Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience

Our plain-English summary of Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience, by A. Arjona-Sanchez, S. Rufian-Peña, J.M. Sanchez-Hidalgo, et al (World Journal of Surgery, 2018).

The study

• Authors: A. Arjona-Sanchez, S. Rufian-Peña, J.M. Sanchez-Hidalgo, A. Casado-Adam, A. Cosano-Alvarez, J. Briceño-Delgado
• Journal: World Journal of Surgery
• Published: 2018;42(10):3120-3124
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard treatment in patients with carcinomatosis peritoneal from different origins. The use of a minimally invasive approach for this high complex procedure might be an alternative that provides them less morbidity and faster recovery with similar oncologic outcomes.

Methods: We describe the initial experience of CRS and HIPEC done via the laparoscopic route in patients with minimal peritoneal metastases in our Unit from March 2016 to January 2018.

Results: A total of eight patients were operated by this minimally invasive approach. The different diagnoses were low-grade pseudomyxoma peritonei (2), benign multicystic mesothelioma (2), primary epithelial ovarian carcinomatosis (2) and locally advanced colon carcinoma T4 (2). The median age was 54 (20-62) years, the median PCI was 3 (2-4), the median operative time was 287 min (240-360), complete cytoreduction CC0 was achieved in all the patients, and no major morbidity was observed. The median length of stay was 4.75 days (4-5). After a median follow-up of 9.5 months, no relapse has been observed.

Conclusion: The results suggest that this minimally invasive approach for CRS and HIPEC is feasible and safe in a highly selected group of patients with peritoneal surface malignancies.

In plain English

This article reported a small series of eight patients treated at a surgical unit of University Hospital Reina Sofía in Córdoba, Spain, between March 2016 and January 2018. The authors described cytoreductive surgery (removing tumour from the abdominal lining) followed by heated chemotherapy inside the abdomen (HIPEC), done by keyhole (laparoscopic) surgery rather than open surgery. The eight were selected from 162 patients treated with CRS and HIPEC in that period and had limited disease. Two had low-grade pseudomyxoma peritonei, two benign multicystic mesothelioma, two primary epithelial ovarian carcinomatosis and two locally advanced (T4) colon carcinoma. The article does not discuss asbestos. Complete cytoreduction (CC0) was reported in all eight, and no severe complications (Grade 3 or higher) were observed. The article reported a hospital stay of 4.75 days and, after a median follow-up of 9.5 months, no relapse. Some of these printed summary figures do not match the article's own patient table. The authors concluded the approach appeared feasible and safe in a highly selected group, and acknowledged that follow-up was short.

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 retrospective study (case series) of prospectively collected data on eight patients
• Who was studied: 8 of 162 patients treated with CRS and HIPEC at the Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofía, Córdoba, Spain, from March 2016 to January 2018. All had limited peritoneal disease (estimated PCI less than 10) and no previous major surgery.
• Exposure: No asbestos exposure was studied. The study examined a treatment: laparoscopic cytoreductive surgery plus closed-technique HIPEC for 60 minutes at 42 degrees C. The drug depended on diagnosis: mitomycin C for colon carcinoma and low-grade PMP, paclitaxel for ovarian carcinomatosis, and cisplatin plus doxorubicin for benign multicystic mesothelioma.
• Main results:
  • Diagnoses among the 8 patients: low-grade pseudomyxoma peritonei (2), benign multicystic mesothelioma (2), primary epithelial ovarian carcinomatosis (2), locally advanced colon carcinoma T4 (2)
  • As printed for the 8 patients: median age 54 (20 to 62) years and median PCI 3 (2 to 4)
  • Complete cytoreduction (CC0) was achieved in all 8 patients
  • No severe morbidity (Grade 3 or higher) was observed in the 8 patients
  • Intestinal resections were performed in two patients (sigmoid and right colon)
  • Length of hospital stay reported as 4.75 days (4 to 5)
  • After a median follow-up of 9.5 months, no relapse was observed in the 8 patients
• The authors' conclusion: The authors concluded that the minimally invasive approach appeared feasible and safe in a highly selected group of patients with peritoneal surface malignancies, including low-grade tumours with limited spread (PCI of 10 or less). At their current stage of experience, they recommended it only for patients with minimally invasive disease or with cancers very sensitive to systemic chemotherapy, such as epithelial ovarian cancer.
• Limitations the authors state:
  • Follow-up was short
  • The favourable complication results may reflect that only patients with limited disease (PCI 10 or less) were selected
  • Laparoscopic surgery may limit thorough exploration of the whole abdomen and pelvis to determine a true PCI, so small tumour nodules could be missed

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Chemotherapy, HIPEC, Multicystic Mesothelioma (MCM), Carcinoma.

Related studies

• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• 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)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia — A. Galan, P. Rousset, et al. (2018)

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