Debulking Research Articles

The history of cytoreduction and HIPEC: Heating up or just blowing smoke?

Peritoneal carcinomatosis carries a grim survival prognosis with complications ranging from the physical to the psychological. Cytoreductive surgery and infusion of heated intraperitoneal chemotherapy have evolved to become a commonly used treatment option in the multi-modal management of peritoneal carcinomatosis. Here, we examine the origins of surgery over a century ago as a potential cure for peritoneal carcinomatosis and how it has evolved with our knowledge of the disease to its present state. The origin of chemotherapy is similarly described as well as its progressive application in regional therapy, guided by the ongoing development of new agents, better understanding of peritoneal physiology, and improved systemic treatment. We show how these modalities began to be used in tandem, and standardized, leading to randomized trials and better understanding of the possibilities and limitations of treatment. Finally, we discuss the current status of patient selection for cytoreduction and future directions of intraperitoneal chemotherapy.

Ninety-day readmissions after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in advanced ovarian cancer

Ninety-day readmissions after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in advanced ovarian cancer

ASO Author Reflections: It Does Not Matter Whether Radical Prostatectomy is Performed in High-Risk Localized Disease or at the Oligometastatic Stage.

Radical prostatectomy (RP) alone has traditionally been considered insufficient for patients with high-risk localized prostate cancer (HRPC) owing to the frequent need for adjuvant salvage radiotherapy or androgen deprivation therapy (ADT) following surgery. Previously, systemic therapy, such as ADT, was the standard treatment for metastatic prostate cancer (PC) patients; RP was not considered viable for these patients. However, since 2015, there has been a recognition that metastatic PC patients can be categorized based on the extent of their metastases, leading to the consideration of RP for some metastatic cases. In recent years, the concept of cytoreductive RP has gained traction; studies suggest that it may improve survival rates in metastatic PC patients through mechanisms, such as tumor debulking and enhancement of the immune response. A meta-analysis of retrospective studies has shown that cytoreductive RP is associated with higher cancer-specific survival rates at 1-year, 3-year, and 5-year intervals compared with systemic therapy alone. In our study, which followed HRPC and oligometastatic PC patients for an average of 46 months, we observed biochemical recurrence in 17.8% of HRPC and 13% of oligometastatic patients, with overall survival rates of 96.4% and 87%, respectively. Although prospective or randomized studies are still lacking, current retrospective studies, including our own, suggest promising outcomes for RP in HRPC and oligometastatic patients. With the increasing prevalence of robotic surgery, improved pelvic anatomy observation, and growing surgical confidence, the realization of prospective randomized study results may not be far off.

The impact of the cancer genome atlas status among patients with recurrent endometrioid endometrial carcinoma treated with secondary cytoreductive surgery

The impact of the cancer genome atlas status among patients with recurrent endometrioid endometrial carcinoma treated with secondary cytoreductive surgery

Assessment of the five factor modified frailty index in predicting postoperative complications and non-home discharge in patients undergoing interval cytoreductive surgery for ovarian cancer

Assessment of the five factor modified frailty index in predicting postoperative complications and non-home discharge in patients undergoing interval cytoreductive surgery for ovarian cancer

Cytoreductive surgery for oligometastatic prostate cancer: a promising strategy - correspondence.

Cytoreductive surgery for oligometastatic prostate cancer: a promising strategy - correspondence.

Hypoalbuminemia alone is not a contraindication to primary cytoreductive surgery in advanced ovarian cancer

Hypoalbuminemia alone is not a contraindication to primary cytoreductive surgery in advanced ovarian cancer

Evaluating the risks of pleural effusions and chest tube placement at the time of cytoreductive surgery for advanced ovarian cancer

Evaluating the risks of pleural effusions and chest tube placement at the time of cytoreductive surgery for advanced ovarian cancer

Stepwise approach of hysteroscopic cytoreductive surgery for adenomyosis in patients with recurrent implantation failure

Stepwise approach of hysteroscopic cytoreductive surgery for adenomyosis in patients with recurrent implantation failure

Developing ovarian cancer innovative diversion criteria (OV-Divert) to decrease the rate of diverting ileostomy among patients undergoing cytoreductive surgery for gynecologic malignancy

Developing ovarian cancer innovative diversion criteria (OV-Divert) to decrease the rate of diverting ileostomy among patients undergoing cytoreductive surgery for gynecologic malignancy

Further analysis of phase III, single-dose, open-label study to investigate the efficacy of pafolacianine sodium injection (OTL38) for intraoperative imaging during cytoreductive surgery of folate receptor-positive ovarian cancer (NCT03180307)

Further analysis of phase III, single-dose, open-label study to investigate the efficacy of pafolacianine sodium injection (OTL38) for intraoperative imaging during cytoreductive surgery of folate receptor-positive ovarian cancer (NCT03180307)

Heated intraperitoneal chemotherapy is associated with improved overall survival among advanced-stage ovarian cancer patients undergoing interval cytoreductive surgery: A National Cancer Database analysis

Heated intraperitoneal chemotherapy is associated with improved overall survival among advanced-stage ovarian cancer patients undergoing interval cytoreductive surgery: A National Cancer Database analysis

CA-125 KELIM score predicts progression-free and overall survival in patients with epithelial ovarian cancer undergoing HIPEC at time of interval cytoreductive surgery

CA-125 KELIM score predicts progression-free and overall survival in patients with epithelial ovarian cancer undergoing HIPEC at time of interval cytoreductive surgery

Chemotherapy followed by interval cytoreductive surgery: The most prevalent approach in the upfront treatment of patients with advanced-stage epithelial ovarian cancer in the United States

Chemotherapy followed by interval cytoreductive surgery: The most prevalent approach in the upfront treatment of patients with advanced-stage epithelial ovarian cancer in the United States

Bioethical and Medical-Legal Challenges in Multimodal Cancer Treatment: Addressing Misinformation and Informal, Unregistered Advice

This article addresses the bioethical and medico-legal challenges in the multimodal treatment of cancer, emphasizing the growing gap between therapeutic advances and their clinical implementation. Many patients remain uninformed or lack access to advanced therapies, such as immunotherapy or targeted treatments, due to outdated practices in their healthcare centers. This situation often leads to frustration, as patients feel that not all potential treatment options have been explored. The right of patients to receive clear, informed, and transparent guidance on their treatment is highlighted, as well as the necessity for proper documentation of medical decisions to ensure traceability and protect both the patient and the medical professionals involved. The lack of information or bias directly impacts patient autonomy, limiting their ability to make well-founded decisions. The article also highlights the significant benefits of multimodal therapies, such as cytoreductive surgery and personalized immunotherapy, which have been shown to improve outcomes and quality of life in advanced cancer cases. It calls for treating physicians to act as guides or, when necessary, defer to specialized centers with proven expertise, thus avoiding limiting patients to conventional protocols. The need for a multidisciplinary approach is clear, with a committee of clinical oncologists, radiation-oncologists, surgical oncologists, and pathologists, alongside immuno- oncopathology specialists, being essential to the development of personalized, biologically driven therapies. Advances in cancer treatment confirm the importance of this integrated approach, particularly through collaboration between pathologists and clinical oncologists who have specialized in biotechnology and precision medicine.

Adenomatoid Tumor Mimicking Peritoneal Carcinomatosis: A Case Report.

An adenomatoid tumor (AT) is a benign lesion, which is commonly located in the genital tract of both sexes. We present a case of a 66-yr-old woman with the unusual characteristics of an AT mimicking peritoneal carcinomatosis. The tumor was detected incidentally by ultrasound examination, and an ensuing imaging study raised suspicion of ovarian cancer with peritoneal carcinomatosis. From the pathologic diagnosis of frozen specimens, clear cell carcinoma was noted and the patient subsequently underwent cytoreductive surgery. An 8.5-cm-sized mass was observed on the uterine serosa, extending into the myometrium. In addition, multi-cystic nodular lesions were identified in the omentum, appendiceal and small bowel serosa, and the peritoneum. After histologic and extensive immunohistochemical examinations, the final diagnosis was AT. Recognition of the diverse presentations of AT is crucial for accurate diagnosis and appropriate treatment, as these tumors can involve multiple sites and mimic peritoneal carcinomatosis, potentially leading to a misdiagnosis of malignancy.

Is There a Correlation Between Platelet Count, Mesenteric Lymph Node Involvement, and Hematogenous Metastases in Advanced Stage Ovarian Cancer?

Ovarian cancer remains a major cause of death in women worldwide, mainly due to late diagnosis and the lack of a reliable screening test for early detection of the disease. In this context, attention has been focused on the identification of other prognostic factors that might allow a better identification of cases with worse long-term outcome. Data of patients who underwent cytoreductive surgery between 2014-2019 were retrospectively reviewed and 57 patients were considered eligible for this study. These cases were further classified according to preoperative platelet count, with a cut-off value of 335,000/μl as a positive predictive value for long-term survival. According to this value, there were 27 cases with a preoperative platelet count lower than 335,000/μl and 30 cases with a preoperative platelet count higher than 335,000/μl. Cases in the second group had a significantly higher peritoneal carcinomatosis index (p=0.002), a higher proportion of digestive serosa involvement (p<0.001), and a higher proportion of mesenteric lymph node involvement and hematogenous metastases (p=0.005 and p=0.001, respectively). When analyzing long-term outcomes, all these factors had a significant impact on overall survival. Preoperative thrombocytosis appears to be positively associated with gastrointestinal serosa involvement, mesenteric lymph node invasion, and the presence of hematogenous metastases, thus significantly influencing the long-term outcome of patients with advanced ovarian cancer.

Results of complete cytoreductive strategy in patients with peritoneal metastases of colorectal origin with or without extraperitoneal metastases: A bicentric analysis

BackgroundIncreased survival can be achieved in patients with colorectal cancer peritoneal metastases (CRPM) treated with cytoreductive surgery. The benefit of this strategy remains uncertain when CRPM are associated with extraperitoneal metastases (EPM). The aim of this study was to compare short- and long-term outcomes of patients treated with CRS for CRPM, with or without EPM. MethodsThis study included 413 consecutive patients who underwent CRS for CRPM: 120 with EPM (EPM+) and 293 without (EPM-). Patients with isolated ovarian metastases were included in EPM-group (n = 83). ResultsEPM were mainly located to the liver (66 %,n = 79), retroperitoneal lymph nodes (33 %,n = 40); less frequently to the spleen (9 %,n = 12), lung (9 %,n = 10) or pleura (1 %,n = 1). Ovarian metastases were present in 126 patients (83 in EMP-, 43 in EPM+). Peritoneal carcinomatosis index (PCI) was similar in EPM- (8 [4–14]) and EPM+ (8 [3–13],p = 0.335) groups, as postoperative mortality (3 % vs 3 %,p = 1) and major morbidity rates (28 % vs 35 %,p = 0.223). Median overall survival (mOS) and disease-free survival were significantly higher in the EPM-group (58m vs 39m, and 16m vs 10m,p = 0.003). We highlighted 3 prognostic groups 1) EPM-with PCI<10 (mOS 93m), 2) EPM+ with PCI<10 (mOS 57m), 3) EPM-with 10<PCI<15 (mOS 35m) or EPM+ with 10<PCI<15 (mOS 31m) or PCI>15 regardless EPM (mOS 26m, p < 0.001). ConclusionComplete cytoreductive surgery seems to be feasible in patients with EPM, without increase in postoperative morbidity and mortality compared to patients without EPM. This strategy provides prolonged survival in selected patients with limited peritoneal metastases from colorectal cancer.

Clinical Outcomes of Poly(ADP–Ribose) Polymerase Inhibitors as Maintenance Therapy in Patients with Ovarian Cancer in the Southeastern Region of Korea

Purpose: In this study, we aimed to retrospectively investigate the real-world clinical efficacy and adverse events of poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors in real-world clinical practice among patients with newly diagnosed epithelial ovarian cancer. Methods: We retrospectively reviewed the medical records from hospitals. Patients with epithelial ovarian cancer treated with olaparib or niraparib as frontline maintenance treatment between 1 January 2014 and 31 December 2022 were included. Progression-free survival (PFS) was analyzed using the Kaplan–Meier method, and adverse events associated with PARP inhibitor treatment were investigated. Results: Ninety-six patients treated with PARP inhibitors were identified. The median follow-up period was 21.8 months (95% confidence interval [CI] 19.4–24.0). Twenty (20.1%) patients experienced disease progression, and two patients died. The median PFS was 45.3 months (95% CI 39.4–NA). BRCA1 or BRCA2 gene mutations and primary cytoreductive surgery were associated with better PFS. Adverse events of any grade occurred in 74 (77.1%) patients. Nineteen (19.8%) patients experienced PARP inhibitor therapy interruptions, and 35 (36.5%) patients experienced dose reductions. Only three patients discontinued the drug due to adverse events. Conclusions: In a real-world setting, PARP inhibitors showed efficacy comparable to that reported in published randomized controlled trials and had acceptable safety profiles.

Surgical and oncological outcome after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma : Aretrospective single center experience.

Peritoneal mesothelioma (PM) is arare disease with various histopathological subtypes. For malignant peritoneal mesothelioma and borderline subgroups locoregional therapy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been implemented. The aim of our study was to retrospectively present the outcome after CRS and HIPEC for patients with different subtypes of peritoneal mesothelioma. In total 15patients received CRS and HIPEC due to peritoneal mesothelioma at our tertiary referral hospital between 2013 and 2022. Surgical and oncologic outcomes of 14 of those patients were retrospectively evaluated as one patient was lost to follow-up. The cohort consisted of 9patients with diffuse malignant peritoneal mesothelioma (64.3%), 3patients with multicystic peritoneal mesothelioma (21.4%) and 2patients with well-differentiated peritoneal mesothelioma (14.3%). Complete cytoreduction was possible in 85.7% (n = 12). The major complication rate was 28.6% (n = 4) and the reoperation rate was 14.3% (n = 2). Median follow-up was 55months (standard error, SE 15.0%, 95% confidence interval, CI 25.6-84.4 months). Over this time period 64.3% (n = 9) had no evidence of disease, 21.4% (n = 3) were alive with disease and 14.3% (n = 2) died of peritoneal mesothelioma. The median recurrence-free survival of patients was 13months (SE13.0%, 95% CI 0.0-32.2 months). None of the patients with multicystic peritoneal mesothelioma had evidence of disease at the time of last follow-up. Patients with peritoneal mesothelioma should receive locoregional treatment as good oncological results can be achieved with reasonable postoperative morbidity. Thus, awareness is necessary for this rare but potentially aggressive disease to offer the best medical care.