A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma

Our plain-English summary of A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma, by T.P. Batista, B.J.Q. Sarmento, J.F. Loureiro, et al (Revista Do Colégio Brasileiro de Cirurgiões, 2017).

The study

• Authors: T.P. Batista, B.J.Q. Sarmento, J.F. Loureiro, A. Petruzziello, A. Lopes, C.C. Santos, C.A. Quadros, E.H. Akaishi, E.Z. Cordeiro, F.J.F. Coimbra, G.A. Laporte, L.S. Castro, R.M.S.S. Batista, S. Aguiar, W.L. Costa, F.O. Ferreira, BSSO/SBCO Committee on Peritoneal Surface Malignancies and HIPEC
• Journal: Revista Do Colégio Brasileiro de Cirurgiões
• Published: 2017;44(5):530-544
• Type of article: Guideline
• Language: Portuguese
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.

In plain English

This review article is a proposal by a Brazilian Society of Surgical Oncology committee to standardize cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC: heated chemotherapy circulated through the abdomen during the operation) in Brazil. It covers pseudomyxoma peritonei, appendiceal tumors and diffuse malignant peritoneal mesothelioma. It did not study patients or asbestos exposure. Four members did a non-systematic literature review and drafted it, and the full committee and three experts from outside Brazil reviewed it. For peritoneal mesothelioma, the committee suggested complete parietal peritonectomy (removing the abdominal wall lining). It suggested cisplatin 100mg/m2 plus doxorubicin 15mg/m2, or carboplatin 800mg/m2, each for 60 minutes in 4 liters of fluid. Doses would be reduced by about 30% for specified patients, such as those over 60-70 years. Surgery plus platin-based HIPEC was suggested as the standard first approach. Patients with biphasic or sarcomatoid mesothelioma must not be considered for this treatment. Routine early postoperative intraperitoneal chemotherapy was not recommended. The authors concluded that standardization may improve outcomes and care in Brazil. They noted that high-level evidence was lacking and that the recommendations rested on clinical experience and expert views.

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: Review article presenting a professional society's consensus proposal for standardizing procedures, based on a non-systematic literature review and expert agreement
• Who was studied: No patients were studied. The proposal was developed by the BSSO Committee on Peritoneal Surface Malignancies and HIPEC (Brazil) and externally reviewed by three experts from outside Brazil. It addresses patients with pseudomyxoma peritonei, appendiceal tumors and diffuse malignant peritoneal mesothelioma (DMPM).
• Exposure: No asbestos or other environmental exposure was studied. The subject is a treatment: cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.
• Main results:
  • The committee chose a closed-abdomen HIPEC technique, while stating there are no convincing data favoring any technique.
  • For DMPM, the suggested HIPEC regimens were cisplatin (CDDP) 100mg/m2 plus doxorubicin 15mg/m2, or carboplatin 800mg/m2, each for 60 minutes at 4L of perfusate.
  • For pseudomyxoma peritonei and appendiceal tumors, the suggested regimens were oxaliplatin 360mg/m2 for 30 minutes, or cisplatin plus doxorubicin for 60 minutes, at 4L of perfusate.
  • Drug doses should be reduced by about 30% for specified patients, including those over 60-70 years and those previously exposed to multiple lines of systemic chemotherapy.
  • Patients with biphasic or sarcomatoid DMPM must not be considered for CRS/HIPEC.
  • The committee suggested complete parietal peritonectomy for DMPM, citing a controlled study by Baratti et al.
  • Upfront CRS plus platin-based HIPEC was suggested as the standard approach for DMPM.
  • Early postoperative intraperitoneal chemotherapy (EPIC) should not be given routinely for either disease group.
  • Mitomycin was described as currently unavailable in Brazil.
• The authors' conclusion: The authors concluded that standardizing CRS/HIPEC practices may improve patient outcomes and care standards across Brazilian centers, and may help produce homogeneous data for the developing Brazilian register.
• Limitations the authors state:
  • High-level evidence was lacking for all points addressed, so recommendations were based on clinical experience and expert views.
  • The literature review behind the proposal was non-systematic.
  • The authors' disclaimer states the information should not be relied upon as complete or accurate, nor as a statement of the standard of care.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Chemotherapy, Neoplasm.

Related studies

• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia — A. Galan, P. Rousset, et al. (2018)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)
• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases — M. Dhir, L. Ramalingam, et al. (2017)

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