Abstract
ObjectivesPerception of cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) for treating peritoneal surface malignancies (PSM) differ widely among physicians.MethodsThis on-site survey performed during a major oncology congress in 2019 evaluated the current opinion, perceptions, knowledge and practice of HIPEC and PIPAC among oncologists in India.ResultsThere were 147 respondents (gynecologists (30%), surgical oncologists and gastrointestinal surgeons (64%), and medical oncologists (6%)). Whereas most respondents considered CRS and HIPEC an appropriate therapeutic option, 25% would not recommend CRS and HIPEC. The main barriers to referral to an expert center were inaccessibility to such a center (37.8%), non-inclusion of CRS and HIPEC in clinical practice guidelines (32.4%), and a high morbidity/mortality (21.6%). Variations were found in the various practice patterns of CRS/HIPEC like eligibility criteria, HIPEC protocols and safety measures. Although PIPAC awareness as a novel therapeutic option was high, only a limited number of centers offered PIPAC, mainly because of non-access to technology and missing training opportunities (76.2%).ConclusionsLack of widespread acceptance, poor accessibility and low utilization presents a significant challenge for HIPEC and PIPAC in India. There is a need to raise the awareness of curative and palliative therapeutic options for PSM. This might be achieved by the creation of expert centers, specialized training curricula and of a new sub-speciality in oncology.
Highlights
IntroductionThe multimodality treatment of cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) combines radical surgery with circulation of heated chemotherapy in the peritoneal cavity
Peritoneal surface malignancies (PSM) represents a special locoregional disease pattern limited to the abdominal cavity and has traditionally been considered a death sentence by the medical fraternity due to the very poor prognosis and dismal survival of 6–12 months [1, 2].The multimodality treatment of cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) combines radical surgery with circulation of heated chemotherapy in the peritoneal cavity
More than half the doctors (53.7%) had not been involving any peritoneal surface malignancies (PSM) specific treatment at the time of survey while 30.6% were working in the department which offered CRS/hyperthermic intraperitoneal chemotherapy (HIPEC). 25.9% of the respondents were actively involved in offering CRS/HIPEC to their patients and 8.2% offered pressurized intraperitoneal aerosol chemotherapy (PIPAC)
Summary
The multimodality treatment of cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) combines radical surgery with circulation of heated chemotherapy in the peritoneal cavity This is a therapeutic option showing improved outcomes and quality of life compared to standard systemic chemotherapy for appropriately selected patients with PSM. Somashekhar et al.: Practice patterns and knowledge regarding HIPEC and PIPAC chemotherapy into the abdominal cavity by laparoscopy as an aerosol under pressure. This concept seems to enhance the effectiveness of intraperitoneal chemotherapy by taking advantage of the physical properties of gas and pressure by generating an artificial pressure gradient and enhancing tissue uptake and distributing drugs homogeneously within the closed and expanded peritoneal cavity. Recommendations of operative technique, safety checklist and treatment protocols are well established [9,10,11,12]
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