Morbidity and Mortality Outcomes of Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy at a Single Tertiary Institution: Towards a New Perspective of This Treatment

Introduction:Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) is a treatment option for peritoneal surface malignancy. Despite the survival benefits, this treatment was previously associated with a high morbidity and mortality rates and the perception of the poor perioperative outcomes associated with this regimen remains. The aim of this study was to report the perioperative outcomes of CRS and PIC from a single institution to review factors that are associated with a poor perioperative outcome. Methods:The clinical- and treatment-related data of 243 consecutive procedures performed were prospectively collected and retrospectively reviewed. Adverse events were rated according to the National Cancer Institute's Common Toxicity Criteria (grade I–V). Univariate and multivariate analyses were performed to identify significant clinical and treatment-related factors for a poor perioperative outcome (grades III/IV/V morbidity). Results:The perioperative mortality rate was 3%. The rate of severe morbidity was 43%. Multivariate analysis demonstrated that left upper quadrant peritonectomy (P < 0.001) and small bowel resection (P < 0.01) were factors that predicted for a poor perioperative outcome. Conclusions:The morbidity and mortality rates of CRS and PIC are within an acceptable range for a major gastrointestinal surgery which is performed with a curative intent. Patient selection is important in ensuring that suitable patients receive this treatment. A new perspective of this treatment needs to be sought.

[1]  K. Soo,et al.  Towards randomized trials of cytoreductive surgery using peritonectomy and hyperthermic intraperitoneal chemotherapy for ovarian cancer peritoneal carcinomatosis. , 2009, Gynecologic oncology.

[2]  T. Chua,et al.  Should the Treatment of Peritoneal Carcinomatosis by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Still be Regarded as a Highly Morbid Procedure?: A Systematic Review of Morbidity and Mortality , 2009, Annals of surgery.

[3]  T. Chua,et al.  Long-Term Survival in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy: 10 Years of Experience from a Single Institution , 2009, Annals of Surgical Oncology.

[4]  A. Stojadinovic,et al.  Cytoreductive surgery and heated intra‐peritoneal chemotherapy in the treatment of peritoneal carcinomatosis of colorectal origin: The need for practice altering data , 2008, Journal of surgical oncology.

[5]  R. A. Forse,et al.  In hospital outcomes after pancreatectomies: An analysis of a national database from 1996 to 2004 , 2008, Journal of surgical oncology.

[6]  N. Gusani,et al.  Aggressive Surgical Management of Peritoneal Carcinomatosis With Low Mortality in a High-Volume Tertiary Cancer Center , 2008, Annals of Surgical Oncology.

[7]  P. Sugarbaker,et al.  Cytoreduction of the small bowel surfaces , 2008, Journal of surgical oncology.

[8]  R. Newcombe,et al.  Volume and Outcome for Major Upper GI Surgery in England , 2008, Journal of Gastrointestinal Surgery.

[9]  P. Sugarbaker,et al.  Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer. , 2007, Annals of oncology : official journal of the European Society for Medical Oncology.

[10]  F. Zoetmulder,et al.  Learning curve of combined modality treatment in peritoneal surface disease , 2007, The British journal of surgery.

[11]  M. Links,et al.  Learning Curve for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy—A Journey to Becoming a Nationally Funded Peritonectomy Center , 2007, Annals of surgical oncology.

[12]  P. Sugarbaker,et al.  A Systematic Review on the Efficacy of Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei , 2007, Annals of Surgical Oncology.

[13]  Michael A. Choti,et al.  1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience , 2006, Journal of Gastrointestinal Surgery.

[14]  D. Giannarelli,et al.  120 peritoneal carcinomatoses from colorectal cancer treated with peritonectomy and intra-abdominal chemohyperthermia: a S.I.T.I.L.O. multicentric study. , 2006, In vivo.

[15]  P. Sugarbaker,et al.  Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  H. Yamamoto,et al.  Operative morbidity and mortality after D2 and D4 extended dissection for advanced gastric cancer: a prospective randomized trial conducted by Asian surgeons. , 2006, Hepato-gastroenterology.

[17]  J. Esquivel,et al.  Prospective Morbidity and Mortality Assessment of Cytoreductive Surgery Plus Perioperative Intraperitoneal Chemotherapy To Treat Peritoneal Dissemination of Appendiceal Mucinous Malignancy , 2006, Annals of Surgical Oncology.

[18]  M. Deraco,et al.  Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion , 2006, Cancer.

[19]  F. Kwiatkowski,et al.  Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  H. van Tinteren,et al.  Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  E. Cotte,et al.  Intraperitoneal Chemohyperthermia Using a Closed Abdominal Procedure and Cytoreductive Surgery for the Treatment of Peritoneal Carcinomatosis: Morbidity and Mortality Analysis of 216 Consecutive Procedures , 2003, Annals of Surgical Oncology.

[22]  K. Dumon,et al.  Effects of exogenous recombinant human granulocyte colony-stimulating factor (filgrastim, rhG-CSF) on neutrophils of critically ill patients with systemic inflammatory response syndrome depend on endogenous G-CSF plasma concentrations on admission , 2003, Intensive Care Medicine.

[23]  J. Birkmeyer,et al.  Hospital volume and surgical mortality in the United States. , 2002, The New England journal of medicine.

[24]  J. Esquivel,et al.  Morbidity and Mortality Analysis of 200 Treatments With Cytoreductive Surgery and Hyperthermic Intraoperative Intraperitoneal Chemotherapy Using the Coliseum Technique , 1999, Annals of Surgical Oncology.

[25]  P. Sugarbaker,et al.  Morbidity and mortality of early postoperative intraperitoneal chemotherapy as adjuvant therapy for gastric cancer. , 1998, The American surgeon.

[26]  P. Sugarbaker.  Peritonectomy Procedures , 1995, Surgical oncology clinics of North America.

[27]  M. Sierzega,et al.  Standard D2 versus extended D2 (D2+) lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomized, clinical trial. , 2007, American journal of surgery.

[28]  P. Sugarbaker,et al.  A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. , 2007, Annals of oncology : official journal of the European Society for Medical Oncology.

[29]  PhD Chikara Kunisaki MD,et al.  Comparison of Surgical Results of D2 Versus D3 Gastrectomy (Para-Aortic Lymph Node Dissection) for Advanced Gastric Carcinoma: A Multi-Institutional Study , 2006, Annals of Surgical Oncology.

[30]  P. Sugarbaker,et al.  Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. , 1996, Cancer treatment and research.