The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan

Our plain-English summary of The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan, by T. Kitai (Surgery Today, 2021).

The study

• Author: T. Kitai
• Journal: Surgery Today
• Published: 2021;51(7):1085-1098
• Type of article: Systematic review
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The prognosis of peritoneal carcinomatosis is poor. However, the emergence of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) as a treatment option has prolonged survival and it can even potentially cure patients with peritoneal carcinomatosis. Randomized controlled studies and other observational studies indicated that this combined therapy potentially improved the prognosis of patients with colon, gastric, and ovarian cancers with acceptable morbidity and mortality rates. Even in rarer diseases, such as pseudomyxoma peritonei and malignant peritoneal mesothelioma, CRS + HIPEC markedly improved the prognoses over those with conventional treatment. Based on the accumulated evidence, clinical guidelines recommend CRS + HIPEC for selected patients with peritoneal carcinomatosis. However, several issues still need to be overcome. A standard method for HIPEC has not yet been established. Furthermore, the criteria employed for patient selection need to be clarified to achieve real benefits. The peritoneal cancer index, chemo-sensitivity and several biological markers are considered to be key factors.

In plain English

This was a review article by a single author at Kishiwada City Hospital in Japan. It surveyed published studies, including Japanese ones, on cytoreductive surgery combined with heated chemotherapy in the abdomen (CRS + HIPEC). The main cancers covered were colorectal, gastric and ovarian cancer spreading over the abdominal lining, pseudomyxoma peritonei and malignant peritoneal mesothelioma; rarer cancers were mentioned briefly. The article does not describe how studies were found or chosen, and it does not discuss asbestos. For peritoneal mesothelioma, the review described others' work. A single-institution series of 108 cases reported overall survival of 63.2 months. A meta-analysis pooled 1047 cases from 20 published studies. In a Japanese series of 63 cases, the 14 with complete cytoreduction (which allows residual tumor under 2.5 mm) had 5-year survival of 42%. A Dutch population-based study associated CRS + HIPEC with longer survival. The author noted that the mesothelioma evidence was of low level, but stated that prognosis appeared markedly better after CRS + HIPEC than after conventional therapy. The author concluded that no standard HIPEC method exists and that patient selection criteria need clarification.

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 (titled a systematic review) by a single author. No search or selection method is described.
• Who was studied: Published studies, including evidence from Japan, of patients with peritoneal carcinomatosis. The main groups were colorectal, gastric and ovarian cancer, pseudomyxoma peritonei and malignant peritoneal mesothelioma. Rarer cancers were mentioned briefly.
• Exposure: Treatment with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy, using drugs such as mitomycin C, cisplatin and oxaliplatin. Asbestos exposure is not discussed.
• Main results:
  • The review briefly notes that earlier studies of peritoneal carcinomatosis from small intestinal cancer, sarcoma, hepatocellular carcinoma, bile duct cancer, pancreatic cancer and desmoplastic small round cell tumors reported potential benefit, and that further investigation is needed.
  • A study by Baratti, cited in the review, of 108 malignant peritoneal mesothelioma cases at one institution: morbidity 38.9%, mortality 1.9%, recurrence-free survival 25.1 months, overall survival 63.2 months.
  • A meta-analysis by Helm (2015), cited in the review, pooled 1047 malignant peritoneal mesothelioma cases from 20 published studies.
  • A Japanese series by Yonemura, cited in the review: of 63 malignant peritoneal mesothelioma cases, complete cytoreduction was achieved in 14. Five-year survival among patients with CC-0/1 was 42%.
  • In the review's scoring system, CC-1 (counted as complete resection) means residual tumor smaller than 2.5 mm.
  • A Dutch population-based study (2019), cited in the review, found that longer survival in malignant peritoneal mesothelioma was independently associated with CRS + HIPEC (HR = 0.33) and with surgery plus adjuvant systemic chemotherapy (HR = 0.33).
  • A US National Cancer Database study, cited in the review: mesothelioma patients who had radical surgery had overall survival of 38.4 months, compared with 7.1 months in patients without surgery.
  • A registry study by Yan, cited in the review, covered 405 malignant peritoneal mesothelioma cases at multiple specialized centers.
• The authors' conclusion: The author concluded that, although the evidence level of the studies was low, the prognosis of malignant peritoneal mesothelioma patients was markedly better after CRS + HIPEC than after conventional therapy. The author also stated that no standard HIPEC method has been established and that patient selection criteria need clarification.
• Limitations the authors state:
  • The author notes that retrospective studies and small randomized trials do not provide solid evidence.
  • The author states that it is difficult to draw conclusions about patient selection from the tabulated data.

Topics

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

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Systematic Review, Prognosis, Ovarian Cancer, Peritoneal Mesothelioma, Peritoneal Cancer Index (PCI).

Related studies

• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis — J.H. Helm, J.T. Miura, et al. (2015)

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