Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Outcomes in Peritoneal Carcinomatosis: 11-year Tertiary-center Experience

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2025 Mar 16

PMID 40089698

Authors

Burak Dincer

Ali Fuat Kaan Gok

Mehmet Ilhan

Leman Damla Ercan

Cemil Burak Kulle

Celal Caner Ercan

Neslihan Berker

Cemalettin Ertekin

Affiliations

Soon will be listed here.

Abstract

Background: Cytoreductive Surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are techniques developed for curative treatment of peritoneal carcinomatosis (PC). Studies have shown that CRS + HIPEC provides a survival advantage in PC, and long-term survival can be achieved in selected cases. This study aimed to evaluate CRS + HIPEC cases performed for curative purposes and to examine the prognostic factors.

Methods: PC patients who underwent CRS + HIPEC with curative intent between January 2011 and September 2022 were included. Demographic, clinical, and pathological findings, procedure-specific parameters, complications, mortality, progression-free survival (PFS), and overall survival (OS) were analyzed.

Results: Optimal cytoreduction was achieved in 70% of the patients. The median PFS for the entire series was 9.2 months, while the median OS was 20.5 months, with a 3-year OS rate of 36%. Appendiceal origin, cytoreduction score, absence of lymph node metastasis, and absence of complications were factors associated with a positive impact on both PFS and OS. In multivariate analysis, cytoreduction score emerged as the sole independent factor influencing both PFS and OS.

Conclusions: Considering the results in our series, cases of PC in which complete cytoreduction can be achieved should be evaluated for CRS + HIPEC.

References

Coccolini F, Gheza F, Lotti M, Virzi S, Iusco D, Ghermandi C . Peritoneal carcinomatosis. World J Gastroenterol. 2013; 19(41):6979-94. PMC: 3819534. DOI: 10.3748/wjg.v19.i41.6979. View

Chu D, Lang N, Thompson C, Osteen P, Westbrook K . Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer. 1989; 63(2):364-7. DOI: 10.1002/1097-0142(19890115)63:2<364::aid-cncr2820630228>3.0.co;2-v. View

Sadeghi B, Arvieux C, Glehen O, Beaujard A, Rivoire M, Baulieux J . Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000; 88(2):358-63. DOI: 10.1002/(sici)1097-0142(20000115)88:2<358::aid-cncr16>3.0.co;2-o. View

Glehen O, Osinsky D, Beaujard A, Gilly F . Natural history of peritoneal carcinomatosis from nongynecologic malignancies. Surg Oncol Clin N Am. 2003; 12(3):729-39, xiii. DOI: 10.1016/s1055-3207(03)00044-9. View

Spratt J, Adcock R, Muskovin M, Sherrill W, McKeown J . Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res. 1980; 40(2):256-60. View

Sugarbaker P . Peritonectomy procedures. Ann Surg. 1995; 221(1):29-42. PMC: 1234492. DOI: 10.1097/00000658-199501000-00004. View

Jacquet P, Stephens A, Averbach A, Chang D, Ettinghausen S, DALTON R . Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer. 1996; 77(12):2622-9. DOI: 10.1002/(SICI)1097-0142(19960615)77:12<2622::AID-CNCR28>3.0.CO;2-T. View

Sugarbaker P, Jablonski K . Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg. 1995; 221(2):124-32. PMC: 1234945. DOI: 10.1097/00000658-199502000-00002. View

Sugarbaker P, Chang D . Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol. 2000; 6(8):727-31. DOI: 10.1007/s10434-999-0727-7. View

10.

Verwaal V, van Ruth S, de Bree E, van Sloothen G, van Tinteren H, Boot H . 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):3737-43. DOI: 10.1200/JCO.2003.04.187. View

11.

Elias D, Delperro J, Sideris L, Benhamou E, Pocard M, Baton O . Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 2004; 11(5):518-21. DOI: 10.1245/ASO.2004.09.008. View

12.

Bhatt A, de Hingh I, van Der Speeten K, Hubner M, Deraco M, Bakrin N . HIPEC Methodology and Regimens: The Need for an Expert Consensus. Ann Surg Oncol. 2021; 28(13):9098-9113. DOI: 10.1245/s10434-021-10193-w. View

13.

Sugarbaker P . Patient selection and treatment of peritoneal carcinomatosis from colorectal and appendiceal cancer. World J Surg. 1995; 19(2):235-40. DOI: 10.1007/BF00308632. View

14.

Baratti D, Kusamura S, Mingrone E, Balestra M, Laterza B, Deraco M . Identification of a subgroup of patients at highest risk for complications after surgical cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg. 2012; 256(2):334-41. DOI: 10.1097/SLA.0b013e31825704e3. View

15.

de Bree E . Optimal drugs for HIPEC in different tumors. J BUON. 2015; 20 Suppl 1:S40-6. View

16.

Oken M, Creech R, Tormey D, Horton J, Davis T, McFadden E . Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5(6):649-55. View

17.

Gilly F, Cotte E, Brigand C, Monneuse O, Beaujard A, Freyer G . Quantitative prognostic indices in peritoneal carcinomatosis. Eur J Surg Oncol. 2006; 32(6):597-601. DOI: 10.1016/j.ejso.2006.03.002. View

18.

Portilla A, Sugarbaker P, Chang D . Second-look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic features. World J Surg. 1998; 23(1):23-9. DOI: 10.1007/s002689900560. View

19.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

20.

Chua T, Moran B, Sugarbaker P, Levine E, Glehen O, Gilly F . Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012; 30(20):2449-56. DOI: 10.1200/JCO.2011.39.7166. View