Indications and outcomes for repeat cytoreductive surgery and heated intra-peritoneal chemotherapy in peritoneal surface malignancy
AuthorsSutton, Paul A
O'Dwyer, Sarah T
Renehan, Andrew G
Wilson, Malcolm S
AffiliationColorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
MetadataShow full item record
AbstractIntroduction: Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is offered in specialist centres as a treatment for peritoneal surface tumours. Despite its demonstrated efficacy, intra-abdominal recurrence occurs in 31-57% of patients. The aim of this study is to review the early and long-term outcomes in patients who undergo repeat CRS/HIPEC. Materials and methods: A retrospective review of a prospectively maintained database of patients who had undergone repeat CRS/HIPEC for appendiceal neoplasms and colorectal peritoneal metastases (CRPM) from 2003 to 2019 was performed at a single specialist centre. Data pertaining to both short term outcomes and survival were evaluated. Results: Of 1259 patients who had undergone CRS/HIPEC, 84(6.7%) underwent repeat surgery: 45(53.6%) had pseudomyxoma peritonei (PMP) secondary to low grade appendiceal mucinous neoplasms (LAMN), 21(25.0%) had appendix carcinoma and 18(21.4%) had CRPM. Demographics, intra-operative findings and short-term outcomes were comparable across tumour types and between procedures. Median (95% CI) interval between procedures was 22.7(18.9-26.6) months and was comparable between tumour types. Median (95%CI) overall survival was not reached for the cohort overall or for those with PMP, but was 61.0(32.6-89.4) months for those with appendix cancer and 76.9(47.4-106.4) months for CRPM (p=<0.001). Survival was favourable in the PMP group (HR [95%CI] 0.044 [0.008-0.262]; p = 0.000) and unfavourable in the CC2-3 at index CRS procedure group (HR [95%CI] 25.612 [2.703-242.703]; p = 0.005). Conclusion: Our findings demonstrate that repeat cytoredutive surgery with HIPEC can result in favourable survival, especially for patients with PMP when complete cytoreduction is achieved at index operation. We recommend that detailed patient assessment is performed through an expert multidisciplinary team meeting (MDT).
CitationSutton PA, O’Dwyer ST, Barriuso J, Aziz O, Selvasekar CR, Renehan AG, et al. Indications and outcomes for repeat cytoreductive surgery and heated intra-peritoneal chemotherapy in peritoneal surface malignancy. Surgical Oncology. 2021 Sep;38:101572.
- Evaluation of repeat cytoreductive surgery and heated intraperitoneal chemotherapy for patients with recurrent peritoneal carcinomatosis from appendiceal and colorectal cancers: a multicentre Canadian study
- Authors: Jost E, Mack LA, Sideris L, Dube P, Temple W, Bouchard-Fortier A
- Issue date: 2020 Feb 21
- Predictors of progression in high-grade appendiceal or colorectal peritoneal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
- Authors: Baumgartner JM, Tobin L, Heavey SF, Kelly KJ, Roeland EJ, Lowy AM
- Issue date: 2015 May
- Sites of Recurrence After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Carcinomatosis from Colorectal and Appendiceal Adenocarcinoma: A Tertiary Center Experience.
- Authors: Feferman Y, Solomon D, Bhagwandin S, Kim J, Aycart SN, Feingold D, Sarpel U, Labow DM
- Issue date: 2019 Feb
- Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center.
- Authors: Berger Y, Aycart S, Mandeli JP, Heskel M, Sarpel U, Labow DM
- Issue date: 2015 Sep
- Long term survival analysis after hyperthermic intraperitoneal chemotherapy with oxaliplatin as a treatment for appendiceal peritoneal carcinomatosis.
- Authors: Masckauchan D, Trabulsi N, Dubé P, Aubé-Lecompte ME, Cloutier AS, Mitchell A, Sideris L
- Issue date: 2019 Mar