Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies

Our plain-English summary of Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies, by G. Passot, N. Bakrin, S. Isaac, et al (European Journal of Surgical Oncology, 2014).

The study

• Authors: G. Passot, N. Bakrin, S. Isaac, E. Decullier, F.N. Gilly, O. Glehen, E. Cotte
• Journal: European Journal of Surgical Oncology
• Published: 2014;40(8):957-62
• Cited by: 51 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the only curative treatment for many peritoneal surface malignancies. The purpose of this study was to evaluate feasibility and safety of CRS combined with HIPEC by laparoscopy for patients with limited peritoneal disease and to compare postoperative outcomes with those for an open procedure.

Methods: Between January 2011 and November 2012, all patients with low-grade pseudomyxoma peritonei (PMP) or multicystic mesothelioma (MM) and limited peritoneal disease (Peritoneal Cancer Index [PCI] less than 10) underwent CRS and HIPEC by a laparoscopic approach. The study cohort was matched with a historical cohort of patients with the same characteristics (completeness of cytoreduction, HIPEC agent, PCI ± 11 and age ± 20 years) treated with CRS and HIPEC by laparotomy.

Results: Eight patients (five low-grade PMP and three MM) treated by a laparoscopic approach were compared to eight patients treated by laparotomy. All patients underwent complete cytoreductive surgery with HIPEC, and no conversion to laparotomy was needed. The median surgical length was 210 min (150-300) vs 240 (210-360), with a median hospital stay of 12 days (9-18) vs 19 (13-33). One patient had a postoperative complication (intraperitoneal haematoma treated by radiological drainage) vs four in the laparotomy group.

Conclusion: Laparoscopic CRS combined with HIPEC is feasible and safe for curative treatment of strictly selected patients with peritoneal surface malignancy and might reduce postoperative complications and length of hospital stay.

Copyright © 2013 Elsevier Ltd. All rights reserved.

In plain English

This study, from Lyon Sud hospital in France, tested whether surgery to remove all visible tumour, combined with heated chemotherapy circulated through the abdomen (HIPEC), could be done by keyhole (laparoscopic) surgery. Between January 2011 and November 2012, eight of 49 patients treated with this combination met strict criteria for the keyhole approach. Five had low-grade pseudomyxoma peritonei and three had multicystic mesothelioma, all with limited disease. They were compared with eight earlier patients treated by open surgery and matched on several features, although the open-surgery group had more extensive disease. No keyhole operation had to be switched to open surgery, and all removed the visible disease completely. One keyhole patient had a complication, a pelvic blood collection drained by radiology, compared with four of eight open-surgery patients (P value 0.28). Median hospital stay was 12 days versus 19 days, which the authors reported as significantly shorter. The authors concluded the approach was safe and feasible for strictly selected patients and called for larger studies. The article does not discuss asbestos.

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: Small single-centre series of laparoscopic (keyhole) surgery compared with a matched historical control group treated by open surgery (laparotomy) in the same institution
• Who was studied: 49 patients had cytoreductive surgery and HIPEC at Lyon Sud Hospital, France, from January 2011 to November 2012. Of these, 8 (16%) met the criteria for the laparoscopic approach: 5 with low-grade pseudomyxoma peritonei and 3 with multicystic mesothelioma; 6 women and 2 men, median age 47.5 years (range 26 to 71). The control group was 8 laparotomy patients: 5 low-grade pseudomyxoma peritonei, 1 multicystic mesothelioma and 2 with peritoneal carcinomatosis of colorectal origin.
• Exposure: No asbestos exposure was studied. The intervention was laparoscopic cytoreductive surgery plus HIPEC at 42 degrees C. Pseudomyxoma patients received oxaliplatin (4 patients) or mitomycin plus cisplatin (1 patient). Multicystic mesothelioma patients received cisplatin (20 mg/m2) and doxorubicin (15 mg/m2) for 60 min.
• Main results:
  • In the laparoscopic group, no patient needed conversion to open surgery and cytoreduction was complete (CC 0) in all 8 patients
  • Complications: 1 of 8 laparoscopic patients (a pelvic haematoma requiring radiological drainage) versus 4 of 8 laparotomy patients; table P value 0.28
  • Median hospital stay was 12 days (range 9 to 18) in the laparoscopic group versus 19 days (13 to 33) in the laparotomy group; the authors reported it as significantly shorter (P 0.01)
  • Median surgery length was 210 minutes (range 150 to 300) in the laparoscopic group versus 240 minutes (210 to 360) in the laparotomy group; table P value 0.12
  • Disease extent (Peritoneal Cancer Index) was higher in the laparotomy group: median 8 (range 4 to 13) versus 2.5 (1 to 7) in the laparoscopic group; P 0.001
  • With a median follow-up of 192 days (range 43 to 638), all patients were alive without recurrence
• The authors' conclusion: The authors concluded that their results confirm the safety and feasibility of laparoscopic cytoreductive surgery and HIPEC with curative intent, which may reduce postoperative complications and hospital stay, but that it should be reserved for patients with non-aggressive, limited disease.
• Limitations the authors state:
  • The matching did not achieve comparable disease extent: the authors could not find enough historical patients to avoid a significant difference in Peritoneal Cancer Index
  • The authors stated that larger prospective studies with longer follow-up are needed to confirm the benefits and to assess effects on survival
  • The authors noted that laparoscopy may not allow a full exploration of the abdomen, especially the entire mesentery

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Multicystic Mesothelioma (MCM), Peritoneal Cancer Index (PCI), Laparotomy.

Related studies

• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)
• 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)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Malignant peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is GLUT1 expression a major prognostic factor? A preliminary study — J. Hommell-Fontaine, S. Isaac, et al. (2013)
• 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)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)

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