Assessing morbidity, mortality, and survival in patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Our plain-English summary of Assessing morbidity, mortality, and survival in patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, by J.S.A. Vallejo, F.L. Queiroz, A. Lacerda Filho, et al (Revista Do Colégio Brasileiro de Cirurgiões, 2023).

The study

• Authors: J.S.A. Vallejo, F.L. Queiroz, A. Lacerda Filho, P.R. França Neto, B.X.M.D. Costa, R.A. Paiva, S.L.M. Garcia, S.B. Silva
• Journal: Revista Do Colégio Brasileiro de Cirurgiões
• Published: 2023;50:e20233421
• Language: Portuguese
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: Peritoneal carcinomatosis (PC) indicates advanced stage cancer, which is generally associated with a poor outcome and a 6 to 12 months. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an option for treating patients with primary PC, such as mesothelioma, or secondary PC, such as colorectal cancer (CRC) or pseudomixoma. Until recently, such patients were deemed untreatable. The purpose of this study was to assess the results of CRS + HIPEC in patients with PC. Postoperative complications, mortality and survival rates were evaluated according to the diagnosis.

Results: Fifty-six patients with PC, undergoing full CRS + HIPEC between October 2004 and January 2020, were enrolled. The mortality rate was 3.8% and the morbidity rate was 61.5%. Complications were significantly higher in proportion to the duration of surgery (p<0.001). The overall survival rates, as shown in the Kaplan-Meyer curve, were respectively 81%, 74% and 53% at 12, 24 and 60 months. Survival rates according to each diagnosis for the same periods were 87%, 82% and 47% in patients with pseudomixoma, and 77%, 72% and 57% in patients with CRC (log-rank 0.371, p=0.543).

Conclusion: CRS with HIPEC is an option for pacients with primary or secondary PC. Although complication rates are high, a longer survival rate may be attained compared to those seen in previously published results; in some cases, patients may even be cured.

In plain English

In this retrospective, observational study from the Felício Rocho Hospital in Brazil, the authors reviewed 56 patients with peritoneal carcinomatosis (cancer spread across the abdominal lining). All had complete cytoreductive surgery plus heated chemotherapy inside the abdomen (HIPEC) between October 2004 and January 2020. Twenty-four had pseudomyxoma, 19 had colorectal cancer and 13 had other tumors, including two mesotheliomas, which were not analyzed separately. The complication table covered only 52 of the 56 patients: 32 of them (61.5%) had complications, 23 graded severe (Clavien-Dindo type IV), and 2 (3.8%) died within 30 days. Complications were significantly more frequent the longer the operation lasted. Overall survival was 81% at 12 months, 74% at 24 months and 53% at five years. Five-year survival was 47% for pseudomyxoma and 57% for colorectal cancer; the difference between these groups was not statistically significant. Patients with other diagnoses, including mesothelioma, had 56% survival at 24 months. The authors concluded that the treatment is an option despite high complication rates, and called for randomized studies. They noted the small sample and the lack of a control group.

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, observational single-hospital study (case series without a control group)
• Who was studied: 56 patients with peritoneal carcinomatosis treated at the Felício Rocho Hospital, Brazil, October 2004 to January 2020: 24 pseudomyxoma, 19 colorectal cancer, 13 other (one gastric cancer, seven ovary tumors, two mesotheliomas, one sarcoma, one neuroendocrine tumor)
• Exposure: No asbestos exposure was studied. The exposure was the treatment: complete cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy at 40°C to 42°C, using Mitomycin C, Oxaliplatin with intravenous 5-FU, or Cisplatin (4 cases)
• Main results:
  • Complications occurred in 32 patients (61.5%), of which 23 were severe (Clavien-Dindo type IV). The complication table (Table 4) accounts for 52 patients: 20 without complications and 32 with complications, including 2 grade V (deaths). The percentages therefore correspond to 32 of 52 and 2 of 52, not to all 56 patients. The article does not explain the other four patients.
  • Death within the first 30 days occurred in 3.8% of patients (2 of the 52 in the complication table)
  • Complications were significantly more frequent with longer surgical time (p<0.001)
  • Overall survival for all patients was 81% at 12 months, 74% at 24 months and 53% at five years
  • Survival at 12 months, 24 months and five years was 87%, 82% and 47% for pseudomyxoma and 77%, 72% and 57% for colorectal cancer (log-rank 0.371, p=0.543)
  • Patients with other diagnoses (including the two mesotheliomas) had survival of 56% at 24 months
  • Severe (type IV) complications occurred in 19 of 38 patients (50%) given Mitomycin, with two (5%) deaths, and in 5 of 14 (36%) given Oxaliplatin; the authors described this as a trend (p=0.078)
  • Disease-free survival was 86% at 12 months and 55% at 60 months for colorectal cancer, and 81% and 76% for pseudomyxoma (p=0.248)
• The authors' conclusion: The authors concluded that CRS with HIPEC is an option for patients with primary or secondary peritoneal carcinomatosis. Although complication rates are high, they wrote that longer survival may be attained than in previously published results. They also stated that more prospective, randomized studies are needed to determine whether adding HIPEC to CRS is beneficial.
• Limitations the authors state:
  • Small sample size, no control group that did not receive HIPEC, and no randomization of the drug used (Oxaliplatin versus Mitomycin)
  • Too few patients with sarcoma, mesothelioma, ovarian and gastric tumors for a detailed analysis of those tumor types

Topics

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

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

Related studies

• Phase II Trial of Adjuvant Dendritic Cell Vaccine in Combination with Celecoxib, Interferon-α, and Rintatolimod in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases — R. Ramanathan, H. Choudry, et al. (2021)
• Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• A Canadian single-centre experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for abdominal malignancies — R. Nassabein, R. Younan, et al. (2022)
• Repeated cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with recurrent peritoneal carcinomatosis — N. Vassos, T. Förtsch, et al. (2016)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)

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