Repeated cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy in patients with peritoneal carcinomatosis: A retrospective cohort study

Our plain-English summary of Repeated cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy in patients with peritoneal carcinomatosis: A retrospective cohort study, by C. Paasch, G. De Santo, H.N. Gamal-Eldin, et al (Annals of Medicine and Surgery, 2021).

The study

• Authors: C. Paasch, G. De Santo, H.N. Gamal-Eldin, M. Hünerbein
• Journal: Annals of Medicine and Surgery
• Published: 2021;70:102824
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: The prognosis of abdominal cancer with peritoneal carcinomatosis (PC) is poor. In literature, some authors described a repeated Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in patients with recurrent PC as feasible for overall survival improvement. Hence, we implemented this approach at our hospital and analyzed our cases.

Methods: A unicentric retrospective observational study took place at the Helios hospital Berlin-Buch in 2020. The data of individuals who received a HIPEC in the time of 2007-2019 were extracted. The data were entered in the HIPEC database of the German Society of General and Visceral Surgery (StuDoQ|HIPEC, German society for general and visceral surgery). The primary objective was the overall survival after first HIPEC procedure.

Results: A total of 292 data files from were extracted and 14 patients were identified as eligible for further analysis (7× colorectal, 3x gastric, 1× appendix cancer, 1× cancer of unknown primary, 1× Mesothelioma, 1× Pseudomyxoma peritonei). The mean age was 57 (8) years. The BMI was on average 23.5 (3.5) kg/m2. A total of 8 individuals were female and 6 male (6xASA-Score I, 8xASA-Score II). The initial Peritoneal Cancer Index (PCI) was on average 11.5 (9.1). The average overall survival after 1. HIPEC for colonic cancer was 74 months (n = 3; 43, 70 and 90 month), for gastric cancer 29 months (n = 2; 19 and 39 month) and for mesothelioma 44 months (n = 1).

Conclusions: Based on our findings Repeated Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy may improve overall survival of selected patients suffering from peritoneal carcinomatosis.

© 2021 The Authors.

In plain English

This retrospective study looked back at records of patients treated at the Helios hospital Berlin-Buch in Germany for cancer spread across the lining of the abdomen (peritoneal carcinomatosis). From 292 patients who received heated chemotherapy delivered into the abdomen (HIPEC) between 2007 and 2019, 14 who received HIPEC more than once, usually with repeated tumor-removal surgery, were analyzed. Seven had colonic cancer and 3 had gastric cancer. One each had pseudomyxoma peritonei, a low-grade appendiceal mucinous neoplasm, mesothelioma, and cancer of unknown primary. The article does not discuss asbestos. Average overall survival after the first HIPEC was 74.4 months for colonic cancer (3 patients) and 29 months for gastric cancer (2 patients). The one man with mesothelioma survived 44 months. Five of the 14 patients (35.7%) had died. The authors concluded that repeated treatment may improve survival of selected patients and said randomized trials are needed. They named as limitations the retrospective design, the small sample, the mix of diseases, missing tumor-extent scores in 8 cases, and selection bias. Some numbers in the article do not agree with each other.

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: Single-center retrospective observational (cohort) study of registry data, analyzed descriptively
• Who was studied: 14 patients with peritoneal carcinomatosis who received repeated HIPEC at Helios hospital Berlin-Buch, Germany, between 2007 and 2019. They were selected from 292 HIPEC patients in the StuDoQ|HIPEC registry: 18 were eligible and 4 were excluded for palliative treatment intention. The group comprised 7 colonic cancer, 3 gastric cancer, 1 pseudomyxoma peritonei, 1 low-grade appendiceal mucinous neoplasm, 1 mesothelioma and 1 cancer of unknown primary. Mean age was 57 (SD 8) years; 8 were female and 6 male.
• Exposure: No asbestos exposure is reported. The treatment studied was repeated cytoreductive surgery with HIPEC. The chemotherapy was Cisplatin plus Mitomycin C, or 5-Fluorouracil for patients with renal insufficiency or Cisplatin resistance, infused over 1 hour at 40 degrees.
• Main results:
  • The one male patient with mesothelioma with peritoneal carcinomatosis survived 44 months after the first HIPEC. His initial Peritoneal Cancer Index was 11, and he received HIPEC twice.
  • Colonic cancer patients: average overall survival after the first HIPEC was 74.4 months (n = 3; 43, 70 and 90 months).
  • Gastric cancer patients: average overall survival after the first HIPEC was 29 months (n = 2; 19 and 39 months).
  • Of the 14 patients, 5 (35.7%) had died, and 7 were reported as still alive.
  • Complications within 30 days (Clavien-Dindo classification) were: 1 patient grade 0, 1 grade I, 8 grade II, 1 grade III and 1 grade IV. Information was not available in 2 cases.
  • Cumulative length of hospital stay averaged 43 (SD 15.1) days.
• The authors' conclusion: The authors concluded that repeated cytoreductive surgery with HIPEC may improve overall survival of selected patients with peritoneal carcinomatosis. They said randomized trials are needed to confirm this.
• Limitations the authors state:
  • Retrospective design, small sample size, and initial Peritoneal Cancer Index scores missing in 8 cases
  • The study mixed several diseases; an analysis focused on one disease would be preferable.
  • Only patients with ASA scores I or II were analyzed, which the authors note may be a selection bias.
  • Results were compared with historic data from studies with different inclusion criteria and endpoints, so they are only partly comparable.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Cohort Study, Prognosis, Overall Survival, Mesothelioma, Peritoneal Cancer Index (PCI), Stomach Cancer.

Related studies

• Repeated cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with recurrent peritoneal carcinomatosis — N. Vassos, T. Förtsch, et al. (2016)
• Influence of the effectiveness of sarcopenia on postoperative major complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal surface malignancy: a retrospective cohort study — N. Havan, S. Gülmez, et al. (2025)
• Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — G. Glockzin, H.J. Schlitt, et al. (2009)
• Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan — T. Kitai (2021)

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