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Liu Y, Yonemura Y, Levine EA, Glehen O, Goere D, Elias D, Morris DL, Sugarbaker PH, Tuech JJ, Cashin P, Spiliotis JD, de Hingh I, Ceelen W, Baumgartner JM, Piso P, Katayama K, Deraco M, Kusamura S, Pocard M, Quenet F, Fushita S. Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases From a Small Bowel Adenocarcinoma: Multi-Institutional Experience. Ann Surg Oncol 2018; 25:1184-1192. [PMID: 29484565 PMCID: PMC5891561 DOI: 10.1245/s10434-018-6369-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The multi-institutional registry in this study evaluated the outcome after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal metastases (PM) from small bowel adenocarcinoma (SBA). METHODS A multi-institutional data registry including 152 patients with PM from SBA was established. The primary end point was overall survival (OS) after CRS plus HIPEC. RESULTS Between 1989 and 2016, 152 patients from 21 institutions received a treatment of CRS plus HIPEC. The median follow-up period was 20 months (range 1-100 months). Of the 152 patients, 70 (46.1%) were women with a median age of 54 years. The median peritoneal cancer index (PCI) was 10 (mean 12; range 1-33). Completeness of cytoreduction (CCR) 0 or 1 was achieved for 134 patients (88.2%). After CRS and HIPEC, the median OS was 32 months (range 1-100 months), with survival rates of 83.2% at 1 year, 46.4% at 3 years, and 30.8% at 5 years. The median disease-free survival after CCR 0/1 was 14 months (range 1-100 months). The treatment-related mortality rate was 2%, and 29 patients (19.1%) experienced grades 3 or 4 operative complications. The period between detection of PM and CRS plus HIPEC was 6 months or less (P = 0.008), and multivariate analysis identified absence of lymph node metastasis (P = 0.037), well-differentiated tumor (P = 0.028), and PCI of 15 or lower (P = 0.003) as independently associated with improved OS. CONCLUSION The combined treatment strategy of CRS plus HIPEC achieved prolonged survival for selected patients who had PM from SBA with acceptable morbidity and mortality.
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Affiliation(s)
- Yang Liu
- NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Japan
- Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Yutaka Yonemura
- NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Japan.
- Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, Osaka, Japan.
- Peritoneal Dissemination Center, Kusatsu General Hospital, Shiga, Japan.
| | - Edward A Levine
- Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Olivier Glehen
- Centre Hospitalo-Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre, France
| | - Diane Goere
- Institut Gustave Roussy Cancer Center, Villejuif, France
| | | | - David L Morris
- University of New South Wales, St George Hospital, Sydney, Australia
| | - Paul H Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, Washington DC, USA
| | | | - Peter Cashin
- Department of Surgical Sciences, Colorectal Surgery, Uppsala University, Uppsala, Sweden
| | - John D Spiliotis
- Department of Surgical Oncology, Metaxa Cancer Memorial Hospital, Pireus, Greece
| | | | - Wim Ceelen
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Joel M Baumgartner
- Division of Surgical Oncology of Moores Cancer Center, University of California San Diego, San Diego, USA
| | - Pompiliu Piso
- Krankenhaus Barmherzige Brueder Regensburg, Regensburg, Germany
| | - Kanji Katayama
- Cancer Care Promotion Center, Medical School Hospital, University of Fukui, Fukui, Japan
| | - Marcello Deraco
- Department of Surgery, National Cancer Institute, Milan, Italy
| | | | - Marc Pocard
- Hopital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Sachio Fushita
- Department of Surgery, Kanazawa University Hospital, Kanazawa University, Kanazawa, Japan
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