Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for disseminated intra-abdominal malignancies in children-a single-institution experience

Our plain-English summary of Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for disseminated intra-abdominal malignancies in children-a single-institution experience, by O. Zmora, A. Hayes-Jordan, A. Nissan, et al (Journal of Pediatric Surgery, 2018).

The study

• Authors: O. Zmora, A. Hayes-Jordan, A. Nissan, I. Kventsel, Y. Newmann, K. Itskovsky, S. Ash, S. Levy-Mendelovich, D. Shinhar, A. Ben-Yaakov, A. Toren, R. Bilik
• Journal: Journal of Pediatric Surgery
• Published: 2018;53(7):1381-1386
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Our purpose was to present our institutional experience with performing complete cytoreduction surgery and heated intraoperative chemotherapy (CRS-HIPEC) for children with disseminated intraabdominal malignancies, guided by a leading international center performing CRS-HIPEC in children.

Methods: Retrospective chart review of all cases of CRS-HIPEC in children in our institution, examining diagnosis, preoperative management, operative management, postoperative treatment, short term outcome including length of stay and complications, and long term outcome including survival and recurrence of disease.

Results: 9 children underwent CRS-HIPEC over 48months. The mean age of the patients was 8years. Tumors were: rhabdomyosarcoma (RMS), mesothelioma, Sertoli-Leydig, desmoplastic small round cell tumor, colon carcinoma and Wilms' tumor. Most patients received intraperitoneal cisplatin. Short term outcome was very good with median length of hospital stay of 13days and low rate of complications. Seven patients were alive at last follow up. Five patients developed a recurrent disease. Recurrence was intraabdominal in two of these patients.

Conclusions: CRS-HIPEC for children with disseminated intraabdominal malignancies performed in a dedicated institution and with guidance by a leading international center can be performed safely.

Type Of Study: Treatment study.

Level Of Evidence: IV.

Copyright © 2017 Elsevier Inc. All rights reserved.

In plain English

This article is a retrospective review of the medical charts of every child treated with cytoreductive surgery (removing all visible tumor in the abdomen) plus heated chemotherapy bathed through the abdomen during the operation (HIPEC) at Chaim Sheba Medical Center in Israel, December 2012 to December 2016. It does not discuss asbestos. Nine children were treated, with a mean age of 8 years. Two had mesothelioma; the others had rhabdomyosarcoma, desmoplastic small round cell tumor, Sertoli–Leydig tumor, colon carcinoma or Wilms' tumor. Most received cisplatin, and the two mesothelioma patients also had chemotherapy into the abdomen after surgery. All visible tumor was removed in all nine. Median hospital stay was 13 days. Four children had complications, and the authors saw no whole-body toxic side effects specific to HIPEC. Over a median follow-up of 21 months, disease returned in 5 children and 2 died of their disease. Both mesothelioma patients were listed with no evidence of disease at last follow-up. The authors concluded the procedure is safe when done by experienced surgeons in dedicated hospitals working with experienced international centers.

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 chart review (case series) from a single institution; the authors classed it as a treatment study, level of evidence IV
• Who was studied: 9 children with cancer spread within the abdomen, mean age 8 years, treated at Chaim Sheba Medical Center, Israel, December 2012 to December 2016. Two had mesothelioma, three rhabdomyosarcoma, and one each had desmoplastic small round cell tumor, recurrent Sertoli–Leydig tumor, signet ring colon carcinoma and recurrent Wilms' tumor.
• Exposure: No asbestos exposure was studied or reported. The exposure was the treatment: cytoreductive surgery followed by HIPEC, usually 100 mg/m2 of cisplatin heated to 41 °C for 90 minutes. One patient received mitomycin C instead and one received doxorubicin. The two mesothelioma patients also received postoperative intraperitoneal chemotherapy.
• Main results:
  • Complete cytoreduction was achieved and HIPEC was delivered as planned in all 9 patients
  • Median length of hospital stay was 13 days (range 8 to 21)
  • Postoperative complications occurred in 4 of the 9 patients: two mild superficial wound infections, a ureteral mucosal flap, a urinary tract infection followed by neurogenic incontinence that resolved after 9 months, and a partial small bowel obstruction that resolved without surgery
  • The authors observed no adverse systemic cytotoxic side effects specific to HIPEC
  • Over a median follow-up of 21 months (range 7 to 48), disease recurred in 5 patients: within the abdominal lining in 2 and outside it in 3
  • Two patients with recurrence died of their disease: one with desmoplastic small round cell tumor at 21 months after surgery and one with recurrent rhabdomyosarcoma at 7 months
  • In the outcome table, both mesothelioma patients (patients 1 and 6) were listed as having no evidence of disease (NED) at last follow-up, at 48 and 20 months
• The authors' conclusion: The authors concluded that CRS-HIPEC in children is safe and can be performed by experienced surgeons in dedicated tertiary hospitals collaborating with experienced international centers. They added that it should be part of a treatment plan that includes other therapies before and after surgery.
• Limitations the authors state:
  • The results were obtained by highly experienced surgeons working closely with a specialized center, which the authors note as a qualification of their safety findings
  • The authors' observation that patients without gastrostomy or jejunostomy recovered as quickly as those with one needs statistical confirmation
  • The tumor types are so rare that prospective randomized trials are not feasible

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Chemotherapy, Mesothelioma, Desmoplastic Small Round Cell Tumor, Carcinoma, Cisplatin.

Related studies

• Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for children, adolescents, and young adults: the first 50 cases — A. Hayes-Jordan, H. Green, et al. (2015)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)
• 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)
• 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)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Asian patients: 100 consecutive patients in a single institution — M.C. Teo, G.H. Tan, et al. (2013)

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