Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Asian patients: 100 consecutive patients in a single institution

Our plain-English summary of Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Asian patients: 100 consecutive patients in a single institution, by M.C. Teo, G.H. Tan, C.K. Tham, et al (Annals of Surgical Oncology, 2013).

The study

• Authors: M.C. Teo, G.H. Tan, C.K. Tham, C. Lim, K.C. Soo
• Journal: Annals of Surgical Oncology
• Published: 2013;20(9):2968-74
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in selected patients with peritoneal carcinomatosis. We review our institutional experience with the procedure and evaluate the overall survival (OS) and disease-free survival (DFS) rates in 100 consecutive patients.

Methods: Data were prospectively collected from 100 consecutive patients with peritoneal carcinomatosis treated by CRS and HIPEC at the National Cancer Centre Singapore between April 2001 and May 2012. Our primary end points were OS and DFS.

Results: Of the 100 patients, 84 were of Chinese ethnicity, 3 were Malay, 6 were Indian, and 7 were of other ethnicities. Primary tumors were ovarian cancer (n=39), colorectal cancer (n=28), primary peritoneal (n=6), appendiceal cancer (n=20), and mesothelioma (n=7). Median follow-up duration was 21 months. At 5 years, the DFS was 26.3% and OS was 50.9%. Factors influencing OS and DFS were cytoreductive score, primary cancer, and disease-free interval of more than 12 months on univariate analysis. The only factors that remained significant for prognosis after multivariate analysis were primary cancer and cytoreductive score. Thirty-day morbidity was 56%, and there were no 30-day mortalities.

Conclusions: CRS and HIPEC can be safely carried out in Asian patients with peritoneal carcinomatosis from ovarian, colorectal, appendiceal, mesothelioma, and primary peritoneal origins. Overall, the ovarian, appendiceal, mesothelioma, and primary peritoneal cancer patients tended to do better than the colorectal patients, but careful patient selection ensuring that optimal cytoreduction can be achieved is essential for the success of this procedure.

In plain English

This study reported on the first 100 consecutive patients treated at the National Cancer Centre Singapore between April 2001 and May 2012 with cytoreductive surgery (removing visible tumor inside the abdomen) followed by heated chemotherapy circulated through the abdomen (HIPEC). All had cancer spread through the abdominal lining. Most were Chinese (84). Primary cancers were ovarian (39), colorectal (28), appendiceal (20), primary peritoneal (6) and mesothelioma (7). Mesothelioma patients received cisplatin. Median follow-up was 21 months. For all 100 patients, overall survival at 5 years was 50.9% and disease-free survival was 26.3%. Mesothelioma results were not reported separately. Patients with primary peritoneal, appendiceal and mesothelioma cancers were analysed as one group, with 73% overall survival at 5 years, compared with 18.2% for colorectal cancer. Type of primary cancer and completeness of tumor removal remained significant in multivariate analysis. Complications occurred in 55 patients, and none died within 30 days. The authors concluded the procedure was feasible with reasonable complication and death rates in Asian patients.

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: Single-institution series of 100 consecutive treated patients, with data collected prospectively
• Who was studied: 100 consecutive patients with peritoneal carcinomatosis treated at the National Cancer Centre Singapore, April 2001 to May 2012. 84 were Chinese, 3 Malay, 6 Indian and 7 of other ethnicities. 80 were female and 20 male, with a median age of 51.5 (range 14 to 74). Primary tumors were ovarian 39, colorectal 28, primary peritoneal 6, appendiceal 20 and mesothelioma 7. The article gives no further detail on the mesothelioma patients.
• Exposure: Not an asbestos or fiber exposure study; asbestos is not discussed. The factor studied was treatment: cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. Mitomycin C was used for colorectal and appendiceal cancer, and cisplatin for ovarian cancer and mesothelioma.
• Main results:
  • All 100 patients: overall survival was 91.7%, 59.1% and 50.9% at 1, 3 and 5 years. Median follow-up was 21 months (95% CI 13.9 to 31.3).
  • All 100 patients: disease-free survival was 61.4%, 32.9% and 26.3% at 1, 3 and 5 years.
  • Combined group of primary peritoneal, appendiceal and mesothelioma patients: 73% overall survival at 5 years. No separate figure is given for the 7 mesothelioma patients.
  • Colorectal cancer patients: 18.2% overall survival at 5 years. Ovarian cancer patients: 55.4%.
  • Type of primary cancer and completeness-of-cytoreduction (CC) score remained significant for prognosis after multivariate analysis. Complete cytoreduction (CC-0) was achieved in 90 patients, CC-1 in 7 and CC-2 in 3.
  • Postoperative complications occurred in 55 patients, with no deaths within 30 days. Of 20 patients hospitalised beyond 30 days, 2 died, on postoperative days 86 and 187.
  • Each 1 L increase in blood loss was associated with a 66% increase in the odds of a complication (95% CI 2 to 182, p = 0.002). Each additional visceral resection was associated with a 53% increase in the odds (95% CI 0 to 135).
• The authors' conclusion: The authors concluded that CRS and HIPEC were feasible, with reasonable morbidity and mortality, in Asian patients with peritoneal carcinomatosis. In the abstract they also concluded that ovarian, appendiceal, mesothelioma and primary peritoneal cancer patients tended to do better than colorectal patients, and that careful patient selection ensuring optimal cytoreduction is essential.
• Limitations the authors state:
  • Peritoneal Cancer Index data were missing for 32 patients, so this score was left out of the multivariate model.
  • Disease-free interval applied only to colorectal and ovarian cancer patients, so it was also left out of the multivariate model.

Topics

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

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Overall Survival, Disease-Free Survival, Ovarian Cancer, Colorectal Cancer, Mesothelioma, Prognosis.

Related studies

• Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases — L.S. Kyang, N.A. Alzahrani, et al. (2019)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Long-term Survival and Propensity Score Matched Outcomes of Bilateral vs. Unilateral Diaphragm Interventions in Cytoreductive Surgery plus Intra-peritoneal Chemotherapy — B. Singh, G. Singh, et al. (2018)
• Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience — J. Wong, A.L. Koch, et al. (2014)

Browse more research in Annals of Surgical Oncology, or return to medical research.