A contemporary analysis of morbidity and outcomes in cytoreduction/hyperthermic intraperitoneal chemoperfusion

Michelle Haslinger,Kristopher Attwood,Valerie Francescutti,Judith Andrea Mccart,Marwan Fakih,Joseph J Skitzki,John M Kane

doi:10.1002/cam4.80

Abstract

The risks and benefits of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CS/HIPEC) continue to be debated by the oncology community. A retrospective analysis of contemporary data (2003–2011) was performed to provide objective information regarding surgical morbidity, mortality, and survival for patients undergoing CS/HIPEC at a comprehensive cancer center. While procedure-associated morbidity was comparable to other major surgical oncology procedures, there was no operative or 30-day mortality and 60-day mortality was 2.7%. Increasing numbers of bowel resections were found to correlate to an increased incidence of deep surgical site infections (including abscess and enterocutaneous fistula) and need for reoperation which was in turn associated with a decreased overall survival (OS) and progression-free survival (PFS). Five-year OS rates varied by site of tumor origin and histology (disseminated peritoneal adenomucinosis [91.3%], Mesothelioma [80.8%], Appendiceal Adenocarcinoma [38.7%], and Colorectal Adenocarcinoma [38.2%]). With an acceptable morbidity and mortality rate, CS/HIPEC should be included as an effective treatment modality in the multidisciplinary care of select patients with peritoneal metastases.

Highlights

Peritoneal carcinomatosis (PC) from adenocarcinomas of nongynecologic origin was considered virtually incurable with an average life expectancy of 6 months [1, 2]
The results of our analyses imply that the surgical procedure of cytoreductive surgery (CS)/hyperthermic intraperitoneal chemotherapy (HIPEC) in the contemporary setting can be a 2013 The Authors
Performed safely with minimal postoperative mortality and acceptable morbidity. These data are consistent with low morbidity when including surrogates of complications such as length of stay (LOS) >14 days (24.1% of all patients) and considering the median intensive care unit (ICU) (1 day) and overall hospital stay (12 days)

Summary

Introduction

Peritoneal carcinomatosis (PC) from adenocarcinomas of nongynecologic origin was considered virtually incurable with an average life expectancy of 6 months [1, 2]. Even with the best systemic chemotherapy regimens, current median overall survival (OS) and disease-free survival (DFS) are only 20 and 10 months, respectively [3,4,5]. The clinical application of cytoreduction for nongynecologic malignancies and the addition of concurrent hyperthermic intraperitoneal chemotherapy (HIPEC) for the purpose of eliminating remnant microscopic disease was described [10]. The use of cytoreductive surgery (CS)/HIPEC for nongynecologic malignancies has expanded and is based upon the concept that carcinomatosis is a locoregional phenomenon requiring a locoregional treatment [11]

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Conclusion