoneMVirzìS, et al.Prognostic factors and oncologic outcome in 146 patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: Italian multicenter study S.I.T.I.L.O. Eur J Surg Oncol. 2011;37(2):148-154.
40.
SaxenaAYanTDMorrisDL. A critical evaluation of risk factors for complications after cytoreductive surgery and perioperative intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. World J Surg. 2010;34(1):70-78.
41.
BenizriEIBernardJLRahiliABenchimolDBerederJM. Small bowel involvement is a prognostic factor in colorectal carcinomatosis treated with complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. World J Surg Oncol. 2012;11;(10):56.
42.
SugarbakerPH. Peritonectomy procedures. Cancer Treat Res. 2007;134(1):247-264.
43.
SugarbakerPHLandyDJaffeGPascalR. Histologic changes induced by intraperitoneal chemotherapy with 5-fluorouracil and mitomycin C in patients with peritoneal carcinomatosis from cystadenocarcinoma of the colon or appendix. Cancer. 1990;65(7):1495-1501.
44.
da SilvaRGSugarbakerPH. Analysis of prognostic factors in seventy patients having a complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer. J Am Coll Surg. 2006;203(6):878-886.
