1
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Sarofim M, Wijayawardana R, Ahmadi N, Morris DL. Repeat cytoreductive surgery with HIPEC for colorectal peritoneal metastases: a systematic review. World J Surg Oncol 2024; 22:99. [PMID: 38627808 PMCID: PMC11022433 DOI: 10.1186/s12957-024-03386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Colorectal peritoneal metastases (CRPM) are present in 10-20% of patients at the time of their initial cancer diagnosis, and affects over 20% of those who develop colorectal cancer recurrence. Cytoreductive surgery (CRS) with HIPEC is firmly established as the optimal surgical treatment, but there is very little known about the benefit of repeat or iterative CRS. The aim of this review is to provide a systematic evaluation of the perioperative complications, survival outcomes and quality of life in patients undergoing repeat CRS with HIPEC for CRPM. METHODS A systematic review of PubMed, Ovid MEDLINE, EMBASE, Scopus and Cochrane databases was performed to identify all studies that reported outcomes for repeat CRS with or without HIPEC for CRPM. RESULTS Four hundred and ninety-three manuscripts were screened, and 15 retrospective studies were suitable for inclusion. Sample sizes ranged from 2 to 30 participants and comprised a total of 229 patients. HIPEC was used in all studies, but exact rates were not consistently stated. Perioperative morbidity was reported in four studies, between 16.7% and 37.5%. Nine studies reported mortality rate which was consistently 0%. The median overall survival after repeat CRS ranged from 20 to 62.6 months. No studies provided quality of life metrics. CONCLUSION Repeat CRS for CRPM has perioperative morbidity and mortality rates comparable to initial CRS, and offers a potential survival benefit in selected patients. There is however limited high-quality data in the literature.
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Affiliation(s)
- Mina Sarofim
- Liver and Peritonectomy Unit, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia.
- School of Medicine, University of New South Wales, Sydney, NSW, Australia.
- School of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Ruwanthi Wijayawardana
- Liver and Peritonectomy Unit, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Nima Ahmadi
- Liver and Peritonectomy Unit, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David L Morris
- Liver and Peritonectomy Unit, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
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2
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Sutton PA, O'Dwyer ST, Barriuso J, Aziz O, Selvasekar CR, Renehan AG, Wilson MS. Indications and outcomes for repeat cytoreductive surgery and heated intra-peritoneal chemotherapy in peritoneal surface malignancy. Surg Oncol 2021; 38:101572. [PMID: 33915487 DOI: 10.1016/j.suronc.2021.101572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/16/2020] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION 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).
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Affiliation(s)
- P A Sutton
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK.
| | - S T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - J Barriuso
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
| | - O Aziz
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
| | - C R Selvasekar
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
| | - A G Renehan
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - M S Wilson
- Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK
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3
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Laks S, Schtrechman G, Adileh M, Ben-Yaacov A, Purim O, Ivanov V, Aderka D, Shacham-Shmueli E, Halpern N, Goren S, Perelson D, Nissan A. Repeat Cytoreductive Surgery and Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Recurrences is Safe and Efficacious. Ann Surg Oncol 2021; 28:5330-5338. [PMID: 33591479 DOI: 10.1245/s10434-021-09684-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) for colorectal cancer peritoneal metastases (CRPM) is associated with improved survival in patients with historically dismal prognosis. Nonetheless, peritoneal recurrences remain common and represent a difficult challenge in these patients' management. Repeat CRS/HIPEC is associated with even greater morbidity and its survival benefit has not yet been clearly demonstrated. METHODS We retrospectively reviewed our prospectively maintained database and aimed to assess the safety and oncological efficacy of repeat CRS/HIPEC. RESULTS Two hundred thirty-two patients underwent an initial CRS/HIPEC, whereas 30 subsequently had repeat CRS/HIPEC for CRPM. Groups were similar in demographics, comorbidities, and peritoneal cancer index (PCI). No significant difference in morbidity, hospital stay, or reoperation rate was noted between initial and repeat procedures. Patients who underwent repeat CRS/HIPEC had a median overall survival of 68 months versus 51 months in patients who did not undergo repeat procedure for their peritoneal recurrence (p = 0.03). Disease-free survival (DFS) in patients after repeat and after initial procedure were similar with median of 9.6 versus 12 months, respectively (p = 0.083). Univariate analysis demonstrated that PCI, DFS, and repeat procedure displayed significant factors on outcomes in patients with peritoneal recurrences, whereas PCI > 16 and DFS remained independent predictors on multivariable analysis. CONCLUSIONS Our analysis, which represents the largest series to date of repeat CRS/HIPEC for CRPM, indicates that this approach as a part of multimodal therapy is both safe and efficacious in appropriately selected patients.
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Affiliation(s)
- Shachar Laks
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel. .,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.
| | - Gal Schtrechman
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Ofer Purim
- Department of Oncology, Assuta Samson Hospital, Ashdod, Israel
| | - Vyacheslav Ivanov
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Dan Aderka
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Einat Shacham-Shmueli
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Naama Halpern
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shani Goren
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Daria Perelson
- Department of Anesthesiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
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4
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Narasimhan V, Cheung F, Waters P, Peacock O, Warrier S, Lynch C, Michael M, Ramsay R, Heriot A. Re-do cytoreductive surgery for peritoneal surface malignancy: Is it worthwhile? Surgeon 2020; 18:287-294. [DOI: 10.1016/j.surge.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/10/2019] [Accepted: 11/17/2019] [Indexed: 02/07/2023]
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5
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Jost E, Mack LA, Sideris L, Dube P, Temple W, Bouchard-Fortier A. Evaluation of repeat cytoreductive surgery and heated intraperitoneal chemotherapy for patients with recurrent peritoneal carcinomatosis from appendiceal and colorectal cancers: a multicentre Canadian study. Can J Surg 2020; 63:E71-E79. [PMID: 32080999 DOI: 10.1503/cjs.002519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Peritoneal recurrences after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for appendiceal and colorectal cancers are frequent. This study aimed to evaluate the safety, technical feasibility and perioperative and long-term outcomes of repeat CRS/HIPEC in patients with recurrent peritoneal carcinomatosis of colorectal and appendiceal origin. Methods Data were collected from patients treated from 2000 to 2016 for recurrent peritoneal carcinomatosis from appendiceal or colorectal cancer with CRS/HIPEC at 2 specialist centres. Data on demographics, procedure details, morbidity and survival were recorded. Analyses compared the iterations of CRS/HIPEC to assess the safety and effectiveness of repeat surgery. Results Of all patients who underwent CRS/HIPEC in the 2 centres, 37 patients underwent a repeat procedure. Operative time was similar for the first and second surgeries (412.1 v. 412.5 min, p = 0.74) but patients had a significantly lower peritoneal carcinoma index score with the second surgery (21.8 in the first iteration v. 9.53 in the second iteration, p < 0.001) and significantly less blood loss (1762 mL in the first iteration v. 790 mL in the second iteration, p = 0.001). There was a nonsignificant decrease in grade III–IV complications and there was no 30-day mortality associated with repeat procedures. For patients with colorectal cancer, median disease-free survival was 9.6 months and median overall survival was 40 months. For patients with appendiceal cancer, median disease-free survival was 15 months and overall survival was 64.4 months. Conclusion Repeat CRS/HIPEC procedures for recurrent appendiceal and colorectal peritoneal carcinomatosis are safe in well-selected patients, without increased morbidity or mortality, and they are associated with significant long-term survival, particularly for patients with appendiceal cancers. These results support the use of repeat CRS/HIPEC in these patients.
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Affiliation(s)
- Evan Jost
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Lloyd A. Mack
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Lucas Sideris
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Pierre Dube
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Walley Temple
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
| | - Antoine Bouchard-Fortier
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube)
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6
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Gamboa AC, Zaidi MY, Lee RM, Speegle S, Switchenko JM, Lipscomb J, Cloyd JM, Ahmed A, Grotz T, Leiting J, Fournier K, Lee AJ, Dineen S, Powers BD, Lowy AM, Kotha NV, Clarke C, Gamblin TC, Patel SH, Lee TC, Lambert L, Hendrix RJ, Abbott DE, Vande Walle K, Lafaro K, Lee B, Johnston FM, Greer J, Russell MC, Staley CA, Maithel SK. Optimal Surveillance Frequency After CRS/HIPEC for Appendiceal and Colorectal Neoplasms: A Multi-institutional Analysis of the US HIPEC Collaborative. Ann Surg Oncol 2019; 27:134-146. [PMID: 31243668 DOI: 10.1245/s10434-019-07526-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND No guidelines exist for surveillance following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for appendiceal and colorectal cancer. The primary objective was to define the optimal surveillance frequency after CRS/HIPEC. METHODS The U.S. HIPEC Collaborative database (2000-2017) was reviewed for patients who underwent a CCR0/1 CRS/HIPEC for appendiceal or colorectal cancer. Radiologic surveillance frequency was divided into two categories: low-frequency surveillance (LFS) at q6-12mos or high-frequency surveillance (HFS) at q2-4mos. Primary outcome was overall survival (OS). RESULTS Among 975 patients, the median age was 55 year, 41% were male: 31% had non-invasive appendiceal (n = 301), 45% invasive appendiceal (n = 435), and 24% colorectal cancer (CRC; n = 239). With a median follow-up time of 25 mos, the median time to recurrence was 12 mos. Despite less surveillance, LFS patients had no decrease in median OS (non-invasive appendiceal: 106 vs. 65 mos, p < 0.01; invasive appendiceal: 120 vs. 73 mos, p = 0.02; colorectal cancer [CRC]: 35 vs. 30 mos, p = 0.8). LFS patients had lower median PCI scores compared with HFS (non-invasive appendiceal: 10 vs. 19; invasive appendiceal: 10 vs. 14; CRC: 8 vs. 11; all p < 0.01). However, on multivariable analysis, accounting for PCI score, LFS was still not associated with decreased OS for any histologic type (non-invasive appendiceal: hazard ratio [HR]: 0.28, p = 0.1; invasive appendiceal: HR: 0.73, p = 0.42; CRC: HR: 1.14, p = 0.59). When estimating annual incident cases of CRS/HIPEC at 375 for non-invasive appendiceal, 375 invasive appendiceal and 4410 colorectal, LFS compared with HFS for the initial two post-operative years would potentially save $13-19 M/year to the U.S. healthcare system. CONCLUSIONS Low-frequency surveillance after CRS/HIPEC for appendiceal or colorectal cancer is not associated with decreased survival, and when considering decreased costs, may optimize resource utilization.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mohammad Y Zaidi
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Rachel M Lee
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shelby Speegle
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ahmed Ahmed
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Travis Grotz
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Leiting
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA
| | - Keith Fournier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Lee
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sean Dineen
- Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Andrew M Lowy
- Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA
| | - Nikhil V Kotha
- Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA
| | - Callisia Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sameer H Patel
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tiffany C Lee
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Laura Lambert
- Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ryan J Hendrix
- Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Kara Vande Walle
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Kelly Lafaro
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Byrne Lee
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Jonathan Greer
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Maria C Russell
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Charles A Staley
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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7
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Alzahrani NA, Valle SJ, Fisher OM, Sugarbaker PH, Yonemura Y, Glehen O, Goere D, Honore C, Brigand C, de Hingh I, Verwaal VJ, Deraco M, Baratti D, Kusamura S, Pocard M, Piso P, Maerz L, Marchal F, Moran B, Levine EA, Dumont F, Pezet D, Abboud K, Kozman MA, Liauw W, Morris DL. Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional experience. J Surg Oncol 2018; 119:336-346. [PMID: 30554404 DOI: 10.1002/jso.25277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The aims of this multi-institutional study were to assess the feasibility of iterative cytoreductive surgery (iCRS)/hyperthermic intraperitoneal chemotherapy, iCRS in colorectal peritoneal carcinomatosis (CRPC), evaluate survival, recurrence, morbidity and mortality outcomes, and identify prognostic factors for overall survival. METHODS Patients with CRPC that underwent an iCRS, with or without intraperitoneal chemotherapy, from June 1993 to July 2016 at 13 institutions were retrospectively analyzed from prospectively maintained databases. RESULTS The study comprised of 231 patients, including 126 females (54.5%) with a mean age at iCRS of 51.3 years. The iterative high-grade (3/4) morbidity and mortality rates were 23.4% and 1.7%, respectively. The median recurrence-free survival was 15.0 and 10.1 months after initial and iCRS, respectively. The median and 5-year survivals were 49.1 months and 43% and 26.4 months and 26% from the initial and iCRS, respectively. Independent negative predictors of survival from the initial CRS included peritoneal carcinomatosis index (PCI) > 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI > 10 ( P = 0.03 for PCI 11-20; P < 0.001 for PCI > 20), high-grade complications ( P = 0.012), and incomplete cytoreduction ( P < 0.001). CONCLUSION iCRS can provide long-term survival benefits to highly selected colorectal peritoneal carcinomatosis patients with comparable mortality and morbidity rates to the initial CRS procedure. Careful patient selection is necessary to improve overall outcomes.
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Affiliation(s)
- Nayef A Alzahrani
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia.,College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sarah J Valle
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Oliver M Fisher
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Paul H Sugarbaker
- MedStar Washington Hospital Center, Peritoneal Surface Oncology Unit, Washington, DC
| | - Yutaka Yonemura
- Peritoneal Metastasis Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Olivier Glehen
- Surgical Oncology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Dianne Goere
- Institute Gustave Roussy Cancer Campus, Department of Digestive and Oncology Surgery, Paris, France
| | - Charles Honore
- Institute Gustave Roussy Cancer Campus, Department of Digestive and Oncology Surgery, Paris, France
| | - Cecile Brigand
- General & Digestive Surgery, CHRU Hautepierre, Strasbourg, France
| | - Ignace de Hingh
- Catharina Hospital, Department of Surgery, Eindhoven, Netherlands
| | - Vic J Verwaal
- Catharina Hospital, Department of Surgery, Eindhoven, Netherlands.,Department of Surgical Oncology, Aarhus University Hospital, Denmark
| | - Marcello Deraco
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Dario Baratti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Shigeki Kusamura
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Mark Pocard
- Surgical Oncology Department, St. Louis Hospital Lariboisiere, Paris, France
| | - Pompiliu Piso
- Department of Surgical Oncology, Hospital Barmherzige Brueder Regensburg, Germany
| | - Loreen Maerz
- Department of Surgical Oncology, Hospital Barmherzige Brueder Regensburg, Germany
| | - Frederic Marchal
- Department of Surgical Oncology, Institute of Cancer, Vandoeeuvre Les Nancy, France
| | - Brendan Moran
- Peritoneal Malignancy Department, Basingstoke North Hampshire Hospital, Basingstoke, UK
| | - Edward A Levine
- Wake Forest Baptist Health, Surgical Oncology, Winston-Salem, North Carolina
| | - Frédéric Dumont
- Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - Denis Pezet
- Department of Digestive Surgery, CHU Estaing, Clermont Ferrand, France
| | - Karine Abboud
- Department of General Surgery, CHU Nord, Saint Etienne, France
| | - Mathew A Kozman
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Winston Liauw
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW, Australia
| | - David L Morris
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
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8
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Metastatic Colorectal Cancer to the Peritoneum: Current Treatment Options. Curr Treat Options Oncol 2018; 19:49. [DOI: 10.1007/s11864-018-0563-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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9
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van Eden WJ, Elekonawo FMK, Starremans BJ, Kok NFM, Bremers AJA, de Wilt JHW, Aalbers AGJ. Treatment of Isolated Peritoneal Recurrences in Patients with Colorectal Peritoneal Metastases Previously Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2018; 25:1992-2001. [DOI: 10.1245/s10434-018-6423-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Indexed: 02/06/2023]
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10
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Abstract
Surgical treatment of metastatic colorectal cancer offers a chance for cure or prolonged survival, particularly for those with more favorable prognostic factors and limited tumor burden. The treatment plan requires multidisciplinary evaluation because multiple therapy options exist. Advanced surgical techniques, adjuncts to resection, and modern chemotherapy all contribute to best outcomes for patients with hepatic metastases. Although cure is less common for patients with metastasis to lung or peritoneum, surgical resection for the former and cytoreduction and intraperitoneal chemotherapy for the latter may help to achieve cancer control in selected patients.
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Affiliation(s)
- Jeffery Chakedis
- Division of Surgical Oncology, Department of Surgery, Complex General Surgical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital and Solove Research Institute, 395 West 12th Avenue, Suite 670, Columbus, OH 43210-1267, USA
| | - Carl R Schmidt
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital and Solove Research Institute, 395 West 12th Avenue, Suite 670, Columbus, OH 43210-1267, USA.
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Organoids as preclinical models to improve intraperitoneal chemotherapy effectiveness for colorectal cancer patients with peritoneal metastases: Preclinical models to improve HIPEC. Int J Pharm 2017; 531:143-152. [DOI: 10.1016/j.ijpharm.2017.07.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
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Rajeev R, Turaga KK. Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis. Cancer Control 2016; 23:36-46. [PMID: 27009455 DOI: 10.1177/107327481602300107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Malignant peritoneal disease can lead to significant debility due to bowel obstructions, ascites, and cancer cachexia. Moreover, inadequate imaging techniques can lead to the suboptimal detection of disease, and the poor vascularity of tumors can lead to a poor response to systemic chemotherapy. However, combination cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising novel treatment for patients with this disease. METHODS The medical literature focusing on diagnostic updates and the management of peritoneal disease was reviewed. The application principles of HIPEC for use in peritoneal disease were also summarized. RESULTS Improvements in imaging and the application of laparoscopic techniques have significantly increased the rate of diagnosis of early peritoneal disease with consequently less morbid cytoreductive procedures. Appropriate patient selection based on prognostic scores along with complete cytoreduction can identify a cohort of patients likely to derive durable benefit from this combination treatment. CONCLUSIONS Advances in diagnostic and therapeutic techniques, including surgical cytoreductive techniques, have demonstrated significant survival gains in patients with peritoneal disease. Although HIPEC can be used for the management of various types of histologies, further development of high-level evidence is necessary to advance the field.
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Affiliation(s)
| | - Kiran K Turaga
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Mogal H, Chouliaras K, Levine EA, Shen P, Votanopoulos KI. Repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: review of indications and outcomes. J Gastrointest Oncol 2016; 7:129-42. [PMID: 26941991 DOI: 10.3978/j.issn.2078-6891.2015.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment option in selected patients with peritoneal dissemination from a variety of epithelial primaries. Even though a small proportion will be alive and potentially cured at 10 years, the majority will eventually develop recurrent disease. Repeat CRS/HIPEC is a valid consideration in a selected subpopulation of patients with isolated peritoneal recurrence. This review summarizes the data on patient selection, feasibility, limitations and outcomes of repeat CRS/HIPEC.
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Affiliation(s)
- Harveshp Mogal
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Konstantinos Chouliaras
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Perry Shen
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
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Lungoci C, Mironiuc AI, Muntean V, Oniu T, Leebmann H, Mayr M, Piso P. Multimodality treatment strategies have changed prognosis of peritoneal metastases. World J Gastrointest Oncol 2016; 8:67-82. [PMID: 26798438 PMCID: PMC4714147 DOI: 10.4251/wjgo.v8.i1.67] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/22/2015] [Accepted: 11/11/2015] [Indexed: 02/05/2023] Open
Abstract
For a long time, treatment of peritoneal metastases (PM) was mostly palliative and thus, this status was link with “terminal status/despair”. The current multimodal treatment strategy, consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), has been strenuously achieved over time, but seems to be the best treatment option for PM patients. As we reviewed the literature data, we could emphasize some milestones and also, controversies in the history of proposed multimodal treatment and thus, outline the philosophy of this approach, which seems to be an unusual one indeed. Initially marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources (multi-center and -institutional research), over a period of 30 years, CRS and HIPEC found their place in the treatment of PM. The next 4 years were dedicated to the refinement of the multimodal treatment, by launching research pathways. In selected patients, with requires training, it demonstrated a significant survival results (similar to the Hepatic Metastases treatment), with acceptable risks and costs. The main debates regarding CRS and HIPEC treatment were based on the oncologists’ perspective and the small number of randomized clinical trials. It is important to statement the PM patient has the right to be informed of the existence of CRS and HIPEC, as a real treatment resource, the decision being made by multidisciplinary teams.
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Incidence and treatment of recurrent disease after cytoreductive surgery and intraperitoneal chemotherapy for peritoneally metastasized colorectal cancer: A systematic review. Eur J Surg Oncol 2015; 41:1269-77. [PMID: 26175345 DOI: 10.1016/j.ejso.2015.05.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/24/2015] [Accepted: 05/27/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The optimal treatment for peritoneal carcinomatosis (PC) of colorectal origin is a combination of cytoreductive surgery and intraperitoneal chemotherapy (CRS + IPC). Although 5-year survival rates of up to 40% have been reported, recurrent disease remains common and is estimated to be a strong negative prognostic factor for survival. This systematic review elaborates on the incidence of recurrent disease and the possibilities to prevent and treat recurrence. METHODS Two searches were performed. To identify the magnitude of recurrent the disease, a search was performed in Pubmed and EMBASE until September 2014. A second search was performed in Pubmed to identify treatment of recurrent disease with secondary CRS + IPC. RESULTS The first search resulted in 139 and 94 articles in Pubmed and EMBASE respectively. Among those, 28 were included. Overall recurrence rates ranged from 22.5 to 82%. Local, systemic and combined local-systemic recurrence ranged from 6 to 42.5%, 10.4-43% and 5.8-21.5%. Median time to recurrence varied from 9 to 23 months, three-year disease free survival ranged from 14 to 41.5%. The second search resulted in 140 articles among which 17 met the inclusion criteria. A total of 190 patients underwent secondary CRS. Median survival after the second procedure ranged from 18 to 55.7 months. One, two and three-year survival ranged between 66 and 94, 44-50 and 0-66%. CONCLUSION Recurrence is very common after cytoreductive surgery and intraperitoneal chemotherapy for PC of colorectal origin. Repeat cytoreductive surgery suggests a potential survival benefit for a highly selected group. Therefore, strategies to prevent recurrence are of the utmost importance.
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