Mentored experience of establishing a national peritoneal malignancy programme - Experience of first 50 operative cases

Our plain-English summary of Mentored experience of establishing a national peritoneal malignancy programme - Experience of first 50 operative cases, by K.H. Chang, M. Kazanowski, O. Staunton, et al (European Journal of Surgical Oncology, 2017).

The study

• Authors: K.H. Chang, M. Kazanowski, O. Staunton, R.A. Cahill, B.J. Moran, C. Shields, J. Mulsow
• Journal: European Journal of Surgical Oncology
• Published: 2017;43(2):395-400
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are considered standard of care for pseudomyxoma peritonei (PMP) and selected patients with colorectal peritoneal metastases (CPM) or peritoneal mesothelioma. A National Peritoneal Malignancy programme was established in Ireland (population of 4.5 million) in May 2013 with mentoring and support from the Peritoneal Malignancy Institute, Basingstoke UK. This study reviews the operative and oncological outcomes for the first 50 patients who underwent CRS and HIPEC in Ireland.

Methods: This is a retrospective review of all patients referred, and of the subset who underwent CRS and HIPEC, for peritoneal malignancy in Ireland between May 2013 and November 2015.

Results: During the study period, 130 patients were referred and 50 patients were selected for CRS and HIPEC. Three patients were found to have unresectable disease at laparotomy. Of the remaining 47 patients, eight had major tumour debulking. In total, 39 underwent complete cytoreduction and 45 received HIPEC. After a median follow-up of 12.7 months, 12 patients had developed further metastatic disease. The rates of complete cytoreduction, major complication (Clavien-Dindo III/IV) and operative mortality were 83%, 0% and 0%, respectively. 32% of patients experienced grade I/II complications.

Conclusions: We report the successful establishment of a national peritoneal malignancy programme. Mentoring from an experienced centre may have shortened the known learning curve evident by our encouraging outcomes. The follow-up period is short, however our early results are comparable with internationally reported figures.

Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

In plain English

This retrospective review covered the first patients treated by a new national peritoneal malignancy programme in Dublin, Ireland. The programme began in May 2013 with mentoring from the Peritoneal Malignancy Institute in Basingstoke, UK. The treatment was cytoreductive surgery combined with heated chemotherapy delivered into the abdomen (HIPEC). The study did not examine asbestos, and peritoneal mesothelioma does not appear among the operated patients' tumour types. Between May 2013 and November 2015, 130 patients were referred. Of these, 50 were selected for surgery: 24 with pseudomyxoma peritonei of appendiceal origin and 26 with peritoneal metastases. In three patients the disease could not be removed. Among the remaining 47, 39 (83%) had complete cytoreduction, defined as no residual tumour or no nodule larger than 2.5 mm. Sixteen patients (32.0%) had grade I/II complications. No patient had a grade III/IV complication, and none died within 30 days. After a median follow-up of 12.7 months, 12 of 39 patients who had potentially curative surgery had recurrence. The authors concluded that mentoring may have shortened the learning curve, and they noted that follow-up was short.

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 consecutive patients (single-centre surgical case series) from a prospectively maintained database
• Who was studied: 130 patients were referred with peritoneal malignancy to the national centre in Dublin, Ireland, from May 2013 to November 2015. Of these, 50 were selected for surgery: 24 with pseudomyxoma peritonei (PMP) of appendiceal origin and 26 with peritoneal metastases, mostly colorectal.
• Exposure: No asbestos or fibre exposure was studied. The study examined a treatment: cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC).
• Main results:
  • Three of the 50 patients (two with PMP, one with metastatic disease from a caecal mucinous adenocarcinoma) had inoperable disease found at surgery, and the surgery was abandoned.
  • Excluding those three patients, 39 had complete cytoreduction (CC-0 or CC-1), giving a rate of 83% (84% in the colorectal peritoneal metastases group, 81.8% in the PMP group). CC-0 means no residual tumour; CC-1 means no residual tumour nodule greater than 2.5 mm.
  • Definition of the cytoreduction scores used in this study.
  • Sixteen patients (32.0%) had 21 grade I/II postoperative complications.
  • No patient had a grade III/IV complication, and there were no deaths within 30 days of surgery.
  • Median hospital stay was 14 days (range 6 to 66 days).
  • Of the 39 patients who had potentially curative surgery, 12 had disease recurrence, at a median of 8.5 months after surgery.
  • Of the 11 patients who had non-curative surgery, two had died from disease progression (median follow-up 12.7 months).
• The authors' conclusion: The authors concluded that, with mentorship from an experienced centre, they may have shortened the learning curve for this complex procedure, and they reported satisfactory early outcomes.
• Limitations the authors state:
  • The follow-up period is short.
  • The programme is still in its early stages and continues to evolve.
  • Staging laparoscopy did not fully show unresectable disease in some patients because adhesions compromised the views.

Topics

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

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Unresectable, Laparotomy.

Related studies

• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• 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)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor debulking — S. Riss, K. Chandrakumaran, et al. (2015)
• Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia — A. Galan, P. Rousset, et al. (2018)

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