The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy

Our plain-English summary of The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy, by B. Moran, T. Cecil, K. Chandrakumaran, et al (Colorectal Disease, 2015).

The study

• Authors: B. Moran, T. Cecil, K. Chandrakumaran, S. Arnold, F. Mohamed, A. Venkatasubramaniam
• Journal: Colorectal Disease
• Published: 2015;17(9):772-8
• Cited by: 81 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: The study determined the outcome of 1200 consecutive patients treated for peritoneal malignancy in one surgical unit over a 20-year period.

Method: A retrospective analysis was conducted of a custom designed prospective database of patients undergoing surgery for peritoneal malignancy since 1994. Patient demographics, tumour type, extent of surgery and outcome were recorded.

Results: Between 1994 and January 2014 (when the 1200th case had undergone surgery) 2956 patients were referred with a diagnosis of peritoneal malignancy. Pseudomyxoma peritonei of appendiceal origin was the pathology in 956/1200 (79.7%) patients. Other aetiologies included colorectal peritoneal metastases [89/1200 (7.4%)], abdominal mesothelioma [65/1200 (5.4%)] and miscellaneous [90/1200 (7.5%)]. Overall 863/1200 (71.9%) had complete cytoreduction, 294 (24.5%) had maximal tumour debulking and 43 (3.6%) had laparotomy only. The proportion undergoing complete cytoreduction per quartile of 300 patients was 60.7%, 65.0%, 77.0% and 80.3%. Laparotomy and biopsy fell from 6.4% in the first quartile to 2.7%, 1.7% and 1.3% in subsequent quartiles. The 30-day mortality in the four quartiles was 3.0%, 1.0%, 0.7% and 0.7%. The 5-year survival was 84% in the 636 patients with appendix tumours who had complete cytoreduction, 76% in the 38 with abdominal mesothelioma and 44% in the 60 with colorectal peritoneal metastases.

Conclusion: A centralized approach facilitated high volume experience in a single centre with an increase in the completeness of surgical excision rates and a reduction in mortality and morbidity over time.

Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

In plain English

This retrospective analysis used a prospective database at one specialist unit in Basingstoke, England. It covered the first 1200 consecutive patients operated on for peritoneal malignancy (cancer involving the abdominal lining), March 1994 to January 2014; 2956 were referred. Surgery aimed to remove all visible tumour, with heated chemotherapy inside the abdomen, or otherwise to relieve symptoms. Most patients, 956 of 1200 (79.7%), had appendix tumours; 65 (5.4%) had abdominal mesothelioma. The article does not discuss asbestos. Overall, 863 (71.9%) had all visible tumour removed, 294 (24.5%) had as much removed as possible, and 43 (3.6%) had only an exploratory operation and biopsy. Complete removal rose from 60.7% of the first 300 patients to 80.3% of the last 300. Deaths within 30 days fell from 3.0% to 0.7%. After complete removal, 5-year survival was 84% for 636 patients with appendix tumours, 76% for 38 with abdominal mesothelioma and 44% for 60 with colorectal cancer spread. The authors concluded that a centralized approach increased complete removal rates and reduced deaths and complications over time. They noted disagreement on how appendix tumours should be classified.

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 analysis of a prospectively maintained single-centre surgical database (consecutive case series)
• Who was studied: The first 1200 consecutive patients who had surgery for proven or suspected peritoneal malignancy at a single English national peritoneal malignancy centre (Basingstoke, UK), March 1994 to January 2014. 2956 patients were referred in that period.
• Exposure: No asbestos or other environmental exposure was studied. The article reports outcomes of a treatment strategy: cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC was given at 42°C for 1 hour, using mitomycin C for appendiceal tumours or colorectal peritoneal metastases, and doxorubicin plus cisplatin for mesothelioma or ovarian tumours.
• Main results:
  • Surgery was done for two indications: where complete tumour removal was considered likely, or otherwise to relieve symptoms.
  • Of the 1200 patients, 956 (79.7%) had an appendiceal tumour.
  • Of the 1200 patients, 65 (5.4%) had abdominal mesothelioma.
  • Of all 1200 patients, 863 (71.9%) had complete cytoreduction, 294 (24.5%) had maximal tumour debulking and 43 (3.6%) had laparotomy and biopsy only.
  • The proportion having complete cytoreduction rose from 60.7% in the first quartile of 300 patients to 80.3% in the fourth.
  • The proportion having laparotomy and biopsy only fell from 6.4% in the first quartile to 2.7%, 1.7% and 1.3% in the following quartiles.
  • The 30-day mortality across the four quartiles of 300 patients was 3.0%, 1.0%, 0.7% and 0.7% (as stated in the abstract).
  • Among patients who had complete cytoreduction, 5-year survival was 84% for the 636 with appendix tumours, 76% for the 38 with abdominal mesothelioma and 44% for the 60 with colorectal peritoneal metastases.
  • Surgery for colorectal cancer peritoneal metastases increased from 9 patients (3.0%) in the first quartile to 37 (12.3%) in the last.
• The authors' conclusion: The authors concluded that a centralized approach to managing pseudomyxoma peritonei of appendiceal origin allowed high-volume experience in a single centre. They reported an increase in complete surgical excision rates and a reduction in mortality and morbidity over time.
• Limitations the authors state:
  • The authors note difficulty in pathological categorization and a lack of universal agreement on the pathology of primary appendiceal tumours.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Colon cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Pathology, Mesothelioma, Laparotomy, Biopsy.

Related studies

• Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases — M. Dhir, L. Ramalingam, et al. (2017)
• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor debulking — S. Riss, K. Chandrakumaran, et al. (2015)
• Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma — Y. Huang, N.A. Alzahrani, et al. (2015)
• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)

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