Peritoneal metastases of colorectal origin – cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The financial aspect

2017 ◽  
Vol 89 (6) ◽  
pp. 1-6
Author(s):  
Tomasz Jastrzębski ◽  
Marek Bębenek
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Distant Metastases ◽  
Peritoneal Metastases ◽  
Medical Procedures ◽  
Financial Loss ◽  
Colorectal Origin ◽  
Crs And Hipec ◽  
Financial Aspect

About 10% to 15% of patients with colon cancer have intraperitoneal metastases at diagnosis. The patients with intraperitoneal metastases and without distant metastases can benefit from cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Because up to a half of patients live for at least 5 years after this treatment, the treatment is used more and more often. The treatment of patients with intraperitoneal metastases with CRS and HIPEC costs more than the majority of other medical procedures, because CRS is extensive and takes a lot of time, and after surgery, patients need intensive care and expensive medications and equipment. Currently, only 40% to 80% of costs of CRS and HIPEC are reimbursed in Poland. Because CRS and HIPEC mean a financial loss to hospitals, they are rarely performed. We analyzed the costs of treating patients with peritoneal metastases by CRS and HIPEC in two centers (Gdank, Wroclaw) and showed how this treatment is reimbursed outside Poland. We discussed whether adequate qualification of patients and experience of the teams giving the treatment could reduce the costs.

scholarly journals Uncommon indications for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

2017 ◽  
Vol 2 (3) ◽  
pp. 129-136 ◽  
Author(s):  
Francis Zheng Yi Yee ◽  
Grace Hwei Ching Tan ◽  
Claramae Shulyn Chia ◽  
Khee Chee Soo ◽  
Melissa Ching Ching Teo
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Transitional Cell ◽  
Granulosa Cell Tumor ◽  
Peritoneal Metastases ◽  
Peritoneal Cancer ◽  
Crs And Hipec ◽  
Uncommon Tumor

AbstractBackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed treatment for selected patients with peritoneal metastases (PM) arising from appendiceal, colorectal, epithelial ovarian, primary peritoneal and gastric cancers. However, the results of CRS with HIPEC remain unclear in PM from other tumor histologies.MethodsWe report a series of 10 patients who underwent CRS and HIPEC between 2006 and 2015, for PM arising from uncommon tumor origins.ResultsTen patients with PM from uncommon tumor origins underwent CRS and HIPEC. Median age was 46.5 years. Two patients had ovarian Sertoli-Leydig cell tumors (SLCT) and two had small bowel adenocarcinomas. The other histologies included: ovarian transitional cell carcinoma, ovarian granulosa cell tumor, endometroid adenocarcinoma, endocervical adenocarcinoma, synovial sarcoma, and ovarian leiomyosarcoma. Median peritoneal cancer index was 9 (2–18) and complete cytoreduction was achieved for all patients. Median follow-up was 14 months (2–100), and median time to recurrence from CRS and HIPEC was 16.0 months by Kaplan–Meier estimate. Four patients remain alive and disease-free, five are alive with disease, and one had died with disease. Median survival was not reached.ConclusionsEight of ten patients with peritoneal metastases in the above rare indications survived 10 months or more after CRS and HIPEC. These encouraging results are a rationale for prospective clinical trials in these tumor histologies.

Survival according to mutations in BRAF, KRAS, or microsatellite instability (MSI-H) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastases from colorectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3565-3565 ◽  
Author(s):  
Stein G Larsen ◽  
Svein Dueland ◽  
M Goscinski ◽  
Sonja Steigen ◽  
Eva Hofsli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Disease Free Survival ◽  
Peritoneal Metastases ◽  
Wild Type ◽  
Free Survival ◽  
Crs And Hipec ◽  
Disease Free

3565 Background: Patients with metastatic colorectal cancer (mCRC) and mutations in BRAF V600E (mutBRAF) or KRAS (mutKRAS) have a worse prognosis after liver or lung surgery/ablation, whereas the impact of microsatellite instability (MSI-H) has not been well studied. Few patients with mutBRAF receive liver or lung surgery (1-4%), whereas mutBRAF is present in 5-12% of mCRC trial patients and in up to 20% of the general mCRC population. The frequency and prognostic role of mutBRAF, mutKRAS and MSI has not been well studied after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases from colorectal cancer. Methods: The Norwegian Radium Hospital is the only center offering CRS and HIPEC in Norway. From 2004 to 2015 257 patients with histology proven peritoneal metastasis from colorectal cancer, appendiceal cancer excluded, was consecutively enrolled. Molecular analyses of KRAS, BRAF and MSS/MSI in mutBRAF were done. Fourteen patients were excluded due to missing tumour blocks (7), unsuccessful analysis (4) and other malignant disease (1). Results: 180 of 243 patients obtained complete cytoreductive surgery and received HIPEC for 90 minutes with Mitomycin C (45-70mg). Median survival for the 180 patients was 47 months and 5-year survival rate 40.1%. Median disease-free survival was 10 months. mutBRAF was found in 23.4% of cases, mutKRAS 35.1% and double-wild type 41.5%. mutBRAF with MSS was found in 16.4%, mutBRAF with MSI-H in 7.0%. 3-year disease free survival (DFS) and median overall survival (OS) was 38.9% and 59 months with mutBRAF with MSI-H, significantly higher compared to 24.2% and 30 months in patients with double wild type, 13.2 % and 41 months in mutKRAS and 17.9% and 22 months in mutBRAF with MSS. Conclusions: A surprisingly high frequency of mutBRAF was seen in mCRC patients after CRS and HIPEC for peritoneal metastatic disease. Patients with mutBRAF and MSI-H had a significantly better DFS and OS after CRS and HIPEC. DFS for patients with mutBRAF and MSS was numerically lower but not statistically different from patients with mutKRAS or double wild type.

scholarly journals Prognostic Factors Influencing Infectious Complications after Cytoreductive Surgery and HIPEC: Results from a Tertiary Referral Center

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Maurizio Cardi ◽  
Simone Sibio ◽  
Francesco Di Marzo ◽  
Francesco Lefoche ◽  
Claudia d’Agostino ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Nutritional Status ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Infectious Complications ◽  
Peritoneal Metastases ◽  
Complication Rates ◽  
Crs And Hipec ◽  
Clinical Records

Background. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) showed promising results in selected patients. High morbidity restrains its wide application. The aim of this study was to report postoperative infectious complications and investigate possible correlations with the preoperative nutritional status and other prognostic factors in patients with peritoneal metastases treated with CRS and HIPEC. Methods. For the study, we reviewed the clinical records of all patients with peritoneal metastases from different primary cancers treated with CRS and HIPEC in our Institution from November 2000 to December 2017. Patients were divided according to their nutritional status (SGA) into groups A (well-nourished) and B/C (mild or severely malnourished, respectively). Possible statistical correlations between risk factors and postoperative complication rates have been investigated by univariate and multivariate analysis. Results. Two hundred patients were selected and underwent CRS and HIPEC during the study period. Postoperative complications occurred in 44% of the patients, 35.3% in SGA-A patients, and 53% in SGA-B/C patients. Cause of complications was infective in 42, noninfective in 37, and HIPEC related in 9 patients. Infectious complications occurred more frequently in SGA-B/C patients (32.6% vs. 9.8% of SGA-A patients). The most frequent sites of infection were surgical site infections (SSI, 35.7%) and central line-associated bloodstream infections (CLABSI, 26.2%). The most frequent isolated species was Candida (22.8%). ASA score, blood loss, performance status, PCI, large bowel resection, postoperative serum albumin levels, and nutritional status correlated with higher risk for postoperative infectious complications. Conclusions. Malnourished patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are more prone to postoperative infectious complications, and adequate perioperative nutritional support should be considered, including immune-enhancing nutrition. Sequential monitoring of common sites of infection, antifungal prevention of candidiasis, and careful patient selection should be implemented to reduce the complication rate.

scholarly journals Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in recurrent ovarian cancer with peritoneal metastasis: a prospective registry study on 41 patients

2017 ◽  
Vol 2 (4) ◽  
pp. 171-179
Author(s):  
Melissa Ching Ching Teo ◽  
Claramae Shulyn Chia ◽  
Cindy Lim ◽  
Grace Hwei Ching Tan ◽  
Whay Kuang Chia ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Recurrent Ovarian Cancer ◽  
Peritoneal Metastases ◽  
High Grade ◽  
Crs And Hipec ◽  
Disease Free

AbstractBackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases from ovarian cancer have been shown to have a role in recurrent ovarian cancer, but are still not considered standard therapy.MethodsFrom March 2005 to July 2013, 41 patients who underwent 44 CRS and HIPEC for peritoneal metastases in recurrent ovarian cancer were included in this study. Details were obtained from a prospectively maintained database. Our aim was to report our 5-year overall and disease-free survivals, as well as prognostic factors for survival.ResultsMedian age was 50 years old (range 23–73). Median duration of surgery was 510 min (range 230–840) and median peritoneal carcinomatosis index (PCI) score was 9.5 (range 0–31). About 92.7% of the patients had completeness of cytoreduction (CC) scores of 0 or 1. Median follow-up was 43.9 months (range 0.7–108.9). There were no mortalities and the high-grade morbidity rate was 31.8%. Median overall survival was 42.8 months (range 28.6–99.9) 5-year overall and disease-free survivals were 49.3% and 7.5% respectively. On multivariate analysis, histology and CC score were significantly associated with overall survival while histology and disease-free interval were associated with disease-free survival. The odds of developing a high-grade complication more than doubled for each additional surgical procedure performed (p=0.01).ConclusionsCRS and HIPEC can attain prolonged survival in selected patients with peritoneal metastasis in recurrent ovarian cancer.

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