Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence

Our plain-English summary of Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence, by M. Vaira, M. Robella, A. Mellano, et al (International Journal of Hyperthermia, 2014).

The study

• Authors: M. Vaira, M. Robella, A. Mellano, A. Sottile, M. De Simone
• Journal: International Journal of Hyperthermia
• Published: 2014;30(8):565-9
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: The aim of this study was to analyse feasibility, morbidity and outcome of repeat complete cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). CRS combined with HIPEC is becoming the gold standard treatment for resectable peritoneal carcinomatosis in highly selected patients. As yet treatment of isolated peritoneal recurrence with iterative CRS and HIPEC has not been thoroughly explored.

Materials And Methods: We selected 16 patients presenting isolated peritoneal recurrence who had undergone iterative CRS and HIPEC from a dataset of 322 CRS associated with HIPEC performed between 1996 and 2012.

Results: Peritoneal carcinomatosis (PC) was due to colorectal and ovarian cancer, peritoneal mesothelioma and pseudomyxoma peritonei (PMP). Disease-free survival (DFS) was 13 months after the first procedure and 13.7 months after the second one. Overall morbidity rate was 43.7% (7/16) for all patients, with grade III-IV complications in three patients (18.7%).

Conclusions: Iterative procedures combining cytoreductive surgery and HIPEC are feasible with acceptable morbidity and mortality rates in strictly selected patients. DFS following repeated CRS and HIPEC is comparable to that registered after the first procedure.

In plain English

This study from a single referral centre in Turin, Italy, looked back at the records of 16 patients who had a second round of cytoreductive surgery (removing visible tumour from the abdomen) combined with heated chemotherapy delivered inside the abdomen (HIPEC) after their cancer returned only in the abdominal lining. The patients came from 322 such procedures performed between 1996 and 2012. Their cancers included colorectal and ovarian cancer, peritoneal mesothelioma and pseudomyxoma peritonei. The study did not examine asbestos exposure. No patient died in the post-operative period after the second operation. Seven of 16 (43.7%) had complications, and three (18.7%) had grade III–IV complications. All visible tumour was removed in 12 patients (75%). Mean disease-free survival was 13 months after the first procedure and 13.7 months after the second. That difference was not statistically significant (P = 0.41). Median overall survival was 54 months, and nine patients (56.2%) had a second recurrence. By the end of the study, seven patients had died with recurrence. The authors described their series as limited. They concluded that repeat surgery with HIPEC can be performed with acceptable complication and death rates in highly selected 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: Retrospective analysis of a prospectively kept database at a single centre (case series of repeat procedures)
• Who was studied: 16 patients (seven men, nine women) with isolated peritoneal recurrence who had repeat CRS plus HIPEC. They were selected from 322 CRS plus HIPEC procedures performed from 1996 to 2012 at one referral centre (Candiolo Cancer Institute, Turin, Italy). Cancers were colorectal and ovarian cancer, peritoneal mesothelioma and pseudomyxoma peritonei.
• Exposure: The article does not study asbestos exposure. The exposure studied was a treatment: repeat cytoreductive surgery with HIPEC. Patients with ovarian carcinoma and peritoneal mesothelioma received cisplatin 100 mg/m2 and Adriamycin 15 mg/L at both the first and second procedures.
• Main results:
  • No patient died in the post-operative period after the second procedure.
  • Overall complication rate after the second procedure was 43.7% (7/16) of all patients.
  • Grade III–IV complications occurred in three patients (18.7%).
  • At the second operation, 12 patients (75%) had a CC-0 resection (no visible tumour left); four (25%) were CC-1.
  • Mean disease-free survival was 13 months after the first procedure and 13.7 months after the second. The difference was not statistically significant (P = 0.41).
  • A second recurrence occurred in nine of the 16 patients (56.2%).
  • Median overall survival was 54 months.
  • At the end of the study, seven patients had no evidence of recurrence (including two who died of unrelated causes), two were alive with recurrence, and seven had died with recurrence.
  • Mean hospital stay after the second procedure was 22 days (range 12 to 41 days).
• The authors' conclusion: The authors concluded that repeat CRS with HIPEC can be performed with acceptable morbidity and mortality, similar to the first operation, in highly selected patients with limited and isolated peritoneal recurrence. They also concluded that disease-free survival after the repeat procedure is comparable to that after the first.
• Limitations the authors state:
  • The authors described their data as coming from a limited series.

Topics

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

Related studies

• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma — Y. Huang, N.A. Alzahrani, et al. (2015)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)

Browse more research in International Journal of Hyperthermia, or return to medical research.