Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry

Our plain-English summary of Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry, by A. Arjona-Sanchez, O. Aziz, G. Passot, et al (European Journal of Surgical Oncology, 2021).

The study

• Authors: A. Arjona-Sanchez, O. Aziz, G. Passot, G. Salti, J. Esquivel, K. Van der Speeten, P. Piso, D.S. Nedelcut, A. Sommariva, Y. Yonemura, K. Turaga, C.R. Selvasekar, L. Rodriguez-Ortiz, J.M. Sanchez-Hidalgo, A. Casado-Adam, S. Rufian-Peña, J. Briceño, O. Glehen
• Journal: European Journal of Surgical Oncology
• Published: 2021;47(6):1420-1426
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: A laparoscopic approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (L-CRS+HIPEC) in highly selected patients has been reported in small cohorts with a demonstrable reduction in length of stay and post-operative morbidity. This study aims to analyse individual patient data from these international centres collected through the Peritoneal Surface Oncology Group International (PSOGI) L-CRS+HIPEC registry.

Methods: An international registry was designed through a networking database (REDCAP®). All centres performing L-CRS+HIPEC were invited through PSOGI to submit data on their cases. Patient's characteristics, postoperative outcomes and survival were analysed.

Results: Ten international centres contributed a total of 143 L-CRS+HIPEC patients during the study period. The most frequent indication was low grade pseudomyxoma peritonei in 79/143 (55%). Other indications were benign multicyst mesothelioma in 21/143(14%) and peritoneal metastasis from colon carcinoma in 18/143 (12,5%) and ovarian carcinoma in 13/143 (9%). The median PCI was 3 (2-5). The median length of stay was 6 (5-10) days, with 30-day major morbidity rate of 8.3% and 30-day mortality rate of 0.7%. At a median follow-up of 37 (16-64) months 126/143 patients (88.2%) were free of disease.

Conclusions: Analysis of these data demonstrates that L-CRS+HIPEC is a safe and feasible procedure in highly selected patients with limited peritoneal disease when performed at experienced centres. While short to midterm outcomes are encouraging in patients with less invasive histology, longer follow up is required before recommending it for patients with more aggressive cancers with peritoneal dissemination.

Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

In plain English

This study analysed an international registry of patients treated with laparoscopic (keyhole) cytoreductive surgery plus heated chemotherapy delivered into the abdomen (HIPEC) for limited disease of the peritoneum, the lining of the abdomen. The registry held 200 patients operated on at ten centres between January 2004 and February 2020. Of these, 143 with established peritoneal disease were analysed. Most had low-grade pseudomyxoma peritonei (79). Others had multicystic peritoneal mesothelioma (21), colorectal cancer (18) or ovarian cancer (13). The article does not discuss asbestos. Complete removal of visible disease was achieved in 139 of 143 patients, and the median hospital stay was 6 days. Major complications occurred in 12 of 143 patients, and one patient died of serious heart insufficiency on the 12th day after surgery. Among the multicystic peritoneal mesothelioma patients, no relapses were found over a median 39 months of follow-up. The authors concluded that the approach is promising for limited disease in low-grade pseudomyxoma peritonei and multicystic peritoneal mesothelioma. They added that colon and ovarian cancer need more study with longer follow-up. They noted the analysis was retrospective and that techniques varied between centres.

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 collected international multicentre registry (PSOGI L-CRS+HIPEC registry)
• Who was studied: 200 patients operated on at ten international centres between January 2004 and February 2020. 143 with established low-volume peritoneal disease were included in this analysis; 57 who had risk-reducing procedures without peritoneal disease were excluded. Groups: low-grade pseudomyxoma peritonei 79, high-grade pseudomyxoma peritonei 8, multicystic peritoneal mesothelioma 21, colorectal cancer 18, ovarian cancer 13, others 3.
• Exposure: No asbestos or other environmental exposure was studied. The study examined a treatment: laparoscopic cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (drugs included mitomycin C, oxaliplatin, cisplatin, doxorubicin and paclitaxel).
• Main results:
  • In the whole group of 143 patients, complete cytoreduction (CC0) was achieved in 139/143 (97%)
  • In the whole group, the median length of hospital stay was 6 days
  • In the whole group, major complications occurred in 12/143 (8.3%). One patient died of serious heart insufficiency on the 12th postoperative day.
  • In the whole group, relapse occurred in 17/143 (11.8%). The peritoneum was the first site of relapse in 10/143 (6.9%).
  • Multicystic peritoneal mesothelioma group: complete cytoreduction in 100%, and no relapses at a median of 39 months of follow-up
  • Low-grade pseudomyxoma peritonei group: 5-year disease-free survival 95% and 5-year overall survival 100%
  • Colorectal cancer group (18 patients): 5-year disease-free survival 43% and 5-year overall survival 54%. Eight patients (reported as 33%) relapsed.
  • Ovarian cancer group (13 patients): 5-year disease-free survival 53% and 5-year overall survival 78%
• The authors' conclusion: The authors concluded that the minimally invasive approach is a promising option with limited postoperative complications and deaths. In their view, its indications are limited peritoneal disease from low-grade pseudomyxoma peritonei and multicystic peritoneal mesothelioma. For colon and ovarian cancer, they said more studies or experience with longer follow-up are needed.
• Limitations the authors state:
  • The study was a retrospective analysis of a prospectively collected registry
  • Surgical techniques and procedure definitions varied between centres
  • Surgeons at different centres were at different stages of their learning curve
  • Few patients had high-grade cancers (colorectal, ovarian), and their follow-up was short

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, Metastasis, Peritoneal Surface Oncology, Mesothelioma, Carcinoma, Histology.

Related studies

• The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan — T. Kitai (2021)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, 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)
• 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)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)

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