Building an Efficient Peritoneal Surface Malignancies Program Despite the Lower-Middle-Income Barriers: Ukraine Experience

Our plain-English summary of Building an Efficient Peritoneal Surface Malignancies Program Despite the Lower-Middle-Income Barriers: Ukraine Experience, by V. Kopetskyi, M. Antoniv, R. Yarema, et al (JCO Global Oncology, 2024).

The study

• Authors: V. Kopetskyi, M. Antoniv, R. Yarema, V. Maksymovskyi, V. Chetverikova-Ovchinnik, V. Kryzhevskyi, N. Volodko, V. Gushchin, A. Nikiforchin
• Journal: JCO Global Oncology
• Published: 2024;10:e2300432
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) programs are often limited to centers in developed countries because of extensive requirements. We aimed to analyze efficacy and challenges of CRS/HIPEC centers in lower-middle-income settings in the Ukraine example.

Methods: A multicenter descriptive study was conducted using data sets (2008-2022) from Kyiv, Lviv, and Odesa centers. Patients with appendiceal neoplasm (AN); colorectal cancer (CRC); malignant peritoneal mesothelioma (MPM); and epithelial ovarian, fallopian tube, and primary peritoneal cancer (EOC) treated with CRS ± HIPEC were included. Overall survival (OS) was analyzed for N ≥ 20 cohorts using the Kaplan-Meier method.

Results: We included 596 patients. At Kyiv and Lviv centers, 37 and 28 patients with AN had completeness of cytoreduction (CC-0/1) rates of 84% and 71%, respectively. Thirty-day major morbidity stood at 24% and 18%, respectively. Median OS was not reached (NR) at both centers. Nineteen patients with CRC from Kyiv, 11 from Lviv, and 156 from Odesa had CC-0/1 rates of 84%, 91%, and 86%, respectively. Thirty-day major complications occurred in 16%, 18%, and 8%, respectively. Median OS in the Odesa cohort was 35 (95% CI, 32 to 38) months. Among 15 Kyiv, five Lviv, and six Odesa patients with MPM, CC-0/1 rates were 67%, 80%, and 100%, respectively, while major complications occurred in 13%, 0%, and 17%, respectively. OS was not analyzed because of small MPM cohorts. At Kyiv, Lviv, and Odesa centers, 91, 40, and 89 patients, respectively, had primary EOC. CC-0/1 rates were 79%, 100%, and 80%, and 30-day major morbidity rates were 23%, 5%, and 6%, respectively. Median OS was NR, 71 (95% CI, 32 to 110), and 67 (95% CI, 61 to 73) months, respectively.

Conclusion: CRS/HIPEC programs in lower-middle-income environment can achieve safety and survival that meet global standards. Our discussion highlights common obstacles in such settings and proposes effective overcoming strategies.

In plain English

This multicenter descriptive study used 2008-2022 data from Ukraine's three peritoneal cancer surgery centers, in Kyiv, Lviv and Odesa. It looked at results of cytoreductive surgery (removing visible tumor from the abdominal lining), with or without heated chemotherapy delivered into the abdomen (HIPEC). The article does not discuss asbestos or any patient's exposure. Of 596 patients, 26 had malignant peritoneal mesothelioma: 15 in Kyiv, 5 in Lviv and 6 in Odesa. Surgery was complete in 67%, 80% and 100% of these patients respectively, meaning no visible tumor was left or only remnants under 2.5 mm. Major complications within 30 days occurred in 13%, 0% and 17%. Survival was not analyzed for mesothelioma because each center's group was small. The study also reported results for appendiceal, colorectal and ovarian-type cancers. For example, median overall survival for colorectal cancer patients in Odesa was 35 months (95% confidence interval, 32 to 38 months). The authors concluded that such programs in lower-middle-income settings can achieve safety and survival that meet global standards. They noted the retrospective, descriptive design and the lack of follow-up at the Kyiv center.

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: multicenter descriptive study of the centers' data sets (the authors describe the design as retrospective and descriptive)
• Who was studied: 596 patients treated at three Ukrainian centers (Kyiv, Lviv, Odesa), 2008-2022, with peritoneal spread of appendiceal neoplasms, colorectal cancer, malignant peritoneal mesothelioma, or epithelial ovarian, fallopian tube and primary peritoneal cancer; 26 had malignant peritoneal mesothelioma (15 Kyiv, 5 Lviv, 6 Odesa)
• Exposure: No asbestos exposure was studied or reported. The intervention studied was cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (HIPEC).
• Main results:
  • Definition used: cytoreduction was counted as complete when it was CC-0 (no visible residual tumor) or CC-1 (residual lesions under 2.5 mm)
  • Malignant peritoneal mesothelioma patients (15 Kyiv, 5 Lviv, 6 Odesa): complete cytoreduction (CC-0/1) rates were 67%, 80% and 100%, respectively
  • Malignant peritoneal mesothelioma patients: 30-day major complications occurred in 13% (Kyiv), 0% (Lviv) and 17% (Odesa)
  • Survival was not analyzed for malignant peritoneal mesothelioma because the cohorts at each center were small
  • Appendiceal neoplasm patients: complete cytoreduction rate was 84% in Kyiv and 71% in Lviv
  • Colorectal cancer patients at Odesa (the only colorectal cohort with survival analysis): median overall survival 35 months (95% CI, 32 to 38) and median progression-free survival 14 months (95% CI, 13 to 15)
  • Ovarian-type cancer (EOC) at Lviv: median overall survival 71 months (95% CI, 32 to 110) in primary disease and 58 months (95% CI, 43 to 73) in recurrent disease
  • Primary ovarian-type cancer (EOC) at Odesa: median overall survival 67 months (95% CI, 61 to 73)
• The authors' conclusion: The authors concluded that CRS/HIPEC programs in a lower-middle-income environment can achieve safety and survival that meet global standards
• Limitations the authors state:
  • Retrospective and descriptive design
  • The study was not intended as a direct comparison between centers
  • Histologic subtypes of appendiceal neoplasms were not distinguished and were analyzed together
  • Lack of follow-up at the Kyiv center prevented firm conclusions on long-term outcomes
  • The Lviv data set had no progression-free survival data for ovarian-type cancer patients and no records of such patients treated with surgery alone

Topics

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

Related studies

• Feasibility and outcomes of cytoreductive surgery and HIPEC for peritoneal surface malignancies in low- and middle-income countries: a single-center experience of 232 cases — S. Deo, M. Ray, et al. (2021)
• Advancing Treatment Outcomes for Peritoneal Surface Malignancies in Low- and Middle-Income Countries: Insights from the First Multicenter Study in North Africa — A. Souadka, H. Habbat, et al. (2025)
• Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program — T.C. Chua, S. Martin, et al. (2010)
• Drugs, doses, and durations of intraperitoneal chemotherapy: standardising HIPEC and EPIC for colorectal, appendiceal, gastric, ovarian peritoneal surface malignancies and peritoneal mesothelioma — L. Lemoine, P. Sugarbaker, et al. (2017)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Dose-Dependent Effect of Red Blood Cells Transfusion on Perioperative and Long-Term Outcomes in Peritoneal Surface Malignancies Treated with Cytoreduction and HIPEC — E. Nizri, S. Kusamura, et al. (2018)

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