A Canadian single-centre experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for abdominal malignancies

Our plain-English summary of A Canadian single-centre experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for abdominal malignancies, by R. Nassabein, R. Younan, R. Loungarath, et al (Canadian Journal of Surgery. Journal Canadien de Chirurgie, 2022).

The study

• Authors: R. Nassabein, R. Younan, R. Loungarath, F. Mercier, F. Dagbert, F. Aubin, J.P. Ayoub, M. Tehfé
• Journal: Canadian Journal of Surgery. Journal Canadien de Chirurgie
• Published: 2022;65(3):E342-E351
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has recently shown promise for the treatment of patients with various types of peritoneal carcinomatosis (PC). However, it is an extensive procedure that is associated with a variety of morbidities. We evaluated the safety and clinical outcomes of CRS-HIPEC performed at our centre.

Methods: Patients with abdominal malignancies who underwent CRS-HIPEC between February 2005 and December 2018 at the Centre hospitalier de l'Université de Montréal (CHUM) were retrospectively reviewed.

Results: A total of 141 patients were identified (66 with appendiceal cancer, 62 with colorectal cancer, 10 with mesothelioma and 3 with small intestinal tumours). The median age was 55 years. Median overall survival (OS) was not reached for patients with appendiceal tumours; it was 38.3 months for colorectal cancers. Among patients with colorectal cancer, survival was significantly better for those who received intraperitoneal HIPEC with oxaliplatin (74.9 mo) compared with mitomycin C (29.1 mo) (p = 0.006). Complete cytoreductive surgery and low peritoneal carcinomatosis index were associated with the highest overall survival in patients with appendiceal tumours and those with colorectal tumours.

Conclusion: CRS-HIPEC can be performed with acceptable morbidity in patients with PC. These results validate the outcomes of previously reported trials, but further prospective trials are warranted to determine which patients will most benefit from the addition of HIPEC to CRS.

© 2022 CMA Impact Inc. or its licensors.

In plain English

This retrospective review covered 141 patients whose abdominal cancers had spread to the abdominal lining (peritoneal carcinomatosis). All had cytoreductive surgery combined with heated chemotherapy given inside the abdomen (CRS-HIPEC) at the Centre hospitalier de l'Université de Montréal between February 2005 and December 2018. Of these, 66 had appendiceal cancer, 62 colorectal cancer, 10 mesothelioma and 3 small intestinal tumours. The study did not address asbestos, and the mesothelioma patients were left out of the survival analysis. No patient died within 30 days, and complete removal of visible cancer was achieved in 89 patients (63.1%). Estimated 10-year survival was 89% for one appendiceal tumour type (DPAM) and 75% for another (PMCA). Colorectal cancer patients had a median overall survival of 38.3 months. Among them, those given oxaliplatin had a median of 74.9 months, compared with 29.1 months for those given mitomycin C. The authors noted that mitomycin C went to patients whose disease already had a worse outlook. The authors concluded CRS-HIPEC can be performed with acceptable morbidity. They noted the study was retrospective, small, and had no comparison group without HIPEC.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective single-centre analysis of patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy
• Who was studied: 141 patients (58 male, 83 female; median age 55) with abdominal malignancies with peritoneal spread treated at the Centre hospitalier de l'Université de Montréal, February 2005 to December 2018: 66 appendiceal, 62 colorectal, 10 mesothelioma, 3 small intestinal. Mesotheliomas and small bowel tumours were excluded from the survival analysis.
• Exposure: No asbestos exposure was studied. The exposure examined was the treatment: cytoreductive surgery followed by heated intraperitoneal chemotherapy, mostly mitomycin C (90 minutes) or oxaliplatin (30 minutes) heated to 40 to 42 degrees C.
• Main results:
  • Among all 141 patients, no 30-day mortality was observed.
  • Complete cytoreduction (CC-0) was achieved in 89 patients (63.1%).
  • Estimated 10-year survival was 89% for patients with DPAM and 75% for patients with PMCA (appendiceal tumours).
  • In patients with colorectal tumours, median disease-free survival was 13 months and median overall survival was 38.3 months.
  • In patients with colorectal tumours, the estimated 5-year survival rate was 42%.
  • In colorectal patients, median overall survival was 74.9 months with oxaliplatin versus 29.1 months with mitomycin C (p = 0.006).
  • In colorectal patients, median disease-free survival was 15.7 months with oxaliplatin versus 9 months with mitomycin C (p = 0.017).
  • In PMCA patients, oxaliplatin showed a trend toward better survival that was not statistically significant.
  • In colorectal patients, median overall survival was 41.7 months after complete cytoreduction versus 31.0 months after incomplete cytoreduction (p = 0.02).
  • In colorectal patients, median survival by PCI score was 75.4 months for scores below 11, 32.6 months for scores of 11 to 15, and 28.1 months for scores above 15 (p = 0.002).
• The authors' conclusion: The authors concluded that CRS-HIPEC can be performed with acceptable morbidity in patients with peritoneal carcinomatosis, and that further prospective trials are needed to determine which patients benefit most from adding HIPEC.
• Limitations the authors state:
  • The study was retrospective, with a limited number of patients.
  • Some long-term complications may not have been fully reported because some patients were followed at outside clinics.
  • The patient population may have been highly selected, since surgeons operated only on well, fit patients.
  • There was no comparison group of patients who had CRS without HIPEC.
  • The authors noted that mitomycin C was given to patients whose disease already had a worse prognosis, which can explain the survival difference between chemotherapy groups.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Colon cancer.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Colorectal Cancer, Mesothelioma, Median Overall Survival, Mitomycin C, Overall Survival.

Related studies

• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Asian patients: 100 consecutive patients in a single institution — M.C. Teo, G.H. Tan, et al. (2013)
• Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases — L.S. Kyang, N.A. Alzahrani, et al. (2019)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases — M. Dhir, L. Ramalingam, et al. (2017)
• Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for disseminated intra-abdominal malignancies in children-a single-institution experience — O. Zmora, A. Hayes-Jordan, et al. (2018)

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