Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: morbidity and postoperative outcomes.

BACKGROUND Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) represents a treatment option for peritoneal surface malignancies. Even if it has been reported that this new approach improved survival of selected patients, it is still associated with high morbidity and mortality rates. METHODS From October 1995 to December 2017, over 450 patients affected by peritoneal carcinomatosis (PC) underwent in our Institute CRS associated with HIPEC. For this preliminary analysis we considered 300 patients presenting PC of different origin: pseudomyxoma peritonei (PMP, N.=98), epithelial ovarian cancer (EOC, N.=87), peritoneal mesothelioma (DMPM, N.=49) and colorectal cancer (CRC, N.=66). Postoperative morbidity and mortality were studied in order to identify possible risk factors. RESULTS The morbidity rate was 36.3% in all procedures (109/300). According to the Clavien-Dindo Classification, 67 cases (22.3%) were associated with grade I-II complications and 35 cases (11.7%) with grade III-IV. Surgical and medical complication rates were 8.3% (25/300) and 11.3% (34/300), respectively. The mortality rate was 2.3%. Reoperation was needed in 28 patients (9.3%). The operative time, the number of anastomosis, of peritonectomy procedures, of visceral resections performed and the PCI value resulted the most statistically significant factors influencing postoperative morbidity and mortality. CONCLUSIONS The risks of perioperative morbidity and mortality after CRS and HIPEC are analogous to any other major gastrointestinal surgery. CRS and HIPEC should remain a treatment option for highly-selected patients in whom a curative or life prolonging treatment is a pursuit and should be performed in high volume specialized institutions.

[1]  T. Chua,et al.  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. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  Y. Yonemura,et al.  Morbidity and Mortality Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy at a Single Institution in Japan , 2012, Gastroenterology research and practice.

[3]  M. Deraco,et al.  Multidimensional Analysis of the Learning Curve for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Surface Malignancies , 2012, Annals of surgery.

[4]  M. Solazzo,et al.  Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial. , 2011, Gynecologic oncology.

[5]  S. Msika,et al.  Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy , 2010, Cancer.

[6]  D. Elias,et al.  Pseudomyxoma peritonei: a French multicentric study of 301 patients treated with cytoreductive surgery and intraperitoneal chemotherapy. , 2010, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[7]  G. Fiorentini,et al.  Management of pseudomyxoma peritonei by cytoreduction+HIPEC (hyperthermic intraperitoneal chemotherapy): results analysis of a twelve-year experience. , 2009, In vivo.

[8]  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.

[9]  B. Moran,et al.  Morbidity and Mortality With Cytoreductive Surgery and Intraperitoneal Chemotherapy: The Importance of a Learning Curve , 2009, Cancer journal.

[10]  D. Elias,et al.  Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  H. Schlitt,et al.  Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy , 2009, World journal of surgical oncology.

[12]  C. Obasaju,et al.  Pemetrexed plus gemcitabine as first-line chemotherapy for patients with peritoneal mesothelioma: final report of a phase II trial. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  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.

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

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

[16]  D. Elias,et al.  Malignant peritoneal mesothelioma: treatment with maximal cytoreductive surgery plus intraperitoneal chemotherapy. , 2007, Gastroenterologie clinique et biologique.

[17]  Therese A. Stukel,et al.  Hospital Volume and Late Survival After Cancer Surgery , 2007, Annals of surgery.

[18]  E. Brun,et al.  Prognostic Indicators for Patients Undergoing Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Diffuse Malignant Peritoneal Mesothelioma† , 2006, Annals of Surgical Oncology.

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

[20]  N. Demartines,et al.  Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey , 2004, Annals of Surgery.

[21]  Seth M Steinberg,et al.  Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  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.

[23]  M. Vaira,et al.  Semi‐closed hyperthermic‐antiblastic peritoneal perfusion (HAPP) in the treatment of peritoneal carcinosis , 2003, Journal of surgical oncology.

[24]  K. Shiromizu,et al.  Prognostic factors of stage IV epithelial ovarian cancer: a multicenter retrospective study. , 2001, Gynecologic oncology.

[25]  J. Faure,et al.  Peritoneal carcinomatosis from non‐gynecologic malignancies , 2000, Cancer.

[26]  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.

[27]  M. Fischer,et al.  Peritoneale Mesotheliome – Häufigkeiten und Ätiologie , 1999, Der Pathologe.

[28]  M. Piver,et al.  Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma , 1999, Journal of surgical oncology.

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

[30]  E. Copeland,et al.  Surgical limb perfusion for extremity melanoma. , 1994, Surgical oncology.

[31]  B. Debaene,et al.  [Intraperitoneal hyperthermic chemotherapy (IPHC), a promising treatment of peritoneal carcinomatosis]. , 1994, Bulletin du cancer.

[32]  J. Donohue,et al.  Pseudomyxoma Peritonei Long‐Term Patient Survival with an Aggressive Regional Approach , 1994, Annals of surgery.

[33]  R. Schlinkert,et al.  The Natural History of Surgically Treated Primary Adenocarcinoma of the Appendix , 1994, Annals of surgery.

[34]  M. Slevin,et al.  Cisplatin and carboplatin in combination for the treatment of stage IV ovarian carcinoma. , 1991, Annals of oncology : official journal of the European Society for Medical Oncology.

[35]  T. Shimizu,et al.  Influence of local hyperthermia on the healing of small intestinal anastomoses in the rat , 1991, The British journal of surgery.

[36]  P. Sugarbaker.  New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? , 2006, The Lancet. Oncology.

[37]  P. Sugarbaker,et al.  [Elective surgery in recurrent colon cancer with peritoneal seeding: when to and when not to proceed]. , 1999, Il Giornale di chirurgia.

[38]  E. Venkatraman,et al.  Stage IV ovarian cancer: impact of surgical debulking. , 1997, Gynecologic oncology.

[39]  P. Sugarbaker.  Peritoneal carcinomatosis: natural history and rational therapeutic interventions using intraperitoneal chemotherapy. , 1996, Cancer treatment and research.

[40]  W. Cunliffe,et al.  Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. , 1989, Seminars in oncology.