Abstract
BackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can significantly influence overall and disease-free survival in selected patients suffering from peritoneal surface malignancies (PSM) of various tumor entities. Because of the extent of the therapeutic approach, the associated morbidity and mortality and the multidisciplinarity needed, implementation of a CRS + HIPEC program at an institution is often challenging. MethodsThis single-center analysis included all patients (n = 60, 34 female, 26 male) with PSM from various tumor primaries [colorectal cancer (15/60; 25%), appendix neoplasia (21/60; 35%), and others (24/60; 40%)] treated with CRS + HIPEC at our institution between 2006 and 2014. Charts were reviewed for preoperative patient evaluation, procedure-specific and tumor-specific parameters, morbidity, mortality, tumor recurrence and patients’ overall (OS), and disease-free survival (DFS). ResultsIn 57 of the 60 patients included in the investigation (57/60; 95%), a radical resection (CC 0/1) was achieved. Median operating time was 559 min (253–900) with a median need of packed red blood cells of 1.1 (0–7) or fresh frozen plasma of 4.4 (0–20) concentrates. Twenty (33.3%) patients experienced 24 Dindo-Clavien grade III/IV complications (24/63; 38.1%). Postoperative 30- and 90-day mortality was 0% in our study population. Five-year OS was 43%, 5-year DFS 33%. ConclusionsDue to thorough preoperative patient evaluation, strict inclusion and exclusion criteria, and intense collaboration with other specialties, we were able to achieve an excellent 5-year OS of 43% with a CC score of 0/1 in 95% of our patient population. We were able to demonstrate the feasibility, efficacy, and safety of CRS + HIPEC in patients suffering from PSM at our institution.
Highlights
Peritoneal surface malignancy (PSM) is defined as advanced or terminal stage of a tumor disease and depending on the tumor entity untreated peritoneal surface malignancies (PSM) is associated with death within a brief period of time
With respect to the primary tumor, initial oncologic resection was performed at our surgical department in 42 (42/60; 70%) patients; 18 (18/60; 30%) patients were initially treated at an outside institution and transferred for Cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) (Table 2)
Median OS can be drastically increased with CRS + HIPEC to up to 60 months with a 5year OS of up to 51%
Summary
Peritoneal surface malignancy (PSM) is defined as advanced or terminal stage of a tumor disease and depending on the tumor entity (e.g., gastric cancer) untreated PSM is associated with death within a brief period of time. Since the common assumption of PSM being a systemic metastatic disease changed to the concept of a localized tumor in the peritoneal cavity ( defined as a localized compartment), similar to the occurrence of liver-only metastasis, therapeutic strategies have changed dramatically over the last decade Extensive research in this field evolved multimodal therapeutic approaches combining radical surgical procedures with perioperative and intraoperative chemotherapy with promising results.[4,5,6,7,8] The liaison of complete cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) became a feasible treatment option for several tumor entities with primary or secondary malignancies of the peritoneum We were able to demonstrate the feasibility, efficacy, and safety of CRS + HIPEC in patients suffering from PSM at our institution
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