Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC

Our plain-English summary of Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC, by E. Halkia, A. Tsochrinis, D.T. Vassiliadou, et al (International Journal of Surgical Oncology, 2015).

The study

• Authors: E. Halkia, A. Tsochrinis, D.T. Vassiliadou, A. Pavlakou, A. Vaxevanidou, A. Datsis, E. Efstathiou, J. Spiliotis
• Journal: International Journal of Surgical Oncology
• Published: 2015;2015:610597
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Peritoneal carcinomatosis (PC) is associated with a poor prognosis. Cytoreductive surgery (CRS) and HIPEC play an important role in well-selected patients with PC. The aim of the study is to present the differences in the intraoperative parameters in patients who received HIPEC in two different manners, open versus closed abdomen.

Patients And Methods: The population includes 105 patients with peritoneal carcinomatosis from colorectal, gastric, and ovarian cancer, sarcoma, mesothelioma, and pseudomyxoma peritonei. Group A (n = 60) received HIPEC using the open technique and Group B (n = 45) received HIPEC with the closed technique. The main end points were morbidity, mortality, and overall hospital stay.

Results: There were two postoperative deaths (3.3%) in the open group versus no deaths in the closed group. Twenty-two patients in the open group (55%) had grade III-IV complications versus 18 patients in the closed group (40%). There are more stable intraoperative conditions in the closed abdomen HIPEC in CVP, pulse rate, and systolic pressure parameters.

Conclusions: Both methods are equal in the HIPEC procedures. Perhaps the closed method is the method of choice for frail patients due to more stable hemodynamic parameters.

In plain English

This was a retrospective study comparing two ways of giving heated chemotherapy inside the abdomen (HIPEC) after cancer surgery. It did not study asbestos exposure. It included 105 patients treated from 2009 to 2013 whose cancer had spread through the abdominal lining (peritoneal carcinomatosis). That cancer came from colorectal, ovarian or gastric cancer, mesothelioma, sarcoma or pseudomyxoma peritonei. Sixteen patients had mesothelioma, 8 in each group. Sixty patients received the open technique and 45 the closed technique. Two open-group patients died after surgery (3.3%) and no closed-group patients died, a difference reported as not statistically significant. Grade III to IV complications were reported in 22 open-group patients (printed as 55%, although 22 of 60 is about 37%) and in 18 closed-group patients (40%), also not significant. Mean hospital stay was 8.7 days (open) and 9.1 days (closed). No statistically significant differences were found in temperatures, blood pressure, pulse, central venous pressure or urine output during HIPEC, though the authors observed that the closed technique appeared more stable. The authors concluded that both techniques were safe with equal morbidity and mortality, and that the closed technique was more appropriate for frail patients. They named their small sample as a limitation.

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 comparison of two patient groups treated with different HIPEC techniques (open versus closed abdomen)
• Who was studied: 105 patients with peritoneal carcinomatosis from colorectal, ovarian and gastric cancer, mesothelioma, sarcoma and pseudomyxoma peritonei, treated over five years (2009 to 2013). The authors are from hospitals in Greece.
• Exposure: No asbestos exposure was studied. The comparison was between the open (coliseum) HIPEC technique (60 patients, Group A) and the closed abdomen technique (45 patients, Group B). Intraoperative measurements were recorded every 15 minutes during 90 minutes of HIPEC.
• Main results:
  • Mesothelioma was the origin of peritoneal carcinomatosis in 8 of 60 open-group patients (13.3%) and 8 of 45 closed-group patients (17.8%)
  • Open group: two postoperative deaths (3.3%). Closed group: no postoperative deaths. The difference was reported as not statistically significant (NSS).
  • Grade III and IV complications occurred in 22 open-group patients (printed as 55%) and 18 closed-group patients (40%). The difference was not statistically significant.
  • Mean hospital stay was 8.7 days in the open group and 9.1 days in the closed group, a difference that was not statistically significant
  • No statistically significant differences were found between the groups in abdominal temperature, core temperature, central venous pressure, heart rate, systolic blood pressure or urinary output during HIPEC
  • The authors observed more stable conditions with narrower ranges in the closed group, which they said were not statistically significantly different from the open group
• The authors' conclusion: The authors concluded that both techniques were safe, caused no significant haemodynamic disturbances and had equal morbidity and mortality, but that the more stable conditions with the closed technique made it more appropriate for frail patients.
• Limitations the authors state:
  • The small sample size, which the authors said may explain why the observed stability could not be evaluated statistically

Topics

Medical terms in this study, explained in our Lexicon: HIPEC, Prognosis, Cytoreductive Surgery, Ovarian Cancer, Sarcoma, Mesothelioma.

Related studies

• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy? — C. Honoré, D. Goéré, et al. (2016)
• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)
• Current practice in cytoreductive surgery and HIPEC for metastatic peritoneal disease: Spanish multicentric survey — R. Morales-Soriano, N. Esteve-Pérez, et al. (2018)

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