Surgical treatment of peritoneal carcinomatosis: current treatment modalities

Our plain-English summary of Surgical treatment of peritoneal carcinomatosis: current treatment modalities, by Y. Kulu, B. Müller-Stich, M.W. Büchler, et al (Langenbeck's Archives of Surgery, 2014).

The study

• Authors: Y. Kulu, B. Müller-Stich, M.W. Büchler, A. Ulrich
• Journal: Langenbeck's Archives of Surgery
• Published: 2014;399(1):41-53
• Type of article: Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Selected patients with peritoneal surface malignancies (PSM) have been treated effectively by the combination of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Purpose: The purpose of this study is to summarize the treatment outcomes and general considerations regarding definitions and staging systems of current CRS and HIPEC modalities in malignant peritoneal mesothelioma and in secondary peritoneal malignancies such as peritoneal metastasis from appendiceal, colorectal, gastric, and epithelial ovarian cancers.

Conclusion: Disease progression within the peritoneal cavity has in the past been regarded as a terminal event. Accumulating evidence underlines the therapeutic potential and the acceptable morbidity and mortality rates of CRS and HIPEC in selected patients.

In plain English

This was a review article. It reported no new patient data and did not discuss asbestos. It summarized published studies of cytoreductive surgery (removing all visible tumor) combined with heated chemotherapy placed in the abdomen during the operation (HIPEC). These studies covered cancers spread on the abdominal lining, including malignant peritoneal mesothelioma and abdominal spread of appendiceal, colorectal, gastric and ovarian cancers. For peritoneal mesothelioma, the review cited a reported median survival of 6 months for untreated patients. It also cited studies of selected patients after surgery plus HIPEC that reported median survival of 31 to 92 months. In one cited comparison, five-year survival was 40 % in 30 patients given selective removal of the abdominal-wall lining and 63.9 % in 30 given complete removal. In high-volume centers, cited death rates after the procedure ranged from 0.6 to 5.8 %. The authors noted that randomized trials are scarce and that there is no convincing evidence that HIPEC adds benefit beyond surgery. The authors concluded that the combination has been accepted as standard treatment for pseudomyxoma peritonei and peritoneal mesothelioma, while debate continues for colorectal, gastric and ovarian cancers.

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: Narrative review of published studies (no new patient data)
• Who was studied: Published studies of patients with peritoneal surface malignancies: malignant peritoneal mesothelioma, and peritoneal spread of appendiceal (pseudomyxoma peritonei), colorectal, gastric and ovarian cancers
• Exposure: No asbestos exposure was studied. The subject was a treatment: cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).
• Main results:
  • Cited from another study: untreated patients with malignant peritoneal mesothelioma had a reported median survival of 6 months
  • Cited from another study: systemic treatment (pemetrexed with cisplatin or carboplatin) may improve median survival in malignant peritoneal mesothelioma to 12 months
  • Cited from several investigators: selected patients with malignant peritoneal mesothelioma treated with CRS and HIPEC had median survival times ranging from 31 to 92 months
  • Cited matched-pair analysis by Baratti et al. in malignant peritoneal mesothelioma: five-year overall survival was 40 % in 30 patients with selective parietal peritonectomy versus 63.9 % in 30 patients with complete parietal peritonectomy
  • Cited reports covering CRS and HIPEC in general: in high-volume centers, mortality ranged from 0.6 to 5.8 % and grade III/IV complications from 12 to 52 %
• The authors' conclusion: The authors concluded that CRS and HIPEC has been accepted internationally as standard treatment for pseudomyxoma peritonei and malignant peritoneal mesothelioma, while considerable debate continues for peritoneal spread of colorectal, gastric and ovarian cancers
• Limitations the authors state:
  • Randomized controlled studies are scarce
  • The chemotherapy drugs used vary widely in combinations and concentrations
  • The authors stated there is no convincing evidence that HIPEC adds to the outcome of patients after cytoreductive surgery

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Staging, Peritoneal Mesothelioma, Metastasis, Ovarian Cancer, Disease Progression, Peritoneal Cavity.

Related studies

• Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy — T.C. Chua, W. Liauw, et al. (2011)
• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• A new policy regarding ovarian resection in young women treated for peritoneal carcinomatosis — D. Elias, E. Duchalais, et al. (2013)
• Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy? — C. Honoré, D. Goéré, et al. (2016)

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