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Ionescu S, Marincas M, Madge OL, Dicu-Andreescu IG, Chitoran E, Rotaru V, Cirimbei C, Gherghe M, Ene A, Rosca R, Radu M, Simion L. Ovarian Causes of Pseudomyxoma Peritonei (PMP)-A Literature Review. Cancers (Basel) 2024; 16:1446. [PMID: 38672528 PMCID: PMC11047873 DOI: 10.3390/cancers16081446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing, inadequately understood neoplasm with a 5-year progression-free survival rate of as low as 48%. It is characterized by varying degrees of malignancy and the production of mucinous and gelatinous structures. Typically, the development of pseudomyxoma peritonei is associated with the rupture of appendiceal mucinous tumors and other gastrointestinal or ovarian mucinous tumors. The goal of our literature review was to identify various aspects that characterize the ovarian causes of pseudomyxoma peritonei. MATERIALS AND METHODS The authors performed an extensive literature search between 1 February 2024 and 2 March 2024 on the following databases: Pubmed, Scopus, Oxford Journals, and Reaxys, and the findings were summarized into seven main clinical and paraclinical situations. RESULTS According to our research, the main instances in which pseudomyxoma peritonei can be triggered by an ovarian cause are the following: (1) mucinous cystadenoma; (2) mucinous ovarian cancer; (3) colon cancer with ovarian metastasis; (4) malignant transformation of an ovarian primary mature cystic teratoma; (5) appendiceal mucocele with peritoneal dissemination mimicking an ovarian tumor with peritoneal carcinomatosis; (6) mucinous borderline tumor developing inside an ovarian teratoma; and (7) the association between a mucinous bilateral ovarian cancer and a colonic tumor. CONCLUSIONS In our study, we aimed to provide a comprehensive overview of the ovarian causes of pseudomyxoma peritonei, including its epidemiology, imagery characteristics, symptoms, current treatment, and promising future therapies, in the hopes of finding feasible solutions, as a lack of understanding of this mucus-secreting malignant disease increases the risk of delayed diagnosis or uncontrolled deterioration.
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Affiliation(s)
- Sinziana Ionescu
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Marian Marincas
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Octavia Luciana Madge
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
- Faculty of Letters, University of Bucharest, 030018 Bucharest, Romania
| | - Irinel Gabriel Dicu-Andreescu
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Elena Chitoran
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Vlad Rotaru
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Ciprian Cirimbei
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Mirela Gherghe
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- The Clinical Nuclear Medicine Laboratory, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Adina Ene
- Pathology Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania; (A.E.); (M.R.)
| | - Robert Rosca
- Pathology Department, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Madalina Radu
- Pathology Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania; (A.E.); (M.R.)
| | - Laurentiu Simion
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
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Pawar A, Warikoo V, Salunke A, Sharma M, Pandya S, Bhardwaj A, KS S, Aaron J. Outcomes of minimal access cytoreductive surgery (M-CRS) and HIPEC/EPIC vs. open cytoreductive surgery (O-CRS) and HIPEC/EPIC in patients with peritoneal surface malignancies: a meta-analysis. Pleura Peritoneum 2024; 9:1-13. [PMID: 38558870 PMCID: PMC10980983 DOI: 10.1515/pp-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Minimal Access Surgery (MAS) has shown better peri-operative outcomes with equivalent oncological outcomes in gastrointestinal and thoracic oncology. Open CRS (O-CRS) procedure accompanies inevitable and significant surgical morbidity in patients. The aim of the review article is to compare outcomes of M-CRS and HIPEC/EPIC with open procedure in peritoneal surface malignancies. Content Comprehensive search of databases was done and total 2,807 articles were found (2793-PubMed and 14-Cochrane review). PRISMA flow chart was prepared and 14 articles were selected. Meta-analysis was performed according to PRISMA guidelines using random-effects model (DerSimonian Laird) and fixed effect model. Publication bias was tested with Funnel plot and Egger's regression test. Quality of studies was assessed by Newcastle-Ottawa scale. Summary and Outlook Patients in both groups [total (732), M-CRS(319), O-CRS(413)] were similar in demographic characteristics. Peri-operative outcomes were significantly better in M-CRS group in terms of blood loss SMD=-2.379, p<0.001 (95 % CI -2.952 to -1.805), blood transfusion RR=0.598, p=0.011 (95 % CI 0.402 to 0.889), bowel recovery SMD=-0.843, p=0.01 (95 % CI -1.487 to -0.2), hospital stay SMD=-2.348, p<0.001 (95 % CI -3.178 to -1.519) and total morbidity RR=0.538, p<0.001 (95 % CI 0.395 to 0.731). Duration of surgery SMD=-0.0643 (95 % CI -0.993 to 0.865, p=0.892) and CC0 score RR=1.064 (95 % CI 0.992 to 1.140, p=0.083) had no significant difference. Limited studies which evaluated survival showed similar outcomes. This meta-analysis shows that M-CRS and HIPEC/EPIC is feasible and has better peri-operative outcomes compared to open procedure in patients with limited peritoneal carcinoma index (PCI) peritoneal surface malignancies. Survival outcomes were not calculated. Further studies are warranted in this regard.
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Affiliation(s)
- Ajinkya Pawar
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Vikas Warikoo
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | | | - Mohit Sharma
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | | | - Amol Bhardwaj
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Sandeep KS
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Jebin Aaron
- Department of Surgical Oncology, GCRI, Ahmedabad, India
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Kang SJ, Shin HW, Seo AN, Park SY. Laparoscopic peritonectomy with or without rectal resection for peritoneal metastases of colon cancer involving the pouch of Douglas: a video vignette. Colorectal Dis 2024; 26:572-573. [PMID: 38225793 DOI: 10.1111/codi.16856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Su Jin Kang
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Wook Shin
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - An Na Seo
- Department of Department of Pathology, School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Bortoli N, Tonello M, Pizzolato E, Cenzi C, Pilati P, Sommariva A. Laparoscopic Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Metastasis: Improved Short-term Outcomes Revealed Through Propensity Score Matching Analysis. J Gastrointest Cancer 2024:10.1007/s12029-024-01014-w. [PMID: 38224418 DOI: 10.1007/s12029-024-01014-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the standard of care for selected cases of primary or secondary peritoneal surface malignancies. The study aims to verify the postoperative advantages of laparoscopic CRS-HIPEC. METHODS A retrospective analysis of patients who underwent CRS-HIPEC at our institution was performed. Records were extracted from a prospectively maintained database. Patients were divided into two groups, laparoscopic CRS-HIPEC and open CRS-HIPEC, and matched for age, ASA, comorbidities, Prior Surgical Score (PSS), and Peritoneal Cancer Index (PCI) using propensity score analysis. Demographics, clinical, and operative data were compared between the two groups using chi-square or Fisher's exact test and T-test or Mann-Whitney U test. RESULTS Between 2016 and 2022, 13 patients underwent laparoscopic CRS-HIPEC. These were matched to 32 open CRS-HIPEC patients (1:2.5), obtaining comparable demographics and clinical and preoperative variables. The two groups had a similar duration and complexity of surgery; however, the mean estimated blood loss was lower during laparoscopic procedures (p = 0.008). Overall morbidity rates were lower after laparoscopic CRS-HIPEC (p = 0.043); however, grade III-IV complications, reintervention, and 90-day readmission rates were comparable between the two groups. A faster postoperative recovery in all aspects of the postoperative course was observed, including hospital length of stay (6 vs. 9.5 days, p = 0.003). CONCLUSIONS Laparoscopic CRS-HIPEC is a feasible and safe procedure and shows improved short-term postoperative outcomes in selected patients with limited peritoneal disease compared to the open approach.
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Affiliation(s)
- Nicolò Bortoli
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marco Tonello
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisa Pizzolato
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Carola Cenzi
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Pierluigi Pilati
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
- Advanced Surgical Oncology Unit, Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16/Z, 31033, Castelfranco Veneto, TV, Italy.
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Durán-Martínez M, Gómez-Dueñas G, Rodriguez-Ortíz L, Sanchez-Hidalgo JM, Gordón-Suárez A, Casado-Adam Á, Rufián-Peña S, Valenzuela-Molina F, Rufián-Andujar B, Vázquez-Borrego MC, Romero-Ruiz A, Briceño-Delgado J, Arjona-Sánchez Á. Laparoscopic versus open approach for interval cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced epithelial ovarian cancer: a matched comparative study. Surg Endosc 2024; 38:66-74. [PMID: 37903884 DOI: 10.1007/s00464-023-10508-w] [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: 03/05/2023] [Accepted: 10/01/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND The use of the laparoscopic approach for the treatment of carcinomatosis from epithelial ovarian cancer (EOC) is controversial. The aim of this study was to compare the short-term outcomes of both laparoscopic and open approach for interval CRS+HIPEC in a matched cohort of patients with advanced EOC. METHODS A retrospective analysis of a prospectively maintained database including 254 patients treated with interval CRS-HIPEC between January 2016 and December 2021 was performed. Patients with primary disease and limited carcinomatosis (PCI ≤ 10) were selected. A comparative analysis of patients treated by either open (O-CRS-HIPEC) or the laparoscopic (L-CRS-HIPEC) approach was conducted. Overall survival (OS), disease-free survival (DFS), and perioperative outcomes were analysed. RESULTS Fifty-three patients were finally selected and enrolled into two comparable groups in this study. Of these, 14 patients were treated by interval L-CRS-HIPEC and 39 by interval O-CRS-HIPEC. The L-CRS-HIPEC group had a shorter hospital stay (5.6 ± 1.9 vs. 9.7 ± 9.8 days; p < 0.001) and a shorter time to return to systemic chemotherapy (4.3 ± 1.9 vs. 10.3 ± 16.8 weeks; p = 0.003). There were no significant differences in postoperative complications between both groups. The 2-year OS and DFS was 100% and 62% in the L-CRS-HIPEC group versus 92% and 60% in the O-CRS-HIPEC group, respectively (p = 0.96; p = 0.786). CONCLUSION This study suggests that the use of interval L-CRS-HIPEC for primary advanced EOC is associated with shorter hospital stay and return to systemic treatment while obtaining similar oncological results compared to the open approach. Further prospective research is needed to recommend this new approach for these strictly selected patients.
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Affiliation(s)
| | | | - Lidia Rodriguez-Ortíz
- Surgical Oncology Unit, Reina Sofia University Hospital, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | - Juan Manuel Sanchez-Hidalgo
- Surgical Oncology Unit, Reina Sofia University Hospital, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | - Antonio Gordón-Suárez
- Surgical Oncology Unit, Reina Sofia University Hospital, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | - Ángela Casado-Adam
- Surgical Oncology Unit, Reina Sofia University Hospital, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | - Sebastián Rufián-Peña
- Surgical Oncology Unit, Reina Sofia University Hospital, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | - Francisca Valenzuela-Molina
- Surgical Oncology Unit, Reina Sofia University Hospital, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | - Blanca Rufián-Andujar
- Surgical Oncology Unit, Reina Sofia University Hospital, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | - María Carmen Vázquez-Borrego
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | - Antonio Romero-Ruiz
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain
| | | | - Álvaro Arjona-Sánchez
- Surgical Oncology Unit, Reina Sofia University Hospital, Cordoba, Spain.
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Av. Menendez Pidal, 14004, Cordoba, Spain.
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Arjona-Sanchez A, Aziz O, Passot G, Salti G, Serrano A, Esquivel J, Van der Speeten K, Sommariva A, Kazi M, Shariff U, Martínez-Regueira F, Piso P, Yonemura Y, Turaga K, Sgarbura O, Avanish Saklani A, Tonello M, Rodriguez-Ortiz L, Vazquez-Borrego MC, Romero-Ruiz A, Glehen O. Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Long term oncologic outcomes from the international PSOGI registry. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107001. [PMID: 37579618 DOI: 10.1016/j.ejso.2023.107001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/07/2023] [Accepted: 07/29/2023] [Indexed: 08/16/2023]
Abstract
The laparoscopic approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (L-CRS + HIPEC) in highly selected patients was previously reported from the PSOGI registry with a demonstrable reduction in length of stay and post-operative morbidity. This study aims to update this international PSOGI registry with a larger cohort of patients and a longer follow-up period. METHODS An international registry was designed through a networking database (REDCAP®). All centers performing L-CRS + HIPEC were invited through PSOGI to submit data on their cases. Variables such as demographics, clinical outcomes, and survival were analyzed. RESULTS A total of 315 L-CRS + HIPEC cases were provided by 14 worldwide centers. A total of 215 patients were included in the L-CRS + HIPEC group. The median peritoneal cancer index (PCI) was 3 (3-5). The median length of stay was 7 days (5-10) and the major morbidity (Clavien-Dindo ≥3) was 6.1% after 30 days. The 5-year disease-free survival (DFS) per tumor origin was: 94% for PMP-LG, 85% for PMP-HG, 100% for benign multicyst peritoneal mesothelioma (MPM), 37.4% for colonic origin, and 54%(at 3 years) for ovarian origin. The 5 years overall survival (OS) per tumor origin was: 100% for PMP-LG, PMP-HG and MPM; 61% for colonic origin, and 74% (at 3 years) for ovarian origin. In addition, a total of 85 patients were analyzed in the laparoscopic risk-reducing HIPEC (L-RR + HIPEC). The median length of stay was 5 days (4-6) and the major morbidity was 6% after 30 days. The 5-year DFS per tumor origin was: 96% for perforated low grade appendiceal mucinous neoplasm (LAMN II) and 68.1% for colon origin. The 5 years OS per tumor origin was: 98% for LAMN II and 83.5% for colonic origin. CONCLUSIONS Minimally invasive CRS + HIPEC is a safe procedure for selected patients with peritoneal carcinomatosis in specialized centers. It improves perioperative results while providing satisfactory oncologic outcomes. L-RR + HIPEC represents a promising strategy that could be evaluated in patients with high risk of developing peritoneal carcinomatosis into prospective randomized trials.
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Affiliation(s)
- A Arjona-Sanchez
- Unit of Surgical Oncology, Reina Sofia University Hospital, Cordoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain.
| | - O Aziz
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - G Passot
- Department of Surgical Oncology, Hospices Civils de Lyon, Lyon, France
| | - G Salti
- Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA; The University of Illinois, Chicago, USA
| | - A Serrano
- Unit of Surgical Oncology, University Hospital Fuenlabrada, Madrid, Spain
| | | | | | - A Sommariva
- Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - M Kazi
- Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Mumbai. Homi Bhabha National Institute, Mumbai. Advanced Centre for Treatment, Research, And Education in Cancer, India
| | - U Shariff
- University Hospitals Birmingham NHS Foundation Trust and Birmingham Peritoneal Malignancy Unit, Good Hope Hospital, Birmingham, UK
| | | | - P Piso
- Department for General and Visceral Surgery, Krankenhaus Barmherzige Brueder Regensburg, Germany
| | | | - K Turaga
- Department of Surgery, Yale University School of Medicine, USA
| | - O Sgarbura
- Unit of Surgical Oncology, Institut Du Cancer Montpellier, France
| | - A Avanish Saklani
- Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Mumbai. Homi Bhabha National Institute, Mumbai. Advanced Centre for Treatment, Research, And Education in Cancer, India
| | - M Tonello
- Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - L Rodriguez-Ortiz
- Unit of Surgical Oncology, Reina Sofia University Hospital, Cordoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - M C Vazquez-Borrego
- Unit of Surgical Oncology, Reina Sofia University Hospital, Cordoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - A Romero-Ruiz
- Unit of Surgical Oncology, Reina Sofia University Hospital, Cordoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - O Glehen
- Department of Surgical Oncology, Hospices Civils de Lyon, Lyon, France
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7
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Durán-Martínez M, Gómez-Dueñas G, Rodriguez-Ortíz L, Sanchez-Hidalgo JM, Suárez AG, Casado-Adam Á, Rufián-Peña S, Andujar BR, Valenzuela-Molina F, Vázquez-Borrego MC, Romero-Ruiz A, Briceño-Delgado J, Arjona-Sánchez Á. Learning curve for minimal invasive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) procedures. Langenbecks Arch Surg 2023; 408:146. [PMID: 37046100 DOI: 10.1007/s00423-023-02882-9] [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: 01/04/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE The benefits of the minimally invasive approach for performing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (L-CRS + HIPEC) have been described previously, associating an early recovery with similar oncologic outcomes in patients with limited peritoneal carcinomatosis. Currently, no studies are focusing on the learning curve for this emerging procedure. This study aimed to evaluate the L-CRS + HIPEC learning curve and its knock-on effect on the perioperative outcomes. METHODS We identified all consecutive unselected patients who underwent L-CRS + HIPEC by a single surgeon between April 2016 and January 2022 (n = 51). Patients who underwent risk-reducing CRS + HIPEC (PCI = 0) or initial conversion due to an intraoperative PCI > 10 were excluded from the final analysis. To evaluate the learning curve, perioperative data were analysed using the cumulative sum (CUSUM) analysis. RESULTS Twenty-six patients were included in the final analysis. Major morbidity occurred in one patient (3.8%). The difficulty of the L-CRS + HIPEC procedures was categorised as low in 23.1% (n = 6), intermediate in 19.2% (n = 5), and advanced in 57.7% (n = 15). The mean length of hospital stay was 5.4 ± 1.5 days. No patient had a conversion to open surgery. The learning curve was divided into two distinct phases: the learning phase (1-14) and the consolidation phase (15-26). A significant decrease in the operative time (375 ± 103.1 vs 239.2 ± 63.6 min) was observed with no differences in complexity, the number of peritonectomy procedures, or morbidity. CONCLUSION L-CRS + HIPEC is a complex procedure that must be performed in a high-volume and experienced oncologic unit, requiring a learning curve to achieve the consolidation condition, which could be established after 14 procedures.
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Affiliation(s)
| | | | - Lidia Rodriguez-Ortíz
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Juan Manuel Sanchez-Hidalgo
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Antonio Gordon Suárez
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Ángela Casado-Adam
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Sebastián Rufián-Peña
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Blanca Rufián Andujar
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Francisca Valenzuela-Molina
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - María Carmen Vázquez-Borrego
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | - Antonio Romero-Ruiz
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain
| | | | - Álvaro Arjona-Sánchez
- Unit of Surgical Oncology, University Hospital Reina Sofia, Cordoba, Spain.
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Menendez Pidal Av 14004, Cordova, Spain.
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Wang C, Yin XY, An LB, Zhai XC, Cai Y, Shi GJ, Fan XW, Zhang P, Wang KM, Ma RQ. Significance of laparoscopic cytoreductive surgery for appendiceal pseudomyxoma peritonei with limited disease and low tumor burden. Asian J Surg 2023; 46:1220-1225. [PMID: 36064480 DOI: 10.1016/j.asjsur.2022.08.052] [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: 05/03/2022] [Revised: 07/19/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the clinical value of laparoscopic cytoreductive surgery (CRS) in treating of appendiceal pseudomyxoma peritonei with limited disease and low tumor burden. METHODS The clinical data of patients with appendiceal pseudomyxoma peritonei treated by surgery with CRS at the Aerospace Center Hospital from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into laparoscopic or open CRS groups according to the operation method. A propensity score-matched (PSM) analysis (1:1) was performed, the related clinical variables were compared between the two groups, and the effect on progression-free survival (PFS) was also analyzed. RESULTS One hundred and eight patients were included in this study. After PSM, 33 patients were selected from each group and the age and peritoneal cancer index were matched between the two groups. There were significant differences in operation time (P < 0.001), intraoperative bleeding (P < 0.001), intraoperative blood transfusion (P = 0.007), hospital stay (P < 0.001). The analysis of PFS showed that there was no significant difference between the two operation methods. After multivariate analysis, the pathologic subtype (P = 0.012) was identified as an independent prognostic factor for PFS. CONCLUSION The curative effect of laparoscopic CRS is like that of open operation, which can significantly shorten the operation time and hospital stay and reduce intraoperative bleeding and blood transfusion event. The laparoscopic CRS is safe and feasible in strictly selected patients. The pathologic subtype is an independent factor affecting the prognosis for PFS.
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Affiliation(s)
- Chong Wang
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xiang-Yang Yin
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Beijing, 100049, China
| | - Lu-Biao An
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xi-Chao Zhai
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Ying Cai
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Guan-Jun Shi
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xi-Wen Fan
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Pu Zhang
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Kai-Min Wang
- Department of Hepatobiliary Pancreatic Gastrointestinal, Changchun Tumor Hospital, Jilin, 130000, China.
| | - Rui-Qing Ma
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China.
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9
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Valenzuela CD, Solsky IB, Erali RA, Forsythe SD, Mangieri CW, Mainali BB, Russell G, Perry KC, Votanopoulos KI, Shen P, Levine EA. Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center. Ann Surg Oncol 2023; 30:2666-2675. [PMID: 36754945 DOI: 10.1245/s10434-022-13061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/26/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare diagnosis with a dismal prognosis if untreated. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is shown to significantly improve survival. Our institution is uniquely positioned to report long-term outcomes in MPM with CRS-HIPEC, due to our robust peritoneal surface disease program existing over the past three decades. METHODS Our prospectively maintained, single-institution database of CRS-HIPEC cases was reviewed, identifying 111 consecutive patients with MPM over 28 years (1993-2021). Prognostic, operative, and pathologic factors were reviewed. Overall survival (OS) and conditional survival (CS) analyses were performed. RESULTS The average age was 55.1 years; 58.6% of patients were male; 17 of 111 patients (15.3%) had a second CRS-HIPEC. At first CRS-HIPEC, the average PCI score was 18.7, and the perfusate drugs were platinum-based (72.1%) and mitomycin C (27.9%). The resection status at first CRS-HIPEC was R2a (46.4%), followed by R0-1 (29.1%), and R2b-c (24.5%). Median OS was 3.3 years for the entire cohort, with 75th and 25th percentiles at 10.7 months and 10.6 years. Median CS was improved if patients survived to the 1-year postoperative mark (4.9 years, p < 0.01) and trended toward further improvement with each passing year. If 3-year postoperative survival was achieved, the median CS improved to 6.1 years. CONCLUSIONS This represents one of the largest and lengthiest, single-center, longitudinal, case series of peritoneal mesothelioma treated with CRS-HIPEC. The OS suggests efficacy for CRS-HIPEC for MPM. Long-term survival improves significantly after patients achieve the 1-year, postoperative mark.
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Affiliation(s)
- Cristian D Valenzuela
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Ian B Solsky
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Richard A Erali
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Steven D Forsythe
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Bigyan B Mainali
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Perry Shen
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
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10
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Sommariva A, Valle M, Gelmini R, Tonello M, Carboni F, De Manzoni G, Sorrentino L, Pasqual EM, Bacchetti S, Sassaroli C, Di Giorgio A, Framarini M, Marrelli D, Casella F, Federici O. Laparoscopic Cytoreduction Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Peritoneal Surface Malignancies (PSM): Italian PSM Oncoteam Evidence and Literature Review. Cancers (Basel) 2022; 15:cancers15010279. [PMID: 36612274 PMCID: PMC9818987 DOI: 10.3390/cancers15010279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained increasing acceptance in clinical practice. Performing CRS and HIPEC laparoscopically represents a challenging and intriguing technical evolution. However, the experiences are limited, and the evidence is low. This retrospective analysis was performed on patients treated with laparoscopic CRS-HIPEC within the Italian Peritoneal Surface Malignancies Oncoteam. Clinical, perioperative, and follow-up data were extracted and collected on prospectively maintained databases. We added a systematic review according to the PRISMA method for English-language articles through April 2022 using the keywords laparoscopic, hyperthermic, HIPEC, and chemotherapy. From 2016 to 2022, fourteen patients were treated with Lap-CRS-HIPEC with curative intent within the Italian centers. No conversion to open was observed. The median duration of surgery was 487.5 min. The median Peritoneal Cancer Index (PCI) was 3, and complete cytoreduction was achieved in all patients. Two patients (14.3%) had major postoperative complications, one requiring reintervention. After a median follow-up of 16.9 months, eleven patients were alive without disease (78.6%), two patients developed recurrence (14.3%), and one patient died for unrelated causes (7.1%). The literature review confirmed these results. In conclusion, current evidence shows that Lap-CRS-HIPEC is feasible, safe, and associated with a favorable outcome in selected patients. An accurate patient selection will continue to be paramount in choosing this treatment.
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Affiliation(s)
- Antonio Sommariva
- Advanced Surgical Oncology Unit, Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-423-421306
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Roberta Gelmini
- SC Chirurgia Generale d’Urgenza ed Oncologica, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Marco Tonello
- Advanced Surgical Oncology Unit, Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Fabio Carboni
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | - Lorena Sorrentino
- SC Chirurgia Generale d’Urgenza ed Oncologica, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Enrico Maria Pasqual
- AOUD Center Advanced Surgical Oncology, DAME University of Udine, 33100 Udine, Italy
| | - Stefano Bacchetti
- AOUD Center Advanced Surgical Oncology, DAME University of Udine, 33100 Udine, Italy
| | - Cinzia Sassaroli
- Colorectal Surgical Oncology, Abdominal Oncology Department, “Fondazione Giovanni Pascale” IRCCS, 80131 Naples, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy
| | - Massimo Framarini
- Surgery and Advanced Oncological Therapy Unit, Ospedale “GB.Morgagni-L.Pierantoni”—AUSL Forlì, 47121 Forlì, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy
| | - Francesco Casella
- Upper GI Surgery Division, University of Verona, 37134 Verona, Italy
| | - Orietta Federici
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
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11
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Current Trends in Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Disease from Appendiceal and Colorectal Malignancies. J Clin Med 2022; 11:jcm11102840. [PMID: 35628966 PMCID: PMC9143396 DOI: 10.3390/jcm11102840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is a poor prognostic factor for all malignancies. This extent of metastatic disease progression remains difficult to treat with systemic therapies due to poor peritoneal vascularization resulting in limited drug delivery and penetration into tissues. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are surgical interventions that directly target peritoneal tumors and have improved outcomes for PC resulting from appendiceal and colorectal cancer (CRC). Despite these radical therapies, long-term survival remains infrequent, and recurrence is common. The reasons for these outcomes are multifactorial and signal the need for the continued development of novel therapeutics, techniques, and approaches to improve outcomes for these patients. Here, we review landmark historical studies that serve as the foundation for current recommendations, recent discoveries, clinical trials, active research, and areas of future interest in CRS/HIPEC to treat PC originating from appendiceal and colorectal malignancies.
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12
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Chang SC, Fingerhut A, Chen WTL. Short and long-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal and appendiceal cancer peritoneal metastasis: Propensity score-matched comparison between laparoscopy vs. open approaches. Surg Oncol 2022; 43:101766. [DOI: 10.1016/j.suronc.2022.101766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/11/2022] [Accepted: 04/04/2022] [Indexed: 01/17/2023]
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13
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Sugarbaker PH. Progression of perforated cystadenoma of the appendix to pseudomyxoma peritonei over 18 years. A case report. Int J Surg Case Rep 2022; 91:106756. [PMID: 35032752 PMCID: PMC8760347 DOI: 10.1016/j.ijscr.2022.106756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE In the past, mucinous appendiceal neoplasms (MAN) greater than 2 cm in diameter were treated by a right colon resection. New data shows that treatment options are to be determined by the histopathologic grade of the appendiceal tumor and the condition of the wall of the appendix (intact vs. breached). CASE PRESENTATION A 39-year-old woman had an incidental diagnosis of a low-grade appendiceal mucinous neoplasm (LAMN) at the time of a hysterectomy. The appendiceal tumor had small quantities of mucus surrounding an enlarged appendix. No tumor cells were seen in the mucus by histologic study. The patient was placed in follow-up. Eighteen years later she required treatment for advanced pseudomyxoma peritonei. CLINICAL DISCUSSION When 5 different histopathologic types of MAN are considered with an intact vs. perforated wall of the appendix, four different treatment options develop. With LAMN and well or moderately differentiated mucinous appendiceal adenocarcinoma (MACA), the patient does not require operative intervention if the wall of the appendix is intact. If mucus or mucus plus tumor cells are identified outside the appendix an intervention is indicated. In patients, as the one presented, in whom only small amounts of mucus are outside the appendix, surveillance may be recommended. CONCLUSIONS In patients with a diagnosed low-grade MAN, dissemination to regional lymph nodes is rare. Dissemination to the peritoneal space places the patient at risk to develop pseudomyxoma peritonei. As this case report illustrates, if surveillance is recommended, long-term follow-up is required.
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Affiliation(s)
- Paul H Sugarbaker
- Program in Peritoneal Surface Malignancies, Washington Cancer Institute, Washington, DC, USA.
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14
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Abstract
Peritoneal surface malignancies comprise a heterogeneous group of primary tumours, including peritoneal mesothelioma, and peritoneal metastases of other tumours, including ovarian, gastric, colorectal, appendicular or pancreatic cancers. The pathophysiology of peritoneal malignancy is complex and not fully understood. The two main hypotheses are the transformation of mesothelial cells (peritoneal primary tumour) and shedding of cells from a primary tumour with implantation of cells in the peritoneal cavity (peritoneal metastasis). Diagnosis is challenging and often requires modern imaging and interventional techniques, including surgical exploration. In the past decade, new treatments and multimodal strategies helped to improve patient survival and quality of life and the premise that peritoneal malignancies are fatal diseases has been dismissed as management strategies, including complete cytoreductive surgery embedded in perioperative systemic chemotherapy, can provide cure in selected patients. Furthermore, intraperitoneal chemotherapy has become an important part of combination treatments. Improving locoregional treatment delivery to enhance penetration to tumour nodules and reduce systemic uptake is one of the most active research areas. The current main challenges involve not only offering the best treatment option and developing intraperitoneal therapies that are equivalent to current systemic therapies but also defining the optimal treatment sequence according to primary tumour, disease extent and patient preferences. New imaging modalities, less invasive surgery, nanomedicines and targeted therapies are the basis for a new era of intraperitoneal therapy and are beginning to show encouraging outcomes.
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15
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Bakkers C, Lurvink RJ, Rijken A, Nienhuijs SW, Kok NF, Creemers GJ, Verhoef C, Lemmens VE, van Erning FN, De Hingh IH. Treatment Strategies and Prognosis of Patients With Synchronous or Metachronous Colorectal Peritoneal Metastases: A Population-Based Study. Ann Surg Oncol 2021; 28:9073-9083. [PMID: 34076807 PMCID: PMC8591028 DOI: 10.1245/s10434-021-10190-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to compare treatment strategies and survival of patients with synchronous colorectal peritoneal metastases (CPM) and patients with metachronous CPM in a nationwide cohort. METHODS All patients from the Netherlands Cancer Registry with synchronous or metachronous CPM whose primary colorectal cancer (CRC) was diagnosed between 1 January and 30 June 2015 were included in the study. Treatments were categorized as (A) cytoreductive surgery and hyperthermic intraperitoneal chemotherapy [CRS-HIPEC]; (B) palliative treatment; or (C) best supportive care. Overall survival (OS) for all the patients and disease-free survival (DFS) for those who underwent CRS-HIPEC were compared between the two groups. RESULTS Of 7233 patients, 743 had a diagnosis of CPM, including 409 patients with synchronous CPM and 334 patients with metachronous CPM. The median OS was 8.1 months for the patients with synchronous CPM versus 12 months for the patients with metachronous CPM (p = 0.003). After multivariable correction, OS no longer differed between the patients with synchronous CPM and those with metachronous CPM (HR 1.03 [0.83-1.27]). The patients with metachronous CPM more often underwent CRS-HIPEC than the patients with synchronous CPM (16 % vs 8 %; p = 0.001). The two groups did not differ statistically in terms of DFS and OS (median DFS, 21.5 vs 14.1 months, respectively; p = 0.094; median OS, 37.8 vs. 35.8 months, respectively; p = 0.553). CONCLUSION This population-based study showed that survival for the patients with synchronous CPM and patients with metachronous CPM did not significantly differ. This suggests that a similar prognosis may be expected for patients selected for treatment regardless of the onset of CPM.
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Affiliation(s)
- C Bakkers
- Department of Surgery, Catharina Cancer Institute, P. O. Box 1350, 5602 ZA, Eindhoven, Netherlands
| | - R J Lurvink
- Department of Surgery, Catharina Cancer Institute, P. O. Box 1350, 5602 ZA, Eindhoven, Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands
| | - A Rijken
- Department of Surgery, Catharina Cancer Institute, P. O. Box 1350, 5602 ZA, Eindhoven, Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Cancer Institute, P. O. Box 1350, 5602 ZA, Eindhoven, Netherlands
| | - N F Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - G J Creemers
- Department of Medical Oncology, Catharina Cancer Institute, Eindhoven, Netherlands
| | - C Verhoef
- Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - V E Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands
| | - F N van Erning
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands
| | - I H De Hingh
- Department of Surgery, Catharina Cancer Institute, P. O. Box 1350, 5602 ZA, Eindhoven, Netherlands.
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands.
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.
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Cusumano C, Carrere S, Bouillin A, Nougaret S, Khellaf L, Quénet F, Sgarbura O. Laparoscopic cytoreductive surgery and HIPEC in LAMN with small volume of peritoneal disease: a valuable option of treatment for good patient-related experience measures (PREMs). Surg Endosc 2021; 36:4757-4763. [PMID: 34845545 DOI: 10.1007/s00464-021-08816-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/17/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the best effective treatment for pseudomyxoma peritonei (PMP). In the last years, the advances in histopathology have stratified PMP lesions in different degrees of aggressivity suggesting the possibility of a tailored treatment. In a subset of patients with small volume peritoneal disease, laparoscopic CRS and HIPEC is feasible. The aim of this study is to analyze the results of laparoscopic CRS + HIPEC in a monocentric series of patients under patient-related experience measures (PREMs). METHODS All consecutive patients who underwent laparoscopic CRS-HIPEC with curative intent at Cancer Institute of Montpellier were retrieved from a prospectively maintained database and analyzed. Selection criteria for laparoscopic approach were low-grade PMP with pathological confirmation prior to CRS-HIPEC, age < 75 years, no extra-peritoneal disease, peritoneal cancer index (PCI) < 10, and a limited history of abdominal surgery. A PREMS interview was conducted before analysis with all the included patients. Outcomes of interest included postoperative morbidity, medium-term survival, and PREMs. RESULTS Fourteen patients were operated on for low-grade PMP with a laparoscopic approach at our institution. Conversions to laparotomy were necessary in three patients, and postoperative complications were observed in three patients (Clavien 3b in one patient). In-hospital postoperative median stay was 9.5 days. No death or recurrence was observed during the study period. CONCLUSIONS Laparoscopic CRS-HIPEC for LAMN in presence of small peritoneal disease is feasible in terms of postoperative morbidity and mortality. According to our PREMs questionnaire, patients' expectations were satisfied.
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Affiliation(s)
- Caterina Cusumano
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de HautepierreHôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Molière, 67098, Strasbourg, France
| | - Sébastien Carrere
- Department of Surgical Oncology, Cancer Institute Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier Cedex 05, France
| | - Alix Bouillin
- Department of Surgical Oncology, Cancer Institute Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier Cedex 05, France
| | - Stéphanie Nougaret
- Department of Radiology, Cancer Institute Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier Cedex 05, France
| | - Lakhdar Khellaf
- Department of Pathology, Cancer Institute Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier Cedex 05, France
| | - François Quénet
- Department of Surgical Oncology, Cancer Institute Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier Cedex 05, France
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier Cedex 05, France. .,IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut Régional du Cancer de Montpellier, Université de Montpellier, 34298, Montpellier, France.
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Novel Perspectives in Pseudomyxoma Peritonei Treatment. Cancers (Basel) 2021; 13:cancers13235965. [PMID: 34885075 PMCID: PMC8656832 DOI: 10.3390/cancers13235965] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Pseudomyxoma Peritonei (PMP) represents a rare entity which greatly benefits from Cytoreductive Surgery (CRS) associated with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). In fact, CRS-HIPEC represents the treatment with potential chances of cure and long-term disease control of patients affected by PMP. This therapeutic strategy should be performed in referral centers, where a consolidated know-how of this locoregional treatment and a multidisciplinary approach are available. CRS-HIPEC provides excellent results for PMP patients in terms of postoperative outcome, overall and disease-free survival, and quality of life. However, in patients with an extensive or recurrent disease, few therapeutic opportunities are available. This review is focused on the most recent clinical evidence and provides a better understanding of the molecular prognostic factors and potential therapeutic targets in this rare malignancy. Abstract Pseudomyxoma Peritonei (PMP) is an anatomo-clinical condition characterized by the implantation of neoplastic cells on peritoneal surfaces with the production of a large amount of mucin. The rarity of the disease precludes the evaluation of treatment strategies within randomized controlled trials. Cytoreductive Surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has proven to be the only therapeutic option with potential chances of cure and long-term disease control. The present review discusses the epidemiology, pathogenesis, clinical presentation and treatment of PMP, focusing on the molecular factors involved in tumor progression and mucin production that could be used, in the upcoming future, to improve patient selection for surgery and to expand the therapeutic armamentarium.
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Ceelen W, Demuytere J, de Hingh I. Hyperthermic Intraperitoneal Chemotherapy: A Critical Review. Cancers (Basel) 2021; 13:cancers13133114. [PMID: 34206563 PMCID: PMC8268659 DOI: 10.3390/cancers13133114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Patients with cancer of the digestive system or ovarian cancer are at risk of developing peritoneal metastases (PM). In some patients with PM, surgery followed by intraperitoneal (IP) chemotherapy has emerged as a valid treatment option. The addition of hyperthermia is thought to further enhance the efficacy of IP chemotherapy. However, the results of recent clinical trials in large bowel cancer have put into question the use of hyperthermic intraperitoneal chemotherapy (HIPEC). Here, we review the rationale and current results of HIPEC for PM and propose a roadmap to further progress. Abstract With increasing awareness amongst physicians and improved radiological imaging techniques, the peritoneal cavity is increasingly recognized as an important metastatic site in various malignancies. Prognosis of these patients is usually poor as traditional treatment including surgical resection or systemic treatment is relatively ineffective. Intraperitoneal delivery of chemotherapeutic agents is thought to be an attractive alternative as this results in high tumor tissue concentrations with limited systemic exposure. The addition of hyperthermia aims to potentiate the anti-tumor effects of chemotherapy, resulting in the concept of heated intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal metastases as it was developed about 3 decades ago. With increasing experience, HIPEC has become a safe and accepted treatment offered in many centers around the world. However, standardization of the technique has been poor and results from clinical trials have been equivocal. As a result, the true value of HIPEC in the treatment of peritoneal metastases remains a matter of debate. The current review aims to provide a critical overview of the theoretical concept and preclinical and clinical study results, to outline areas of persisting uncertainty, and to propose a framework to better define the role of HIPEC in the treatment of peritoneal malignancies.
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Affiliation(s)
- Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, 9000 Ghent, Belgium;
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium
- Correspondence: ; Tel.: +32-9332-6251
| | - Jesse Demuytere
- Department of GI Surgery, Ghent University Hospital, 9000 Ghent, Belgium;
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium
| | - Ignace de Hingh
- Department of Surgery, Catharina Cancer Institute, PO Box 1350, 5602 ZA Eindhoven, The Netherlands;
- GROW—School for Oncology and Developmental Biology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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Garrett C, Steffens D, Ansari N, Koh C. A phase I, nonrandomized controlled trial demonstrating the novel technique of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy utilizing warm humidified carbon dioxide insufflation. Colorectal Dis 2021; 23:1573-1578. [PMID: 33599086 DOI: 10.1111/codi.15588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/25/2021] [Accepted: 02/11/2021] [Indexed: 12/12/2022]
Abstract
AIM The aim of this work was to report on the safety and feasibility of warm humidified CO2 (WHCO2 ) insufflation during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHOD Ten consecutive patients with histologically confirmed peritoneal cancer were enrolled in this phase I pilot nonrandomized controlled trial. They were alternately assigned to CRS and HIPEC with WHCO2 versus standard procedure. WHCO2 was delivered at 10 L/min, a pressure of 4.5 bar, 37ºC and 98% relative humidity during CRS using the HumiGardTM system. HIPEC was performed with an open abdomen using the Coliseum technique at 42ºC for 60 min. All patients were admitted to the intensive care unit and commenced on total parenteral nutrition postoperatively. Surface and core temperatures were measured every 30 min using an infrared camera and nasopharyngeal probe, respectively. Clinicopathological, intra- and postoperative details were collated between groups, and median surface and core temperatures were statistically compared. RESULTS Surface and core temperatures were generally higher in the WHCO2 group. Core temperature at 120 and 180 min was significantly higher in the WHCO2 versus the non-WHCO2 group (p = 0.028 and 0.008, respectively). There was a significant linear relationship between core and surface temperature at 30, 60, 90, 120, 150 and 180 min (p = 0.033, 0.004, 0.007, 0.021, 0.009 and 0.006, respectively). The peritoneal cancer index was lower but the estimated blood loss was higher in the non-WHCO2 than the WHCO2 group. CONCLUSION WHCO2 in CRS and HIPEC appears to be safe and feasible. An appropriately powered phase II trial will be required to determine if WHCO2 is associated with improved intra- and postoperative outcomes.
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Affiliation(s)
- Celine Garrett
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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