Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital

Our plain-English summary of Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital, by B. Goslin, S. Sevak, A. Siripong, et al (American Journal of Surgery, 2012).

The study

• Authors: B. Goslin, S. Sevak, A. Siripong, J. Onesti, G.P. Wright, M. Melnik, M. Chung
• Journal: American Journal of Surgery
• Published: 2012;203(3):383-6; discussion 387
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Most cytoreduction with hyperthermic intraperitoneal chemotherapy procedures are performed at academic tertiary referral centers with numerous surgical oncology faculty. The objective of this study was to review the postoperative morbidity and mortality data of our institution, a large community hospital.

Methods: This was a retrospective cohort study of patients who underwent cytoreduction with hyperthermic intraperitoneal chemotherapy at a single institution. Two surgical oncologists performed all the procedures between May 2005 and June 2011.

Results: We retrospectively analyzed 57 patients. The most common pathology being treated was pseudomyxoma peritonei (34 of 57; 59.6%), followed by colorectal cancer (9 of 57; 15.8%). Other types of cancer included peritoneal mesothelioma and gastric adenocarcinoma. The average surgery time was 6.9 hours. Approximately 51% of patients suffered grade 3 or 4 morbidity and there were no perioperative mortalities.

Conclusions: Cytoreduction with hyperthermic intraperitoneal chemotherapy can be performed at our institution with comparable outcomes as academic referral centers.

Copyright © 2012 Elsevier Inc. All rights reserved.

In plain English

This was a retrospective review of the charts of 57 patients treated at Butterworth Hospital, a community hospital in western Michigan, between 2005 and 2011. All had cytoreductive surgery (removal of visible tumor) combined with heated chemotherapy circulated through the abdomen, called HIPEC. Most were treated for pseudomyxoma peritonei (34 of 57). Nine had colorectal adenocarcinoma and 6 had peritoneal mesothelioma. The article did not discuss asbestos exposure, and it did not report results separately for the mesothelioma patients. Operations averaged 6.9 hours, and hospital stays averaged 14.3 days. Twenty-nine patients (50.8%) had a serious (grade 3 or 4) complication, most often ileus (a stalled bowel) with vomiting (35.1%). One patient needed a second operation for bleeding and recovered. No patient died in the period around surgery. Over a median follow-up of 1.2 years, overall survival was 84.6%. The authors concluded that the procedure can be performed at their hospital with outcomes comparable to academic referral centers. They noted limitations: the retrospective design, a mixed group of cancer types, and short follow-up.

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 cohort study (chart review) at a single community hospital
• Who was studied: 57 patients who underwent complete or near-complete cytoreduction with HIPEC at Butterworth Hospital, a community hospital in Grand Rapids, Michigan, between May 2005 and 2011. Ages were 27 to 83, and 29 of 57 were men. Diagnoses: 34 pseudomyxoma peritonei, 9 colorectal adenocarcinoma, 6 peritoneal mesothelioma, 4 intra-abdominal carcinoid, and 4 other tumors.
• Main results:
  • Pseudomyxoma peritonei was the most common diagnosis (34 of 57; 59.6%), followed by colorectal cancer (9 of 57; 15.8%).
  • 6 of the 57 patients were treated for peritoneal mesothelioma.
  • Average operating room time was 6.9 hours (range 3.2 to 14.0 hours) for all 57 patients.
  • Average hospital length of stay was 14.3 days (range 4 to 65 days).
  • 29 of 57 patients (50.8%) had a grade 3 or 4 adverse event.
  • The most frequent grade 3 event was ileus with vomiting (20 of 57, 35.1%). Leak or abscess occurred in 13 of 57 (22.8%).
  • One patient (1 of 57, 1.8%) had a grade 4 event, extensive bleeding requiring reoperation. This patient recovered and was discharged to rehabilitation.
  • There were no perioperative deaths in the cohort.
  • Overall survival was 84.6% over a median follow-up of 1.2 years. 19.2% of patients had experienced recurrence of their disease.
• The authors' conclusion: The authors concluded that patients with peritoneal carcinomatosis requiring HIPEC can be treated at their community hospital with outcomes comparable to academic tertiary referral centers.
• Limitations the authors state:
  • The retrospective design limited the accuracy of data collection.
  • There was no control over study variables; treatment was not based on a strict protocol.
  • The cohort was heterogeneous in the cause of carcinomatosis, so morbidity and mortality were confounded by the underlying disease.
  • Follow-up was short, with a median of about 1.2 years.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Cohort Study, Pathology, Colorectal Cancer, Peritoneal Mesothelioma, Adenocarcinoma.

Related studies

• 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)
• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)
• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability — P.F. Bagnoli, F.C. Cananzi, et al. (2015)

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