scholarly journals Is Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Indicated in Hepatobiliary Malignancies?

2020 ◽  
Author(s):  
Natasha Leigh ◽  
Daniel Solomon ◽  
Eric Pletcher ◽  
Daniel M. Labow ◽  
Deepa R. Magge ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Progression Free Survival ◽  
Oncologic Outcomes ◽  
Current Therapies

Abstract Background: Hepatopancreaticobiliary malignancies with peritoneal carcinomatosis exhibit poor survival with current therapies; hepatocellular carcinoma 11 months with sorafenib, pancreaticobiliary 9-14 months with systemic chemotherapy. However, limited data exist on the utility of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in these patients. Methods: We retrospectively reviewed our institutional hepatopancreaticobiliary malignancies with peritoneal carcinomatosis which underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy from 2007-2017 and analyzed perioperative and oncologic outcomes. Results: 17 patients were included; 9 hepatocellular carcinoma, 8 pancreaticobiliary (4 cholangiocarcinoma, 3 gallbladder, 1 pancreatic). PCI, number of organs resected, completeness of cytoreduction and 30-day morbidity were equivalent. Hepatocellular carcinoma received significantly less neoadjuvant therapy (11%, p=0.008), though adjuvant therapy rates were similar. At a median follow-up of 15 months, progression-free survival was similar amongst all cohorts. However, overall survival was longer in hepatocellular carcinoma (42 months vs. cholangiocarcinoma 19 months, gallbladder 8 months, pancreatic 15 months, p=0.206) with 59% 3-year overall survival (vs. 0% cholangiogarcinoma, 0% gallbladder, 0% pancreatic).Conclusions: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may offer a survival benefit in select hepatocellular carcinoma patients with peritoneal carcinomatosis, though has dubious utility in pancreaticobiliary malignancies.

scholarly journals Is Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Indicated in Hepatobiliary Malignancies?

2020 ◽  
Author(s):  
Natasha Leigh ◽  
Daniel Solomon ◽  
Eric Pletcher ◽  
Daniel M. Labow ◽  
Deepa R. Magge ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Survival Benefit ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Oncologic Outcomes ◽  
Poor Survival ◽  
Current Therapies

Abstract Background Hepatopancreaticobiliary malignancies with peritoneal carcinomatosis (PC) exhibit poor survival with current therapies; HCC 11 months with sorafenib, pancreaticobiliary 9-14 months with systemic chemotherapy. Methods We retrospectively reviewed our institutional hepatopancreaticobiliary malignancies with PC which underwent CRS/HIPEC from 2007-2017 and analyzed perioperative and oncologic outcomes. Results 17 patients were included; 9 HCC, 8 pancreaticobiliary (4 cholangiocarcinoma, 3 gallbladder, 1 pancreatic). PCI (12 vs. 9), completeness of cytoreduction (78% vs. 75%) and 30-day morbidity (11% vs. 13%) were equivalent. HCC received less neoadjuvant therapy (11% vs. 75%, p=0.008), though adjuvant therapy rates were similar (78% vs. 100%, p=0.156). At a median follow-up of 15 months, PFS was similar (7 vs. 10 months p=0.957). However, OS was longer in HCC (42 vs. 15 months p=0.206) with 59% 3-year OS (vs. 0% pancreaticobiliary). Conclusions CRS/HIPEC may offer a survival benefit in select HCC patients with PC, though has dubious utility in PB malignancies.

scholarly journals Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

2016 ◽  
Vol 1 (2) ◽  
pp. 67-77 ◽  
Author(s):  
Claramae Shulyn Chia ◽  
Ramakrishnan Ayloor Seshadri ◽  
Vahan Kepenekian ◽  
Delphine Vaudoyer ◽  
Guillaume Passot ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Median Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Current Evidence ◽  
Term Survival ◽  
Crs And Hipec

AbstractBackground: The current treatment of choice for peritoneal carcinomatosis from gastric cancer is systemic chemotherapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a new aggressive form of loco-regional treatment that is currently being used in pseudomyxoma peritoneii, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer. It is still under investigation for its use in gastric cancer.Methods: The literature between 1970 and 2016 was surveyed systematically through a review of published studies on the treatment outcomes of CRS and HIPEC for peritoneal carcinomatosis from gastric cancer.Results: Seventeen studies were included in this review. The median survival for all patients ranged from 6.6 to 15.8 months. The 5-years overall survival ranged from 6 to 31%. For patients with complete cytoreduction, the median survival was 11.2 to 43.4 months and the 5-years overall survival was 13 % to 23%. Important prognostic factors were found to be a low peritoneal carcarcinomatosis index (PCI) score and the completeness of cytoreduction.Conclusion: The current evidence suggests that CRS and HIPEC has a role to play in the treatment of peritoneal carcinomatosis from gastric cancer. Long term survival has been shown for a select group of patients. However, further studies are needed to validate these results.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: Multi-Institutional Experience

2009 ◽  
Vol 27 (36) ◽  
pp. 6237-6242 ◽  
Author(s):  
Tristan D. Yan ◽  
Marcello Deraco ◽  
Dario Baratti ◽  
Shigeki Kusamura ◽  
Dominique Elias ◽  
...  
Keyword(s):  
Overall Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Peritoneal Mesothelioma ◽  
Malignant Peritoneal Mesothelioma ◽  
End Point ◽  
The Mean

Purpose This multi-institutional registry study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM). Patients and Methods A multi-institutional data registry that included 405 patients with DMPM treated by a uniform approach that used CRS and HIPEC was established. The primary end point was overall survival. The secondary end point was evaluation of prognostic variables for overall survival. Results Follow-up was complete in 401 patients (99%). The median follow-up period for the patients who were alive was 33 months (range, 1 to 235 months). The mean age was 50 years (standard deviation [SD], 14 years). Three hundred eighteen patients (79%) had epithelial tumors. Twenty-five patients (6%) had positive lymph nodes. The mean peritoneal cancer index was 20. One hundred eighty-seven patients (46%) had complete or near-complete cytoreduction. Three hundred seventy-two patients (92%) received HIPEC. One hundred twenty-seven patients (31%) had grades 3 to 4 complications. Nine patients (2%) died perioperatively. The mean length of hospital stay was 22 days (SD, 15 days). The overall median survival was 53 months (1 to 235 months), and 3- and 5-year survival rates were 60% and 47%, respectively. Four prognostic factors were independently associated with improved survival in the multivariate analysis: epithelial subtype (P < .001), absence of lymph node metastasis (P < .001), completeness of cytoreduction scores of CC-0 or CC-1 (P < .001), and HIPEC (P = .002). Conclusion The data suggest that CRS combined with HIPEC achieved prolonged survival in selected patients with DMPM.

scholarly journals RESULTS OF HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY AND CYTOREDUCTIVE SURGERY FOR PERITONEAL CARCINOMATOSIS OF COLORECTAL ORIGIN

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
M Merayo Alvarez ◽  
E Turienzo Santos ◽  
M García Munar ◽  
I Cifrián Canales ◽  
J L Rodicio Miravalles ◽  
...  
Keyword(s):  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Descriptive Analysis ◽  
Disease Free Interval ◽  
Free Interval ◽  
Colorectal Origin ◽  
Disease Free

Abstract INTRODUCTION Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is supported by clinical practice and published series as a fundamental treatment for increasing survival of selected patients with colorectal peritoneal carcinomatosis. The results were evaluated since having implemented a peritoneal oncological surgery program five years ago. MATERIAL AND METHODS Descriptive analysis was conducted to patients who had been diagnosed with peritoneal carcinomatosis from May 2014 to December 2020. 36 out of 100 patients who had undergone surgery were included in the CRS and HIPEC assessment and 6 patients without HIPEC, were excluded. RESULTS The mean preoperative PCI was 7.81±6.61 accomplishing complete cytoreduction CC 0-CC-1 in the 36 cases. An average of 1.86±1.22 peritonectomies were performed. Among procedures, complete pelviperitonectomy (11 patients) and liver metastasis resection (6 patients) should be noticed. Complications were presented in 16 patients (8 patients over Clavien Dindo&gt;III) and 6 required reinterventions due to hematoma (2) or anastomotic leak (2) mostly. The 4-year overall survival is 76.2% and the disease-free interval is 34 months within an average follow-up of 23 months. CONCLUSIONS The overall survival and disease-free interval rates are above the standards. Currently, peritoneal carcinomatosis might be considered a curative disease. The multidisciplinary assessment allows selecting patients who will benefit from surgery.

scholarly journals Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) vs CRS alone for treatment of endometrial cancer with peritoneal metastases: a multi-institutional study from PSOGI and BIG RENAPE groups

BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Manuel Gomes David ◽  
Naoual Bakrin ◽  
Julia Salleron ◽  
Marie Christine Kaminsky ◽  
Jean Marc Bereder ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Progression Free Survival ◽  
Peritoneal Metastases ◽  
Peritoneal Carcinomatosis Index ◽  
Significant Difference ◽  
Treatment Data

Abstract Objective To investigate the benefit of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of endometrial peritoneal carcinomatosis compared to CRS alone. Methods We conducted a retrospective multicentre study of patients from experienced centres in treating peritoneal malignancies from 2002 to 2015. Patients who underwent surgery for peritoneal evolution of endometrial cancer (EC) were included. Two groups of 30 women were matched and compared: “CRS + HIPEC” which used HIPEC after CRS, and “CRS only” which did not use HIPEC. We analysed clinical, pathologic and treatment data for patients with peritoneal metastases from EC. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS). Results In “CRS plus HIPEC” group, 96.7% of women were treated for recurrence, while in “CRS only” 83.3 were treated for primary disease. There was no significant difference between Peritoneal Carcinomatosis Index at laparotomy or Completeness of Cytoreduction score. Grade III and IV complications rates did not significantly differ between “CRS plus HIPEC” group and “CRS only” group (20.7% vs 20.7%, p = 0.739). Survival analysis showed no statistical difference between both groups. Median OS time was 19.2 months in “CRS plus HIPEC” group and 29.7 months in “CRS only” group (p = 0.606). Median PFS survival time was 10.7 months in “CRS plus HIPEC” group and 13.1 months in “CRS only” group (p = 0.511). Conclusion The use of HIPEC combined to CRS did not have any significance as regard the DFS and OS over CRS alone in patients with primary or recurrent peritoneal metastasis of endometrial cancer.

scholarly journals Cytoreductive Surgery (CRS) Plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) vs CRS Alone for Treatment of Endometrial Cancer with Peritoneal Metastases: A Multi-Institutional Study from PSOGI and BIG RENAPE Groups

2021 ◽  
Author(s):  
Manuel GOMES DAVID ◽  
N. Bakrin ◽  
J. Salleron ◽  
M. C. Kaminsky ◽  
J. M. Bereder ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Progression Free Survival ◽  
Peritoneal Metastases ◽  
Peritoneal Carcinomatosis Index ◽  
Significant Difference ◽  
Treatment Data

Abstract ObjectiveTo investigate the benefit of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of endometrial peritoneal carcinomatosis compared to CRS alone.MethodsWe conducted a retrospective multicentre study of patients from experienced centres in treating peritoneal malignancies from 2002 to 2015. Patients who underwent surgery for peritoneal evolution of endometrial cancer (EC) where included. Two groups of 30 women were matched and compared: “CRS +HIPEC” which used HIPEC after CRS, and “CRS only” which did not used HIPEC. We analysed clinical, pathologic and treatment data for patients with peritoneal metastases from EC. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS).ResultsIn “CRS plus HIPEC” group, 96,7% of women were treated for recurrence, while in “CRS only” 83,3 were treated for primary disease. There was no significant difference between Peritoneal Carcinomatosis Index at laparotomy or Completeness of Cytoreduction score. Grade III and IV complications rates did not significantly differ between “CRS plus HIPEC” group and “CRS only” group (20.7% vs 20.7%, p=0.739). Survival analysis showed no statistical difference between both groups. Median OS time was 19.2 months in “CRS plus HIPEC” group and 29.7 months in “CRS only” group (p=0.606). Median PFS survival time was 10.7 months in “CRS plus HIPEC” group and 13.1 months in “CRS only” group (p=0.511).ConclusionThe use of HIPEC combined to CRS appears to be as effective, well tolerated and feasible as CRS alone in patients with primary or recurrent peritoneal metastasis of endometrial cancer.

scholarly journals Clinical features and surgical outcomes of major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotheraphy

2020 ◽  
Vol 12 ◽  
pp. 175628722097592
Author(s):  
Özgül Düzgün ◽  
Murat Kalın ◽  
Resul Sobay ◽  
Ömer Faruk Özkan
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Urinary System ◽  
Urological Procedures ◽  
The Mean ◽  
Grade 3

Background: Urinary system resections and reconstructions are needed in peritoneal carcinomatosis due to abdominal malignancies. The effect of hyperthermic intraperitoneal chemotherapy on these urological procedures after reconstruction remains uncertain. The aim of the study is to evaluate major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in complex abdominal malignancies with peritoneal carcinomatosis. Methods: Forty-four cases underwent surgical intervention related to the urinary system among 208 cases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy because of peritoneal carcinomatosis. Urinary system procedures performed in these patients (radical-partial cystectomy, partial ureter resection ureteroneocystostomy, ureteroureterostomy, nephrectomy) were evaluated in terms of postoperative morbidity–mortality and survival. Results: Urinary system resections were performed during cytoreductive surgery in a total of 44 cases. The mean age was 54 years (20–73). Patients were diagnosed with peritoneal carcinomatosis due to colorectal cancer in 21 (47.8%), ovarian cancer in nine (20.4%), sarcomatosis in five (11.4%), cervical cancer in four (9%) and other cancers (mesothelioma, uterus, breast, gastric) in five (11.4%) cases. Total nephrectomy was performed in three cases and partial nephrectomy in one case. Cystectomy was performed in 21 cases; 16 of these were partial and five were total cystectomies. Ureteroureterocystostomy with double J was performed in four cases and ureteroneocystostomy in 12 cases. While Clavian–Dindo grade 3–4 complications were seen in nine cases (20.4%), three cases (6.8%) became exitus during the first 30-day follow-up. Conclusions: Although urinary system involvements have been regarded as inoperable in the past, we think that with adequate experience radical urinary interventions performed in suitable patients can be carried out with acceptable morbidity and mortality as seen in our series.

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