Hyperthermic Intraperitoneal Chemotherapy In Patients Research Articles

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Appendix Cancer

Background: Appendiceal cancers are very rare cancers that accounting for only 0.5% of all gastrointestinal malignancies The aim of this study was to report the results of CRS(cytoreductive surgery) and HIPEC(hyperthermic intraperitoneal chemotherapy) treated patients with appendiceal cancers which is based on the experience of at Ankara University School of Medicine, Department of Surgical Oncology.

Case Selection for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Surface Malignancy; Our Experience from Peritoneal MDT.

Case Selection for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Surface Malignancy; Our Experience from Peritoneal MDT.

Second Look Surgery and Hyperthermic Intraperitoneal Chemotherapy for Patients with Colorectal Cancer at High Risk of Peritoneal Carcinomatosis: A Single Center Experience.

Background: Second look surgery, complete cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has the rational to treat patients with high recurrence risk, at an early stage with low peritoneal carcinomatosis index (PCI) score and give a better chance of cure. The purpose of this study is to evaluate our results in terms of morbidity and oncologic benefit for the patient.

Does hipec improve outcomes in gastric cancer patients treated with perioperative chemotherapy and radical surgery? A propensity-score matched analysis.

Hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with improved survival when compared with surgery alone for non-metastatic gastric cancer patients in randomized trials and meta-analyses. However, little evidence is available regarding the use of HIPEC in nonmetastatic patients who are treated with perioperative chemotherapy and radical surgery. The aim of this study was to investigate the putative survival benefit of HIPEC in the subgroup of gastric cancer patients treated with perioperative chemotherapy and surgery. This was a retrospective cohort study that included gastroesophageal junctionand gastric cancer patients who were treated with perioperative chemotherapy and curative resection in a single cancer center in the period between 2006 and 2017. In this time period, younger patients with diffuse-type tumors and serosa invasion or positive lymph node disease were often offered an adjuvant HIPEC protocol. This study compared the survival outcomes of these patients to the ones of those who received only perioperative chemotherapy and resection. A 2:1 propensity-score matched analysis for the two groups was also performed, and variables used were postchemotherapy T (ypT) and N (ypN) stages, histology and tumor site. The study population comprised 269 subjects, 241 treated with chemotherapy and surgery and 28 who also received HIPEC. The mean age was 59 years old (standard deviation: 12.2) and 60% of all individuals were male. A total gastrectomy was performed in 137 patients and a distal resection in 132, with a D2-lymphadenectomy in 97.4% of the sample. Overall 60-day morbidity and mortality rates were 35.3% and 3.3%, respectively. In the HIPEC group, patients were younger, and more frequently had American Society of Anesthesiologists (ASA) 1 to 2 classification, tumors located in the gastric body, had diffuse histology, and ypN+ disease. Overall survival (OS; 5 years) results in the HIPEC and no HIPEC group were 59.5% vs 68.7% (P = .453), and disease-free survival (DFS) ones were 49.5% and 65.8% (P = .060), respectively. In the multivariable Cox regression model, ypT and ypN were independent overall and DFS predictors; also, ASA 3 to 4 classification and diffuse histology were associated with worse OS. In the matched analysis, HIPEC did not improve either overall (53.5% vs 59.5%; P = .517) or DFS (50.0% vs 49.5%; P = .993). Treatment with HIPEC in patients who received perioperative chemotherapy and a D2-resection did not improve survival outcomes. Both ypT and ypN stages remained as the most important survival predictors in this cohort.

Clinical outcomes of curative treatment for colorectal liver metastases combined with cytoreductive surgery and intraperitoneal chemotherapy for peritoneal metastases: a systematic review and meta-analysis of current evidence

Background The optimal treatment for colorectal cancer (CRC) with synchronous peritoneal carcinomatosis (PC) and liver metastases (LM) remains controversial. We aimed to investigate clinical outcomes in patients with CRC and concomitant PC and LM who had undergone curative surgery, including resections at both metastatic sites and synchronous intraabdominal chemotherapy. Methods We searched PubMed, EMBASE, and Web of Science databases for eligible studies. Studies focusing on the clinical effects of curative surgery and synchronous intraabdominal chemotherapy for patients with CRC and concomitant PC and LM were included. Meta-analysis results were recorded as hazard ratios (HRs), risk ratios (RRs) and mean differences. Results We included 9 of 998 identified studies in the meta-analysis, involving 746 patients (221 patients with PC + LM, 525 patients with PC). Overall survival (pooled HR 1.68, 95% confidence interval [CI] 1.33–2.13, p < 0.01) and disease-free survival (pooled HR 1.82, 95% CI 1.51–2.20, p < 0.01) were both lower in patients with PC + LM. A higher recurrence rate (RR 1.22, 95% CI 1.04–1.44, p = 0.02) and major postoperative morbidity (RR 1.47, 95% CI 1.19–1.82, p < 0.01) were also observed in patients with PC + LM. Conclusion Liver resection in combination with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for patients with CRC and synchronous hepatic and peritoneal metastases may be associated with worse survival and higher morbidity compared with patients with isolated PC. More restricted patient inclusion criteria should be established to facilitate an optimal prognosis for this patient group.

Hyperthermic intraperitoneal chemotherapy enhances blood coagulation perioperatively evaluated by thromboelastography: a pilot study

Background and Objectives Postoperative thromboembolism is a significant cause of prolonged recovery in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Thromboelastography (TEG) can detect hypercoagulable states and predict thromboembolic complications after surgery. This study assessed the impact of CRS and HIPEC on TEG values. Methods TEG parameters reaction time (R), kinetics time (K), angle (α), maximum amplitude (MA), and lysis percent at 60 min (LY60) were determined preoperatively, and at the end of CRS, during HIPEC, and at the end of the operation using blood samples from 15 HIPEC patients. Platelets, P-TT, and aPTT were also determined before and after CRS. Results A total of 75 samples were analyzed. During CRS, there was a significant reduction in the mean MA (3.06 mm, p = 0.001). The mean P-TT declined by 32% (p < 0.001) and mean platelets by 55 × 109/L (p < 0.001). During HIPEC, the mean R and K shortened by 1.04 min (p = 0.015) and 0.18 min (p = 0.018), respectively, whereas α increased by 2.48° (p = 0.005). Conclusions During CRS, both TEG and conventional laboratory tests indicated hypocoagulation. During HIPEC, however, the initiation of coagulation and the kinetics of thrombin formation were accelerated.

RETRACTED ARTICLE: Upfront citorreduction and hyperthermic intraperitoneal chemotherapy with paclitaxel in patients with stage III-C serous epithelial ovarian cancer.

The main objective of this retrospective multicenter study, conducted by the Spanish Peritoneal Surgical Oncology Group (GECOP) was to analyze the survival outcomes of patients with stage IIIC serous epithelial ovarian cancer, after cytoreduction and intraoperative administration of hyperthermic intraperitoneal chemotherapy (HIPEC) with paclitaxel. Patients with stage IIIC serous epithelial ovarian cancer were recruited between May 2005 and October 2015, and treated by radical surgery using peritonectomy procedures, and HIPEC with paclitaxel. This multi-institutional retrospective study was carried out using a database containing prospectively collected parameters from five Spanish hospitals that were part of the GECOP. In total, 49 patients participated in the study. Complete cytoreduction (CC-0) was achieved in 38 patients (78%) and an optimal cytoreduction (CC-1) in the remaining 11 patients (22%). Following multivariate analysis, the presence of a Peritoneal Cancer Index (PCI) ≥ 20, and the impossibility of achieving a complete cytoreduction were independent factors associated with lower disease-free survival (DFS). The impossibility of achieving complete cytoreduction of disease, together with a PCI ≥ 14 were associated with an overall lower survival. Those patients with complete cytoreduction and who presented with a PCI < 14, reached a median DFS of 95months and an overall survival (OS) of 123months. HIPEC in patients with primary ovarian cancer is an alternative approach that requires serious evaluation for minimal residual disease treatment after complete cytoreduction.

Status of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer.

Peritoneal carcinomatosis (PC) was previously considered an incurable disease with a poor survival outcome. As our understanding of its biology evolved, the paradigm of the management of PC from colorectal cancer (CRC) has changed, including the combination of macroscopic disease control, cytoreductive surgery (CRS), maximal regional chemotherapy to treat residual microscopic disease, and hyperthermic intraperitoneal chemotherapy (HIPEC). As with many surgical innovations, CRS with HIPEC has evolved faster than data to support it, leaving many skeptics and critics. This review highlights the recent evidence of current practice and outcome of CRS with HIPEC. Furthermore, it also summarizes the ongoing clinical trials and potential future progress of this treatment modality.

Anesthesiological support of cytoreducative operations using hyperthermic intraperitoneal chemotherapy (hipec) in patients with ovaryan cancer

The objective of the study : to analyze the experience of anesthesia when performing cytoreductive surgeries using hyperthermic intraperitoneal chemotherapy in patients with advanced forms of ovarian cancer. Subjects and methods . A pilot study of anesthetic management was conducted in 30 patients with ovarian cancer who underwent multiorgan cytoreductive abdominal resection with hyperthermic intraperitoneal chemotherapy. Results . The risk of anesthesia was 5.18 ± 0.39 points (which corresponded to the III degree of risk) according to the recommendations of the Moscow Scientific Society of Anesthesiology Reanimatology (MSSAR). The total volume of infusion‒transfusion therapy (ITT) was 11.070,0 ± 2.243,5 ml. with the hour rate of 21.7 ± 6.1 ml/kg-1/h-1, due to increase in the volume of crystalloids. Important components of anesthetic management were the patient's thermal stability and antiemetic therapy. Conclusion . As a result of the study, it was revealed that anesthesia in patients during cytoreductive operations with HIPEC was fairly complex and required the participation of a well-trained anesthesiological team. The issue of choosing the scale to assess anesthetic risk due to the lack of optimal one for this type of operations, requires further research. Although in our opinion, the scale of anesthesiological risk of the Moscow Scientific Society of Anesthesiologists-Resuscitators is more preferable. In such operations, the volume of ITT should be increased primarily through balanced crystalloids.

CRS and HIPEC in patients with peritoneal metastasis secondary to colorectal cancer: The small-bowel PCI score as a predictor of survival.

BackgroundCombining cytoreductive surgery (CRS) with Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) can benefit patients with peritoneal metastasis from colorectal cancer. The present study evaluates the small bowel subset of the Peritoneal Cancer Index (Small-Bowel-PCI score (SB-PCI), min-max 0–12) as a prognostic factor in such patients.MethodsWe retrospectively analyzed patients that underwent CRS and HIPEC for recurrent colorectal cancer with peritoneal metastasis. Patient characteristics, procedure details, and clinical outcomes were evaluated.ResultsEighty patients were included. The mean intraoperative PCI-score was 16.8, with a mean SB-PCI score of 5.9. CC0/1 was achieved in 62/80 patients. The mean follow-up period was 26.3 months. Univariate regression analysis showed that the ECOG status, the presence of severe complications, the HIPEC regimen (oxaliplatin vs. mitomycin-C), the PCI score, the SB-PCI score and the completeness of cytoreduction correlated significantly with overall survival. In multivariate analysis, the SB-PCI and CC score were identified as independent prognostic factors of survival. When the SB-PCI was stratified in three groups (0–4, 5–8 and 9–12), Kaplan–Meier curve analysis showed significant difference in survival (p<0.001).ConclusionsThe SB-PCI correlates with overall survival in patients with peritoneal metastases secondary to colorectal cancer in this retrospective cohort. Its use should be validated in prospective patient series.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer.

The management of peritoneal metastases from gastric cancer origin has evolved considerably over the last three decades with the establishment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as efficacious therapies in carefully selected patients. Other approaches such as the use of prophylactic/adjuvant HIPEC in patients who are considered high-risk and those with positive peritoneal cytology will benefit from additional data before being adopted into routine clinical practice. Lastly, there are new and emerging intraperitoneal chemotherapy techniques such as early post-operative intraperitoneal chemotherapy (EPIC) for residual microscopic disease, and pressurized intraperitoneal aerosolized chemotherapy (PIPAC) for patients with advanced unresectable peritoneal carcinomatosis, which are currently under evaluation in clinical trials. The following review outlines the natural history of gastric cancer, currently available neoadjuvant and adjuvant therapies for resectable disease, and existing evidence supporting various approaches to CRS and intraperitoneal chemotherapy.

Adjuvant Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for patients at High-Risk of Peritoneal Metastases

BackgroundSelection of patients for hyperthermic intraperitoneal chemotherapy (HIPEC) continues to evolve. We hypothesized that adjuvant HIPEC for patients at high-risk of peritoneal progression is safe and associated with favorable outcomes. MethodsThe institutional database of a high-volume center was queried for patients with high-risk disease undergoing HIPEC with a peritoneal carcinomatosis index (PCI) of 0. High-risk patients were defined as those with ruptured primary tumors or locally advanced (T4) disease. Results37 patients underwent adjuvant HIPEC, with a median follow-up of 5.2 years. 54% had low-grade (LG) tumors while 46% had high-grade (HG) tumors. No patients underwent neoadjuvant chemotherapy, while eleven patients (32.4%) received adjuvant chemotherapy. There were no perioperative mortalities, and the overall complication rate was 43%. For the entire cohort, five year recurrence-free survival (RFS) and overall survival (OS) were 77% and 100%, respectively. Five year RFS and OS were 75% and 100% for LG patients and 81% and 100% for HG patients, respectively. ConclusionsAdjuvant HIPEC for patients at high-risk of peritoneal progression, with PCI 0, is safe and associated with favorable long-term survival. Additional prospective investigation is needed to identify patient populations who may benefit most from HIPEC.

Identifying the incidence of respiratory complications following diaphragmatic cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy.

In patients with peritoneal carcinomatosis (PC), the incidence of respiratory complications following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is not well established. We aimed to describe the center-specific incidence and patient characteristics associated with respiratory complications following CRS and HIPEC in patients receiving treatment for PC. We used the University Hospital of Arrixaca study database to identify patients who underwent CRS and HIPEC for PC. Patients who experienced a post-operative respiratory complication were categorized according to the National Cancer Institute-Common Terminology Criteria for Adverse Events. Multivariable regression methods were used to identify independent risk factors for developing a respiratory complication following CRS and HIPEC. Between 2008 and 2017, we identified 247 patients who underwent CRS and HIPEC for PC. A total of eight patients (3.2%) were categorized as having a post-operative respiratory complication. A diaphragmatic peritonectomy and a PC index of > 14 were identified as independent risk factors for developing a respiratory complication. Radiographic evidence of a pleural effusion was identified in 72 patients who had CRS of the diaphragmatic peritoneum; however, only 6 (8.3%) of these patients required pleural drainage. Only 3.2% of patients developed a symptomatic respiratory complication following CRS and HIPEC. A pleural effusion was identified in almost all patients requiring a diaphragmatic peritonectomy as part of their CRS; however, less than one in ten of these patients required pleural drainage. Prophylactic insertion of a pleural drainage tube is, therefore, not indicated following CRS and HIPEC.

Adjuvant hyperthermic intraperitoneal chemotherapy in patients with locally advanced colon cancer (COLOPEC): a multicentre, open-label, randomised trial

Nearly a quarter of patients with locally advanced (T4 stage) or perforated colon cancer are at risk of developing peritoneal metastases, often without curative treatment options. We aimed to determine the efficacy of adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with locally advanced colon cancer. This multicentre, open-label trial was done in nine hospitals that specialised in HIPEC in the Netherlands. Patients with clinical or pathological T4N0-2M0-stage tumours or perforated colon cancer were randomly assigned (1:1), with a web-based randomisation application, before resection of the primary tumour, to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy (experimental group) or to adjuvant systemic chemotherapy alone (control group). Patients were stratified by tumour characteristic (T4 or perforation), age (<65 years or ≥65 years), and surgical approach of the primary tumour resection (laparoscopic or open). Key eligibility criteria included age between 18 and 75 years, adequate clinical condition for HIPEC, and intention to start adjuvant systemic chemotherapy. Patients with metastatic disease were ineligible. Adjuvant HIPEC consisted of fluorouracil (400 mg/m2) and leucovorin (20 mg/m2) delivered intravenously followed by intraperitoneal delivery of oxaliplatin (460 mg/m2) for 30 min at 42°C, delivered simultaneously or within 5-8 weeks after primary tumour resection. In all patients without evidence of recurrent disease at 18 months, a diagnostic laparoscopy was done. The primary endpoint was peritoneal metastasis free-survival at 18 months, measured in the intention-to-treat population, with the Kaplan-Meier method. Adverse events were assessed in all patients who received assigned treatment. This study is registered with ClinicalTrials.gov, number NCT02231086. Between April 1, 2015, and Feb 20, 2017, 204 patients were randomly assigned to treatment (102 in each group). In the HIPEC group, two patients withdrew consent after randomisation. In this group, 19 (19%) of 100 patients were diagnosed with peritoneal metastases: nine (47%) during surgical exploration preceding intentional adjuvant HIPEC, eight (42%) during routine follow-up, and two (11%) during diagnostic laparoscopy at 18-months. In the control group, 23 (23%) of 102 patients were diagnosed with peritoneal metastases, of whom seven (30%) were diagnosed by laparoscopy at 18-months and 16 during regular follow-up (therefore making them ineligible for diagnostic laparoscopy). In the intention-to-treat analysis (n=202), there was no difference in peritoneal-free survival at 18-months (80·9% [95% CI 73·3-88·5] for the experimental group vs 76·2% [68·0-84·4] for the control group, log-rank one-sided p=0·28). 12 (14%) of 87 patients who received adjuvant HIPEC developed postoperative complications and one (1%) encapsulating peritoneal sclerosis. In patients with T4 or perforated colon cancer, treatment with adjuvant HIPEC with oxaliplatin did not improve peritoneal metastasis-free survival at 18 months. Routine use of adjuvant HIPEC is not advocated on the basis of this trial. Organization for Health Research and Development and the Dutch Cancer Society.

Correction to: Laparoscopic Hyperthermic Intraperitoneal Chemotherapy for Patients with Gastric Peritoneal Metastases: Limitations and Perspectives.

The title of this paper is corrected as reflected here.

Role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer.

Patients with peritoneal carcinomatosis (PC) of gastric origin have a poor prognosis of life with an average survival of 1-3 months. Systemic chemotherapy has improved the survival of those patients with gastric metastatic cancer at 7-10 months. However, this benefit could not be reproduced in those patients with PC. The current literature for the use of hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric PC has significant variation related to patient selection, treatment intent (palliative vs. attempt at curative treatment), surgical technique, intraperitoneal chemotherapy agent utilized, and systemic chemotherapy administered adjuvantly. From the perspective of patient selection for cytoreduction and HIPEC, patients with extensive PC are not candidates. In addition, unresectable location would make a patient a poor candidate for cytoreduction and HIPEC. Optimally, those with positive peritoneal cytology alone could benefit most. However, the role of cytoreductive surgery and HIPEC in patients with PC of gastric origin has not yet been clarified.

Feasibility and safety of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in patients with advanced stage ovarian cancer: a single-center experience.

ObjectivesFor patients with advanced ovarian cancer, neoadjuvant chemotherapy (NACT) can significantly increase the rate of optimal cytoreduction. However, this does not translate into a survival benefit. The aim of this study was to investigate the feasibility and effect of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy (NLHIPEC).MethodsBetween March 2016 and February 2018, 14 patients with advanced ovarian cancer who were not candidates for optimal cytoreduction via primary debulking surgery (PDS) received NLHIPEC. Their clinical data were retrospectively analyzed.ResultsNo patients experienced intraoperative complications during NLHIPEC. Grade 3 adverse events (AEs) were noted in two (14.3%) patients, and all patients received planned NACT without dose delay or dose reduction. Following NACT, CA125 levels <35 U/mL and <20 U/mL were observed in six (42.9%) patients and five (35.7%) patients, respectively. All patients underwent interval debulking surgery (IDS) after the last NACT cycle. After IDS, R0 resection was achieved in 10 (71.4%) patients without intraoperative injury, and one (7.1%) patient developed a grade 3 AE. During a median follow-up time of 16 months, no patients died of disease, and the median progression-free survival (PFS) was not achieved. Progression was noted in six (42.9%) patients (range, 9–21 months).ConclusionsNLHIPEC appears to be a feasible option for ovarian cancer patients who have a low likelihood of achieving optimal cytoreduction during PDS.

Predictors of morbidity and mortality for patients with peritoneal carcinomatosis secondary to colorectal cancer following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Introduction: Even though cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with high morbidity and mortality rates, it has been reported that CRS and HIPEC improved survival of selected patients with peritoneal carcinomatosis. This study aimed to identify risk factors for severe morbidity and mortality after CRS + HIPEC in patients with peritoneal carcinomatosis secondary to colorectal cancer. Methods: Patients diagnosed with peritoneal carcinomatosis secondary to colorectal origin from March 2012 to December 2017 who underwent CRS + HIPEC were included in the study. All data prospectively entered in the HIPEC registry was analyzed with main focus on grade III–IV morbidity and mortality and factors predicting them. Risk factors were identified using logistic regression analysis. Results: The study included 163 cases of colorectal cancer with peritoneal metastasis; 20 were upfront, 94 interval, and 49 recurrent cases. Mean duration of surgery was 9.5 hours, blood loss 1250 mL and PCI 19. Total, upper quadrant, pelvic, paracolic peritonectomy, glissons capsulectomy, and mesenteric stripping was done in 42.5%, 68.1%, 69.3%, 72.5%, 14.7%, and 4.3%, respectively. Multivisceral resection, diaphragmatic resection, and bowel resection were done in 20.9%, 40.5%, and 57.5%, respectively. Based on Common Terminology Criteria for Adverse Events, the overall rate of morbidity grade III–IV was 18.4 %, the major being surgical 26%, hematological 20%, and electrolyte imbalance 19%. The 60-day mortality rate was 5%. Re-operation rate was 9%. Re-operation was needed in 11% and the mortality rate was 2.4%. In multivariate analysis the identified risk factors for severe morbidity were performance status, mean PCI >14, duration of surgery >10 hours, multivisceral resection, total peritonectomy, upper quadrant peritonectomy, more than one. Conclusion: On evaluating the perioperative outcomes following CRS + HIPEC for peritoneal carcinomatosis secondary to colorectal cancer, the impact on early mortality and morbidity was acceptable. The low mortality rate and 18.4 % grade III–IV morbidity of CRS and HIPEC when weighed against overall benefit is reasonable. Optimal patient selection, such as patients with PCI < 14 with good performance status, seems to be of paramount importance to CRS and HIPEC. This multimodal treatment appears feasible for selected patients and in trained HIPEC centers.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for endometrial cancer-derived peritoneal metastases: a systematic review.

Cytoreductive surgery (CRS) is an appropriate treatment for selected patients with endometrial cancer (EC)-derived peritoneal metastases (PM). Hyperthermic intraperitoneal chemotherapy (HIPEC) may enhance the therapeutic efficacy of CRS in these patients. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify clinical trials and case reports reporting on the safety and efficacy of CRS and HIPEC in patients with EC-derived PM. Eight publications reporting on 68 patients were identified. The mean patient age was 57.1years and the mean time from initial treatment of EC to CRS and HIPEC was 22.3months. 41/64 patients had adenocarcinomas, type II cancers were present in 23/64 patients. The mean peritoneal carcinomatosis index (PCI) was 16.7. A complete surgical resection CC-0 was achieved in 44/63 (70%) patients. The chemotherapy regimens used for HIPEC were variable, but all included cisplatin, administered either alone (39/68 patients) or combined with doxorubicin or paclitaxel or mitomycin (29/68 patients). The duration of HIPEC was 60min in 51/68 patients and 90min in 17/68 patients. Mostly, the closed technique was used (55/68 patients). Adverse events grades 1/2, 3, and 4 were observed in 23/63, 12/63, and 6/63 patients, respectively. Treatment-associated mortality was 1% (1/63). After CRS and HIPEC, most patients received systemic chemotherapy (46/63 patients). Median disease-free and overall survival ranged from 7 to 18 and 12 to 33months, respectively. In conclusion,CRS and HIPEC in EC with PM is safe and feasible. An additional therapeutic value of HIPEC is suggested, but prospective comparative trials are warranted.

ASO Author Reflections: Laparoscopic Hyperthermic Intraperitoneal Chemotherapy for Patients with Metastatic Gastric Cancer.

ASO Author Reflections: Laparoscopic Hyperthermic Intraperitoneal Chemotherapy for Patients with Metastatic Gastric Cancer.