Current practice in cytoreductive surgery and HIPEC for metastatic peritoneal disease: Spanish multicentric survey

Our plain-English summary of Current practice in cytoreductive surgery and HIPEC for metastatic peritoneal disease: Spanish multicentric survey, by R. Morales-Soriano, N. Esteve-Pérez, J.J. Segura-Sampedro, et al (European Journal of Surgical Oncology, 2018).

The study

• Authors: R. Morales-Soriano, N. Esteve-Pérez, J.J. Segura-Sampedro, P. Cascales-Campos, P. Barrios, Spanish Group of Peritoneal Malignancy Surface (GECOP)
• Journal: European Journal of Surgical Oncology
• Published: 2018;44(2):228-236
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers.

Aim Of The Study: To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC.

Patients And Methods: All 25 members of the Spanish Surface Peritoneal Malignancy (GECOP), were invited to answer an online survey, to describe their usual practice in different perioperative areas of the CRS-HIPEC.

Results: Survey was responded by 100% of centers. This study represents more than 800 patients treated annually. Seventy per cent of respondents perform CRS-HIPEC for more than 5 years. The most frequent technique was Coliseum (88%). Routinely non-invasive monitoring of cardiac output is used by 92% of centers. More than 50% of centers administer oxaliplatin (74%), or mitomycin-C (65%) in colorectal cancer; cisplatin in gastric cancer (73%) and mesothelioma (74%). Ovarian cancer is treated with cisplatin and various combinations, in 64% or paclitaxel in 54.5%. Spillage protocol was available in 100% centers.

Conclusions: Data showed an important variability in volume of patients per center, selection of cytostatic agents, professional training and safety measures applied. The standardization of CRS/HIPEC procedures based on the best available evidence, the individualization of patients and the consensus among professionals, constitute an important part of the basis that will allow us to improve results of this complex procedure.

Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

In plain English

This was an online survey of how Spanish hospitals carry out cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), meaning surgery for disease spread on the abdominal lining combined with heated chemotherapy given inside the abdomen. In February 2017 the authors invited all 25 member centers of the Spanish peritoneal surface malignancy group (GECOP) to describe their usual practice. All 25 answered, and one did not complete the survey. Experience and workload varied. 32% of centers had over 15 years of experience. Yearly caseloads ranged from under 10 patients (8% of centers) to over 40 (32%). Most centers (88%) used an open technique. For mesothelioma, 86% of centers used cisplatin, and doxorubicin was the drug most often added (39%). For colorectal cancer, 74% used oxaliplatin. Staff safety measures varied: for example, only 50% of centers protected the floor against chemotherapy spills. The authors concluded that practice varied considerably and that standardization based on the best available evidence would help improve results. The article does not discuss asbestos.

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: Cross-sectional online survey of hospital centers (descriptive statistics)
• Who was studied: 25 Spanish hospital centers belonging to the Spanish Peritoneal Surface Malignancy Group (GECOP), surveyed in February 2017; all responded, and one did not complete the survey
• Exposure: No asbestos exposure was studied. The survey covered centers' practices in CRS-HIPEC: technique, chemotherapy agents, team training, staff safety, intraoperative monitoring, postoperative care and pain management, and registries and protocols.
• Main results:
  • 32% of centers had been performing CRS-HIPEC for over 15 years
  • Yearly caseload per center ranged from fewer than 10 patients (8% of centers) to more than 40 patients (32% of centers)
  • 88% of centers used the open (Coliseum) technique
  • For mesothelioma, 86% of centers used cisplatin; doxorubicin was the drug most often combined with it (39%)
  • For colorectal cancer, 74% of centers used oxaliplatin
  • 92% of centers used non-invasive monitoring of cardiac output
  • All patients went to a critical care unit after surgery; in 79% of centers they were discharged from it within 48 to 72 hours
  • Floor protection against chemotherapy spillage during HIPEC was used in 50% of centers
• The authors' conclusion: The authors concluded that there was considerable variability in team organization and perioperative management, including patient volume, choice of chemotherapy agents, training and safety measures. They concluded that standardization based on the best available evidence, individualization of patients and professional consensus would help improve results.

Topics

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

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Colorectal Cancer, Cisplatin, Stomach Cancer, Mesothelioma, Ovarian Cancer.

Related studies

• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis — E. Bekhor, J. Carr, et al. (2020)
• Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases — M. Dhir, L. Ramalingam, et al. (2017)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)

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