Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases

Our plain-English summary of Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases, by L.S. Kyang, N.A. Alzahrani, S.J. Valle, et al (Journal of Surgical Oncology, 2019).

The study

• Authors: L.S. Kyang, N.A. Alzahrani, S.J. Valle, M.K. Rahman, A. Arrowaili, W. Liauw, D.L. Morris
• Journal: Journal of Surgical Oncology
• Published: 2019;120(4):794-802
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objectives: To review long-term survival outcomes of patients with Peritoneal metastasis (PM) who underwent colorectal cancer (CRS) and intraperitoneal chemotherapy (PIC).

Methods: Patients that underwent CRS, with or without PIC, from January 1996 to March 2018 at the Peritonectomy Unit of St. George Hospital, Sydney were retrospectively analyzed from a prospectively maintained database.

Results: The study comprised of 1225 cases, including 687 females (56.1%) and 538 males (43.9%). Diagnoses included CRC (n = 363), followed by HAMN (n = 317), LAMN (n = 297), mesothelioma (n = 101), ovarian cancer (n = 55), and others including gastric, sarcoma, and neuroendocrine tumor (n = 92). The median OS, 5- and 10-year survivals for CRC were 35 months, 33% and 8%, respectively. Patients with LAMN, in relative to HAMN, experienced a higher median OS, 5- and 10-year survivals (248 months vs 63 months; 82% vs 52% and 59% vs 28%). The median OS for mesothelioma was 60 months with 5- and 10-year survivals of 48% and 19%, respectively. In ovarian cancer, the median OS was 30 months with 5- and 10-year survivals of 26% and 10%, respectively. For the remaining histological diagnoses, median OS and 5-year survival were 28 months and 27%, respectively.

Conclusion: Our large-cohort data showed that CRS/PIC can provide long-term survival benefit to patients with PM of gastrointestinal and ovarian origin.

© 2019 Wiley Periodicals, Inc.

In plain English

This retrospective study analyzed St George Hospital's database in Sydney. It covered 1225 cases from January 1996 to March 2018 of surgery removing visible abdominal tumor, with or without chemotherapy inside the abdomen. All had cancer on the abdominal lining: peritoneal mesothelioma, which starts there (101 cases), or cancer spreading there from the colon, rectum, appendix, ovary or elsewhere. Overall, 2% died in hospital; 38% had high-grade complications. Mesothelioma median survival was 60 months (95% confidence interval 35 to 85); 48% alive at 5 years and 19% at 10. Five-year mesothelioma survival was 100%, 53% and 24% in groups with increasing disease found at surgery. Women with mesothelioma survived longer than men, though these figures conflict with the overall median. The article did not report asbestos-exposure data or analyze survival by exposure. The authors suggested, without testing it, that this could relate to less asbestos exposure and higher oestradiol in women. The authors concluded the treatment can give long-term survival benefit for abdominal-lining cancer of digestive-tract or ovarian origin. They noted the study was retrospective and their protocol changed.

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 maintained single-hospital database (case series of surgical outcomes)
• Who was studied: 1225 cases of cytoreductive surgery (including 234 repeat operations) at St George Hospital, Sydney, Australia, January 1996 to March 2018: 687 females and 538 males, mean age 53. Diagnoses were colorectal cancer (363), high-grade appendiceal neoplasms (317), low-grade appendiceal mucinous neoplasms (297), mesothelioma (101), ovarian cancer (55) and others (92). The article describes peritoneal mesothelioma as primary peritoneal disease, as opposed to cancers that spread to the peritoneum.
• Exposure: The study looked at treatment, not asbestos. The treatment was cytoreductive surgery, with heated intraoperative chemotherapy (HIPEC) in 1097 cases and early postoperative intraperitoneal chemotherapy (EPIC) in 446 cases. For mesothelioma the HIPEC drugs were cisplatin and mitomycin C. The article did not report asbestos-exposure data.
• Main results:
  • Across all cases, hospital mortality was 2% (n = 25).
  • Across all cases, high-grade complications (Grade III and IV) occurred in 472 patients (38%).
  • Mesothelioma (101 cases): median overall survival was 60 months (95% CI 35 to 85 months in Table 2), with 5-year survival of 48% and 10-year survival of 19%.
  • Mesothelioma, by Peritoneal Cancer Index (amount of disease found at surgery): 5-year survival was 100% for PCI 0 to 10, 53% for PCI 11 to 20, and 24% for PCI over 20 (P less than .001).
  • Mesothelioma, by sex: median survival was 26 months and 5-year survival 37% in females, compared with 11 months and 14% in males (P = .049).
  • Among repeat operations, median overall survival for mesothelioma was 92 months. Table 4 gives 5-year survival of 71.8% in this group.
  • In multivariate analysis with colorectal cancer as the reference, the text gives mesothelioma HR 0.341 (95% CI 0.229 to 0.506, P less than .001). Table 5 gives a different value: HR 0.419 (0.284 to 0.618).
  • Other diagnoses: median overall survival was 35 months for colorectal cancer and 248 months for low-grade appendiceal mucinous neoplasms.
  • In the discussion, the authors suggested, without testing it, that the better outcome for females with mesothelioma could relate to reduced asbestos exposure and higher oestradiol levels in females.
• The authors' conclusion: The authors concluded that cytoreductive surgery with perioperative intraperitoneal chemotherapy is effective and safe in giving long-term survival benefit to patients with peritoneal metastasis of gastrointestinal and ovarian origin.
• Limitations the authors state:
  • The study was retrospective, and the treatment protocol changed over the years, which may confound the analysis.
  • Some information may have been lost when patients were referred to the center.
  • Some patient and treatment data were lacking, for example histology details and neoadjuvant chemotherapy status.
  • Because surgical performance improved with experience at the center, the results may not apply to other centers.
  • For colorectal cancer, the benefit of HIPEC may be overestimated because most patients received it.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Colon cancer, Lung cancer, Mesothelioma, Ovarian cancer, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Chemotherapy, Metastasis, Colorectal Cancer, Mesothelioma, Ovarian Cancer, Sarcoma.

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• Long-term Survival and Propensity Score Matched Outcomes of Bilateral vs. Unilateral Diaphragm Interventions in Cytoreductive Surgery plus Intra-peritoneal Chemotherapy — B. Singh, G. Singh, 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)
• 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)
• Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis — Y. Huang, N.A. Alzahrani, et al. (2017)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: long-term results at St George Hospital, Australia — N. Alzahrani, J.S. Ferguson, et al. (2016)

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