Clinical course for patients with peritoneal carcinomatosis excluded from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Our plain-English summary of Clinical course for patients with peritoneal carcinomatosis excluded from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, by A.P. Rodt, R.O. Svarrer, L.H. Iversen (World Journal of Surgical Oncology, 2013).

The study

• Authors: A.P. Rodt, R.O. Svarrer, L.H. Iversen
• Journal: World Journal of Surgical Oncology
• Published: 2013;11:232
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Cytoreductive surgery combined with 'Hyperthermic IntraPEritoneal Chemotherapy' (HIPEC) represents the only potentially curative treatment available for carcinomatosis secondary to colorectal cancer (CRC), pseudomyxoma peritonei (PMP), malignant peritoneal mesothelioma (MM) and goblet cell carcinoma (GCC). Despite preoperative investigation some patients are excluded perioperatively because of unacceptably massive tumor extent. The data available on the clinical course of these patients are sparse. The aim of this study was to investigate mortality, morbidity and clinical course for patients who were excluded.

Methods: This was a retrospective observational study based on records from 35 patients (21 men, 14 women) treated in a national center (Surgical Department P, Aarhus University Hospital) from June 2006 to August 2011 and excluded from the cytoreductive surgery perioperatively. The study population included patients aged 18 to 70 years with CRC (n = 19), PMP (n = 11), MM (n = 3) or GCC (n = 2). Vital status was obtained by 29 November 2012. Three patients were lost to follow-up.

Results: The 30-day mortality rate was 0%. Postoperative complications within 30 days occurred in three patients (9.4%). In all, 19 patients (54%) had palliative surgery during exploratory laparotomy. In total, 28 patients (88%) received postoperative palliative chemotherapy. The median survival for CRC and PMP patients was 12.7 (95% CI 4.0 to 21.4) and 26.9 (95% CI 25.7 to 28.1) months, respectively.

Conclusions: Exploratory laparotomy for intended curative treatment of peritoneal carcinomatosis did not imply major morbidity or mortality for patients excluded from treatment due to advanced stage of disease.

In plain English

This retrospective study from a Danish national referral center (Aarhus University Hospital) followed 35 patients with peritoneal carcinomatosis (cancer spread over the abdominal lining). Between June 2006 and August 2011, their disease was found during the operation to be too extensive for planned cytoreductive surgery with heated abdominal chemotherapy (HIPEC). Nineteen had colorectal cancer, 11 pseudomyxoma peritonei, 3 malignant peritoneal mesothelioma and 2 goblet cell carcinoid. None died within 30 days of the exploratory operation. Postoperative records were missing for three patients. Among the others, three (9.4%) had complications within 30 days and 28 (88%) received palliative chemotherapy. Nineteen of 35 (54%) had palliative surgery during the operation. Median survival was 12.7 months (95% confidence interval 4.0 to 21.4) for colorectal cancer and 26.9 months (95% confidence interval 25.7 to 28.1) for pseudomyxoma peritonei. For the three mesothelioma patients, median survival was not reached: two were alive at 32.9 and 45.8 months, and one died within 8.7 months. The authors concluded that the exploratory operation was not associated with considerable morbidity or mortality. They cited small, selected groups and retrospective data as limitations.

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 study. Patients were registered prospectively at the time of operation, and follow-up data were collected retrospectively from records.
• Who was studied: 35 patients (21 men, 14 women) at the Department of Surgery P, Aarhus University Hospital, Denmark, a national referral center. All were excluded during surgery from planned cytoreductive surgery and HIPEC between 1 June 2006 and 1 August 2011: 19 with colorectal cancer, 11 with pseudomyxoma peritonei, 3 with malignant peritoneal mesothelioma and 2 with goblet cell carcinoid.
• Exposure: No asbestos or fiber exposure was studied. The study examined exploratory laparotomy at the scheduled operation, followed by palliative chemotherapy. Palliative surgery was done at the surgeon's discretion, for example omentectomy, bowel resection or bypass, and debulking in mesothelioma patients.
• Main results:
  • 30-day postoperative mortality after the exploratory laparotomy was 0%. Vital status was available for all 35 patients.
  • Postoperative data (complications, readmissions, palliative surgery after discharge) were missing for three patients. The article does not state a denominator for these outcomes. Worked out as 35 minus those 3, it would be 32, which matches the printed percentages.
  • Postoperative complications within 30 days occurred in three patients (9.4%). All three had at least two palliative procedures. The 9.4% matches 3 out of 32, the 35 patients minus the 3 with missing postoperative data; the article does not print that denominator.
  • Palliative surgery was performed during the exploratory operation in 19 of all 35 patients (54%).
  • 28 patients (88%) received palliative chemotherapy. The 88% matches 28 out of 32, the 35 patients minus the 3 lost to follow-up; the article does not print that denominator. Among colorectal cancer patients, 14 (82%) received chemotherapy, and 2 were lost to follow-up.
  • In colorectal cancer and pseudomyxoma patients, chemotherapy started somewhat later after palliative surgery than after exploration only. The difference was not statistically significant (P=0.66 and P=0.90).
  • Secondary operative intervention was later needed in eight patients (25%).
  • Median survival was 12.7 months (95% CI 4.0 to 21.4) for colorectal cancer patients and 26.9 months (95% CI 25.7 to 28.1) for pseudomyxoma peritonei patients.
  • For the 3 malignant peritoneal mesothelioma patients, median survival was not reached. Two were still alive at 32.9 and 45.8 months, and the third died within 8.7 months.
  • Patients who had died by the time of follow-up spent 7% (pseudomyxoma) to 10% (colorectal cancer) of their remaining time in hospital.
• The authors' conclusion: The authors concluded that exploratory laparotomy before planned cytoreductive surgery and HIPEC was not associated with considerable morbidity or mortality in patients excluded during the operation.
• Limitations the authors state:
  • Data collection had the limitations of a retrospective study.
  • Postoperative complications may be underreported in patient records.
  • The groups were very small, especially mesothelioma (three patients) and goblet cell carcinoid (two patients), so the authors focused mainly on colorectal cancer and pseudomyxoma patients.
  • Patients were a selected group already judged fit for major surgery, which could bias results toward a better outcome.
  • The study is of limited size.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Colorectal Cancer, Peritoneal Mesothelioma, Carcinoma, Palliative Care, Laparotomy, Chemotherapy.

Related studies

• Repeated cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with recurrent peritoneal carcinomatosis — N. Vassos, T. Förtsch, et al. (2016)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)
• 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)
• 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)

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