Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands

Our plain-English summary of Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands, by T.R. van Oudheusden, V.E. Lemmens, H.J. Braam, et al (Surgery, 2015).

The study

• Authors: T.R. van Oudheusden, V.E. Lemmens, H.J. Braam, B. van Ramshorst, J. Meijerink, E.A. te Velde, A.M. Mehta, V.J. Verwaal, I.H. de Hingh
• Journal: Surgery
• Published: 2015;157(6):1023-7
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is currently considered the standard of care for pseudomyxoma peritonei, mesothelioma and peritoneal metastases (PM) from colorectal cancer. CRS + HIPEC has also been suggested as a potential treatment option in PM of the much rarer small bowel cancer. Therefore, the current study was undertaken to investigate the results of CRS + HIPEC in all HIPEC centers in The Netherlands.

Methods: From the 4 tertiary referral centers for peritoneal surface malignancies in The Netherlands, data from all patients with peritoneally metastasized small bowel carcinoma intended to undergo CRS and HIPEC were collected between January 2005 and July 2014. Primary tumor characteristics, operative details, and survival outcomes were collected.

Results: Sixteen of 19 patients (84.2%) who underwent explorative laparotomy underwent CRS + HIPEC. Of these patients, 81.3% were female, and primary tumors were mainly located in the ileum (50%). A complete macroscopic resection was achieved in 93.8%. Serious adverse events requiring re-intervention occurred in 25%, and no in-hospital mortality was observed. Recurrent disease was observed in 50% of patients and median survival after CRS and HIPEC was 31 months.

Conclusion: In a select group of patients in whom a complete macroscopic resection can be achieved, survival rates comparable with those in colorectal PM are attainable with acceptable morbidity. The role of adjuvant chemotherapy needs further research.

Copyright © 2015 Elsevier Inc. All rights reserved.

In plain English

This was not a study of asbestos. Mesothelioma is mentioned only as a condition for which this treatment is standard care. The authors reviewed all patients with small bowel adenocarcinoma that had spread to the abdominal lining (peritoneal metastases) intended to undergo cytoreductive surgery plus heated chemotherapy inside the abdomen (CRS + HIPEC) at four Dutch centers between January 2005 and July 2014. Of 19 patients referred, 16 (84.2%) were treated; 13 of these were female. All visible tumor was removed in 15 patients. Four patients (25%) had a serious complication needing reoperation and/or intensive care. No patient died in hospital. During follow-up, 8 patients (50%) had their cancer come back. Median overall survival after treatment was 30.8 months (range 3.4 to 94.4), and median disease-free survival was 9.5 months (95% confidence interval 4.6 to 14.4). The authors concluded that, in selected patients whose visible tumor can be fully removed, survival comparable to colorectal peritoneal metastases is attainable with acceptable complications. They said the role of chemotherapy after surgery needs further research, and named the small patient number 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 multicenter case series (patient records from four referral centers)
• Who was studied: 19 patients with peritoneal metastases from small bowel adenocarcinoma referred to 4 tertiary centers in The Netherlands between January 2005 and July 2014. 16 underwent CRS + HIPEC (13 female, median age 60.9 years).
• Exposure: No asbestos exposure was studied. The treatment studied was cytoreductive surgery with hyperthermic intraperitoneal chemotherapy using mitomycin C for 90 minutes.
• Main results:
  • Complete macroscopic resection (R1) in 15 of 16 treated patients (93.8%)
  • 4 treated patients (25%) had a serious adverse event (grade 3 or higher) requiring reoperation and/or intensive care admission
  • No in-hospital deaths among treated patients
  • Median follow-up was 16.5 months (95% CI, 10.8 to 38.0)
  • Median overall survival after CRS + HIPEC was 30.8 months (range 3.4 to 94.4).
  • Median disease-free survival after CRS + HIPEC was 9.5 months (95% CI, 4.6 to 14.4).
  • 8 of 16 treated patients (50%) developed a recurrence. These were mainly intraperitoneal (87.5%), with lung metastases in 1 patient.
  • The 3 referred patients not treated with CRS + HIPEC had a median survival of 7.1 months (range 2.3 to 7.1)
  • 9 treated patients (56.3%) received adjuvant chemotherapy. Its effect on survival could not be determined.
• The authors' conclusion: The authors concluded that in a select group of patients in whom complete macroscopic resection can be achieved, survival rates comparable with colorectal peritoneal metastases are attainable with acceptable morbidity. They said the role of adjuvant chemotherapy needs further research.
• Limitations the authors state:
  • Relatively small number of patients treated
  • Fewer patients underwent exploration than expected to be eligible, possibly because of low referral rates

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Mesothelioma, Colorectal Cancer, Carcinoma, Laparotomy, Median Survival, Chemotherapy.

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• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)
• 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)
• 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)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)

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