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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2017

01-08-2017 | Gastrointestinal Oncology

Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC

Authors: Marcel André Schneider, M Med, Dilmurodjon Eshmuminov, MD, Kuno Lehmann, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2017

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Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined treatment option for well-selected patients with peritoneal carcinomatosis (PC). The study aimed to identify factors influencing cancer-specific survival (CSS) and disease-free survival (DFS).

Methods

Data of 113 patients with colorectal or appendicular carcinomatosis from a single center operated between 2009 and 2014 were retrospectively collected and analyzed. Patients with high-grade tumors received standard perioperative chemotherapy, and patients with low-grade appendix tumors were directly operated. HIPEC was performed after radical CRS.

Results

Patients had carcinomatosis from appendix neoplasms in 63% (71/113), including low-grade and high-grade tumors, and colorectal cancer in 37% (42/113). Complete cytoreduction and HIPEC were possible in 67% of patients. Major morbidity occurred in 10.6% of patients, and mean follow-up was 28 months. For colorectal PC, median CSS and DFS were 40 and 12 months, respectively. Median DFS was 19 months for high-grade appendix tumors, while median CSS has not been reached. All patients with diffuse peritoneal adenomucinosis were still alive at time of analysis; rate of DFS was 96% for these patients after 3 years. Major postoperative complications (Clavien-Dindo IIIB or higher) and positive nodal state were associated with impaired CSS and DFS, while a peritoneal cancer index score of >10 was independently associated with impaired CSS.

Conclusions

CRS/HIPEC offers a survival benefit in well-selected patients with PC. Major postoperative complications affect long-term oncologic outcome of these patients.
Literature
1.
Glehen O, Mohamed F, Gilly FN. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol. 2004;5:219–28.CrossRefPubMed
2.
Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63–8.CrossRefPubMed
3.
Loupakis F, Cremolini C, Masi G, et al. Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med. 2014;371:1609–18.CrossRefPubMed
4.
Franko J, Shi Q, Goldman CD, et al. Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: a pooled analysis of north central cancer treatment group phase III trials N9741 and N9841. J Clin Oncol. 2012;30:263–7.CrossRefPubMed
5.
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.CrossRefPubMed
6.
Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21:3737–43.CrossRefPubMed
7.
Chua TC, Moran BJ, Sugarbaker PH, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30:2449–56.CrossRefPubMed
8.
Lehmann K, Eshmuminov D, Slankamenac K, et al. Where oncologic and surgical complication scoring systems collide: time for a new consensus for CRS/HIPEC. World J Surg. 2016;40:1075–81.CrossRefPubMed
9.
Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM. Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei.” Am J Surg Pathol. 1995;19:1390–408.CrossRefPubMed
10.
Kajdi ME, Beck-Schimmer B, Held U, Kofmehl R, Lehmann K, Ganter MT. Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience. World J Surg Oncol. 2014;12:136.CrossRefPubMedPubMedCentral
11.
Halkia E, Tsochrinis A, Vassiliadou DT, et al. Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC. Int J Surg Oncol. 2015;2015:610597.PubMedPubMedCentral
12.
Glehen O, Cotte E, Kusamura S, et al. Hyperthermic intraperitoneal chemotherapy: nomenclature and modalities of perfusion. J Surg Oncol. 2008;98:242–6.CrossRefPubMed
13.
14.
Kuijpers AM, Mirck B, Aalbers AG, et al. Cytoreduction and HIPEC in the Netherlands: nationwide long-term outcome following the Dutch protocol. Ann Surg Oncol. 2013;20:4224–30.CrossRefPubMedPubMedCentral
15.
Turaga KK, Pappas SG, Gamblin TC. Importance of histologic subtype in the staging of appendiceal tumors. Ann Surg Oncol. 2012;19:1379–85.CrossRefPubMed
16.
McCusker ME, Coté TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end results program, 1973–1998. Cancer. 2002;94:3307–12.CrossRefPubMed
17.
van Oudheusden TR, Braam HJ, Nienhuijs SW, et al. Poor outcome after cytoreductive surgery and HIPEC for colorectal peritoneal carcinomatosis with signet ring cell histology. J Surg Oncol. 2015;111:237–42.CrossRefPubMed
18.
Miner TJ, Shia J, Jaques DP, Klimstra DS, Brennan MF, Coit DG. Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg. 2005;241:300–8.CrossRefPubMedPubMedCentral
19.
Bruin SC, Verwaal VJ, Vincent A, van’t Veer LJ, van Velthuysen MLF. A clinicopathologic analysis of peritoneal metastases of colorectal and appendiceal origin. Ann Surg Oncol. 2010;17:2330–40.
20.
Baumgartner JM, Tobin L, Heavey SF, Kelly KJ, Roeland EJ, Lowy AM. Predictors of progression in high-grade appendiceal or colorectal peritoneal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2015;22:1716–21.CrossRefPubMed
21.
Glehen O, Gilly FN, Boutitie F, et al. Toward curative treatment of peritoneal carcinomatosis from non-ovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1290 patients. Cancer. 2010;116:5608–18.CrossRefPubMed
22.
Braam HJ, van Oudheusden TR, de Hingh IHJT, et al. Patterns of recurrence following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. J Surg Oncol. 2014;109:841–7.CrossRefPubMed
23.
Elias D, Mariani A, Cloutier A-S, et al. Modified selection criteria for complete cytoreductive surgery plus HIPEC based on peritoneal cancer index and small bowel involvement for peritoneal carcinomatosis of colorectal origin. Eur J Surg Oncol. 2014;40:1467–73.CrossRefPubMed
24.
Goéré D, Souadka A, Faron M, et al. Extent of colorectal peritoneal carcinomatosis: attempt to define a threshold above which HIPEC does not offer survival benefit: a comparative study. Ann Surg Oncol. 2015;22:2958–64.CrossRefPubMed
25.
Chua TC, Saxena A, Schellekens JF, et al. Morbidity and mortality outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy at a single tertiary institution: towards a new perspective of this treatment. Ann Surg. 2010;251:101–6.CrossRefPubMed
26.
Ihemelandu C, Mavros MN, Sugarbaker P, Adverse events postoperatively had no impact on long-term survival of patients treated with cytoreductive surgery with heated intraperitoneal chemotherapy for appendiceal cancer with peritoneal metastases. Ann Surg Oncol. 2016;23(13):4231–7.CrossRefPubMed
27.
Simkens GA, van Oudheusden TR, Luyer MD, et al. Serious postoperative complications affect early recurrence after cytoreductive surgery and HIPEC for colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2015;22:2656–62.CrossRefPubMed
28.
Wallet F, Maucort Boulch D, Malfroy S, et al. No impact on long-term survival of prolonged ICU stay and re-admission for patients undergoing cytoreductive surgery with HIPEC. Eur J Surg Oncol. 2016;42:855–60.CrossRefPubMed
29.
Valle M, Federici O, Carboni F, et al. Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: proposal and results from a prospective protocol study of prevention, surveillance and treatment. Eur J Surg Oncol. 2014;40:950–6.CrossRefPubMed
30.
Capone A, Valle M, Proietti F, Federici O, Garofalo A, Petrosillo N. Postoperative infections in cytoreductive surgery with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis. J Surg Oncol. 2007;96:507–13.CrossRefPubMed
31.
Chua TC, Yan TD, Saxena A, Morris DL. Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? A systematic review of morbidity and mortality. Ann Surg. 2009;249:900–7.CrossRefPubMed
32.
Binkowska AM, Michalak G, Słotwiński R. Current views on the mechanisms of immune responses to trauma and infection. Cent Eur J Immunol. 2015;40:206–16.CrossRefPubMedPubMedCentral
33.
34.
Votanopoulos K, Ihemelandu C, Shen P, Stewart J, Russell G, Levine EA. A comparison of hematologic toxicity profiles after heated intraperitoneal chemotherapy with oxaliplatin and mitomycin C. J Surg Res. 2013;179:e133–9.CrossRefPubMed
35.
Becher RD, Shen P, Stewart JH, Russell G, Bradley JF, Levine EA. Splenectomy ameliorates hematologic toxicity of hyperthermic intraperitoneal chemotherapy. J Gastrointest Oncol. 2011;2:70–6.PubMedPubMedCentral
36.
Deslauriers N, Olney H, Younan R. Splenectomy revisited in 2011: impact on hematologic toxicities while performing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Gastrointest Oncol. 2011;2:61–3.PubMedPubMedCentral
37.
Melero JT, Ortega FG, Gonzalez AM, et al. Prognostic factor analysis of circulating tumor cells in peripheral blood of patients with peritoneal carcinomatosis of colon cancer origin treated with cytoreductive surgery plus an intraoperative hyperthermic intraperitoneal chemotherapy procedure (CRS + HIPEC). Surgery. 2016;159:728–35.CrossRefPubMed
Metadata
Title
Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC
Authors
Marcel André Schneider, M Med
Dilmurodjon Eshmuminov, MD
Kuno Lehmann, MD, PhD
Publication date
01-08-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5821-7

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