Peritoneal metastases of rare carcinomas treated with cytoreductive surgery and HIPEC - A single center case series

Our plain-English summary of Peritoneal metastases of rare carcinomas treated with cytoreductive surgery and HIPEC - A single center case series, by A. Brandl, C.B. Zielinski, W. Raue, et al (Annals of Medicine and Surgery, 2017).

The study

• Authors: A. Brandl, C.B. Zielinski, W. Raue, J. Pratschke, B. Rau
• Journal: Annals of Medicine and Surgery
• Published: 2017;22:7-11
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: In selected cases, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for patients suffering from peritoneal metastases from colorectal, ovarian, gastric or appendiceal origin. The effectiveness of this extensive has not been elucidated within other rare diseases by now.

Methods: We conducted a retrospective analysis of patients treated with CRS for peritoneal carcinomatosis during the period between July 2010 and September 2015. Exclusion criteria were adenocarcinomas of the stomach, colon, neoplasms of the appendix, mesothelioma and ovarian cancers. Aim of this study was to examine the feasibility, complication rate and survival of patients with rare diseases.

Results: A total of 14 Patients were included: Four rare gynecological tumors, three adenocarcinomas of the small intestine, three retroperitoneal sarcomas, one cholangiocellular carcinoma, one neuroendocrine gastric tumor, one malignant peripheral nerve sheath tumor and one cancer of unknown primary syndrome. In 12 of 14 patients a macroscopically complete tumorresection could be achieved. No patient died during hospitalization. Seven of 14 patients experienced general complication of grade III according to NCI CTCAE V4.0, while two experienced complications of grade IV. Median follow-up and one year overall survival were 15.5 months and 46.8%, respectively.

Conclusion: For patients with rare tumors, CRS and HIPEC is feasible with an acceptable perioperative morbidity and mortality. To improve knowledge in patient selection and outcome, rare tumors treated with CRS and HIPEC should be documented in central databases (as for example BIG RENAPE, Pierre-Benite, France).

In plain English

This article is not about asbestos. It was a retrospective case series of 14 consecutive patients treated at Charité, Universitätsmedizin Berlin, Germany, between July 2010 and September 2015. Their cancer had spread to the lining of the abdomen from unusual origins. All had cytoreductive surgery, which removes visible tumor, followed in most cases by heated chemotherapy circulated in the abdomen (HIPEC). Patients with mesothelioma, adenocarcinomas of the stomach or colon, appendix tumors or ovarian cancers were excluded, though the series did include one gastric neuroendocrine tumor and four rare gynecological tumors. Seven unusual tumor origins were included. All visible tumor was removed in 12 patients (86%). Half of the patients had complications after surgery. One needed another operation because the abdominal wall closure came apart, and 8 had non-surgical complications. No patient died during the hospital stay. Over a median follow-up of 16 months, 8 patients (57%) died, and every surviving patient had tumor recurrence or progression. The authors concluded that complications were acceptable in specialized centers and that more data are needed. They noted the usual biases of retrospective studies on rare tumors.

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 single-center case series
• Who was studied: 14 patients treated with CRS and HIPEC for peritoneal spread of cancers of unusual origin, at Campus Mitte, Charité, Universitätsmedizin Berlin, Germany, July 2010 to September 2015. Excluded were adenocarcinomas of the stomach and colon, neoplasms of the appendix, LAMN, mesothelioma and ovarian cancers. Included were four rare gynecological tumors, three adenocarcinomas of the small intestine, three retroperitoneal sarcomas, one cholangiocellular carcinoma, one neuroendocrine gastric tumor, one malignant peripheral nerve sheath tumor and one cancer of unknown primary syndrome.
• Exposure: No asbestos or other environmental or occupational exposure was studied. The study looked at a treatment: cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC).
• Main results:
  • Mesothelioma was among the conditions excluded from the series.
  • The 14 patients included four rare gynecological tumors and one neuroendocrine gastric tumor, among other rare origins.
  • Seven unusual tumor origins were included among the 14 patients.
  • Complete removal of visible tumor was achieved in 12 of the 14 patients (86%).
  • Postoperative morbidity among the 14 patients was 50%.
  • One patient had a severe surgical complication (fascial dehiscence) treated with an operation.
  • Non-surgical complications occurred in 8 patients.
  • No patient died during hospitalization. The median hospital stay was 13 days (range 8 to 34).
  • At a median follow-up of 16 months, 8 of the 14 patients (57%) had died and 6 (43%) were alive.
  • Every patient still alive had developed peritoneal tumor recurrence or tumor progression.
  • Univariate analysis did not identify factors predicting survival.
• The authors' conclusion: The authors concluded that perioperative morbidity is acceptable in specialized centers for peritoneal surface malignancies. They said more data, for example from prospective rare-tumor registries, are needed to better define when to use CRS and HIPEC for rare tumors.
• Limitations the authors state:
  • The authors stated that the study has the typical biases of retrospective studies on rare tumors.

Topics

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

Related studies

• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• Feasibility and outcomes of cytoreductive surgery and HIPEC for peritoneal surface malignancies in low- and middle-income countries: a single-center experience of 232 cases — S. Deo, M. Ray, et al. (2021)
• Efficacy and Insights from an Extensive Series of Cytoreductive Surgery for Peritoneal Neoplasms: A High-Volume Single-Center Experience — M. Aulicino, F. Santullo, et al. (2024)
• Complete cytoreductive surgery plus HIPEC for peritoneal metastases from unusual cancer sites of origin: results from a worldwide analysis issue of the Peritoneal Surface Oncology Group International (PSOGI) — D. Goéré, G. Passot, et al. (2017)
• Practice patterns, attitudes, and knowledge among physicians regarding cytoreductive surgery and HIPEC for patients with peritoneal metastases — T. Bernaiche, E. Emery, et al. (2018)
• The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis — E. Bekhor, J. Carr, et al. (2020)

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