Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy

Our plain-English summary of Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy, by T.C. Chua, W. Liauw, A. Saxena, et al (American Journal of Surgery, 2011).

The study

• Authors: T.C. Chua, W. Liauw, A. Saxena, K. Al-Mohaimeed, S. Fransi, J. Zhao, D.L. Morris
• Journal: American Journal of Surgery
• Published: 2011;201(2):149-56
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Peritoneal carcinomatosis imposes an enormous clinical burden to the oncologic community. This study reports the patterns of care of the locoregional approach of cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy as a curative procedure for peritoneal carcinomatosis from the experience of a single tertiary center in Australia.

Methods: We performed a review of clinical records from a prospective database of patients who were treated at the St George Hospital Peritoneal Surface Malignancy Program according to a standard protocol.

Results: A total of 308 CRS were performed in 249 patients with peritoneal surface malignancy; the mean age was 53 years and 55% were women. Over the years, we expanded the age limit for treatment (P = .03), reduced intensive care unit stays (P = .04), reduced amount of blood transfusion (P = .03), treated patients with a higher peritoneal cancer index (P < .001), achieved higher rates of complete cytoreduction (P = .003), increased use of PIC (P < .001), and improved complication rate (P = .02) and mortality rate (P = .01). The median survival of patients treated over the years also improved (P = .001).

Conclusions: We show the maturity of the treatment of peritoneal carcinomatosis with CRS and perioperative intraperitoneal chemotherapy in our institution after an initial learning curve with expansion of the selection criteria, improved perioperative outcomes, improved surgical results, and long-term survival outcomes.

Copyright © 2011 Elsevier Inc. All rights reserved.

In plain English

This study reviewed a prospective database at St George Hospital in Sydney, Australia. Between January 1997 and February 2009, 249 consecutive patients with cancers on the lining of the abdomen (peritoneal surface malignancy) had 308 operations. All were cytoreductive surgery, which removes visible tumor. Most also included chemotherapy placed directly into the abdomen, but funding limits kept this chemotherapy from some patients. Of the 308 procedures, 35 (11%) were for peritoneal mesothelioma. The most common diagnosis was pseudomyxoma peritonei, with 118 procedures. The article did not study asbestos exposure. Major complications followed 126 (41%) procedures, and 6 patients died within 30 days, a rate of 2%. Across all 249 patients, median survival was 46 months and 5-year survival was 47%. Among 27 patients with peritoneal mesothelioma, median survival was 94 months. By treatment period, median survival was 25 months for patients treated from 1997 to 2003 and 46 months for 2004 to 2006. For 2007 onward, 1-year survival was 92%. The authors concluded that the results showed the treatment had matured at their center, with improving outcomes and survival over the years.

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-center review of clinical records from a prospectively kept database (case series of consecutive patients), with comparison across three time periods
• Who was studied: 249 consecutive patients with peritoneal surface malignancy who had 308 procedures at St George Hospital, Sydney, Australia, from January 1997 to February 2009. There were 103 men and 146 women, with a mean age of 53 years. Diagnoses by procedure were colorectal cancer 72, ovarian cancer 11, appendiceal adenocarcinoma 46, peritoneal mesothelioma 35, pseudomyxoma peritonei 118, and other rare cancers 26.
• Exposure: No asbestos or fiber exposure was studied. The 'exposure' was treatment: cytoreductive surgery, with or without chemotherapy into the abdomen. That chemotherapy could be heated chemotherapy during the operation (HIPEC) and/or early chemotherapy after surgery (EPIC). Some patients did not receive this chemotherapy because of funding restrictions. For peritoneal mesothelioma, HIPEC used cisplatin and doxorubicin.
• Main results:
  • 35 of the 308 procedures (11%) were performed for peritoneal mesothelioma
  • 217 of the 308 procedures (71%) included HIPEC, 190 (62%) included EPIC, and 142 (46%) included both
  • In the survival table, the 27 patients with peritoneal mesothelioma had a median survival of 94 months
  • For all 249 patients, median survival was 46 months, and survival rates at 1, 3 and 5 years were 82%, 56% and 47%
  • Of the 308 procedures, 126 (41%) were followed by major (grade III/IV) complications. Six patients died within 30 days, a treatment-related death rate of 2%.
  • Patients treated from 1997 to 2003 had a median survival of 25 months, with survival at 1, 3 and 5 years of 64%, 38% and 35%
  • Patients treated from 2004 to 2006 had a median survival of 46 months, with survival at 1 and 3 years of 82% and 57%. For patients treated from 2007 onward, 1-year survival was 92%.
  • 226 of the 308 procedures (73%) achieved complete cytoreduction (CC0, no visible cancer left)
• The authors' conclusion: The authors concluded that the study showed the treatment had matured at their institution, with consistent and improving outcomes around the time of surgery and improved survival of patients treated over the years

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Chemotherapy, Peritoneal Cancer Index (PCI), Median Survival.

Related studies

• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• 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)
• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• 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)
• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures — G. Passot, D. Vaudoyer, et al. (2016)
• 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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