Top

Published in:

Open Access 01-12-2024 | Peritonectomy | Research

Morbidity and mortality of patients with peritoneal malignancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Authors: Greta Hotza, Michael Karageorgos, Varvara Pastourmatzi, Nader Baniowda, Dimitrios Kyziridis, Apostolos Kalakonas, Nicolaos Chavouzis, Irene Hotza, Antonios-Apostolos Tentes

Published in: Discover Oncology | Issue 1/2024

Abstract

Background

The purpose of this study was to record the incidence, and identify the prognostic variables of morbidity and mortality in patients with peritoneal malignancy undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

The files of patients with peritoneal malignancy who underwent CRS + HIPEC from 2015–2022 were retrieved. Morbidity and hospital mortality were recorded and correlated to a variety of clinical variables.

Results

A total of 44/192 (22.9%) patients were recorded with postoperative complications. Grade 3 and 4 complications were 12.5%. The possible prognostic variables of morbidity were the extent of peritoneal malignancy and the number of suture lines. The mortality rate was 2.5% (5 patients). The number of FFP units, and peritonectomy procedures were identified as possible prognostic variables of hospital mortality.

Conclusions

The morbidity rate in patients undergoing CRS + HIPEC is acceptable compared to morbidity of previous publications or major gastrointestinal surgical operations. The possible prognostic variables of morbidity are the extent of peritoneal malignancy, and the number of suture lines. The mortality rate is low. The possible prognostic variables of mortality are the number of FFP units, and the number of peritonectomy procedures.

Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg. 1995;221:124–32.CrossRefPubMedPubMedCentral

Chouliaras K, Levine EA, Fino N, Shen P, Votanopoulos KI. Prognostic factors and significance of gastrointestinal leak after cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2016. https://doi.org/10.1245/s10434-016-5738-6.CrossRefPubMedPubMedCentral

Shen P, Levine EA, Hall J, Case D, Russell G, Fleming R, McQuellon R, Geisinger KR, Loggie BW. Factors predicting survival after intraperitoneal hyperthermic chemotherapy with Mitomycin-C after cytoreductive surgery for patients with peritoneal carcinomatosis. Arch Surg. 2003;138:26–33.CrossRefPubMed

Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, Barone R, Yunemura Y, Cavaliere F, Quenet F, Gutman M, Tentes AAK, Lorimier G, Bernard JL, Bereder JM, Porcheron J, Gomez-Portilla A, Shen P, Deraco M, Rat P. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.CrossRefPubMed

Di Fabio F, Mehta A, Chandrakumaran K, Mohamed F, Cecil T, Moran B. Advanced pseudomyxoma peritonei requiring gastrectomy to achieve complete cytoreduction results in good long-term oncologic outcomes. Ann Surg Oncol. 2016;23:4316–21. https://doi.org/10.1245/s10434-016-5389-7.CrossRefPubMed

Yan TD, Brun EA, Cerruto CA, Haveric N, Chang D, Sugarbaker PH. Prognostic indicators for patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma. Ann Surg Oncol. 2007;14:41–9. https://doi.org/10.1245/s10434-006-9169-7.CrossRefPubMed

van Driel WJ, Koole SN, Sikorska K, van Leeuwen JHS, Schreuder HWR, Hermans RHM, de Hingh IHJT, van der Velden J, Arts HJ, Massuger LFAG, Aalbers AGJ, Verwaal VJ, Kieffer JM, Van de Vijver KK, van Tinteren H, Aaronson NK, Sonke JS. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. NEJM. 2018;378:230–40.CrossRefPubMed

Wong LCK, Li Z, Fan Q, Tan JW-C, Tan QX, Wong JSM, Ong C-AJ, Chia CS. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal sarcomatosis. A systematic review and meta-analysis. EJSO. 2022;48:640–8.CrossRefPubMed

Yang X-J, Huang C-Q, Suo T, Mei L-J, Yang G-L, Cheng F-L, Zhou Y-F, Xiong B, Yonemura Y, Li Y. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 2011;18:1575–81. https://doi.org/10.1245/s10434-011-1631-5.CrossRefPubMedPubMedCentral

10.

Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221:29–42.CrossRefPubMedPubMedCentral

11.

Loungnarath R, Causeret S, Bossard N, Faheez M, Sayad-Beaujard AC, Gilly FN, Glehen O. Cytoreductive surgery with intraperitoneal chemohyparthermia for the treatment of pseudomyxoma peritonei: a prospective study. Dis Colon Rectum. 2005;48:1372–9. https://doi.org/10.1007/s10350-0050045-5.CrossRefPubMed

12.

Elias D, Honore C, Ciuchendea R, Billiard V, Raynaud B, Lo Dico R, Dromain C, Duvillard P, Goere D. Peritoneal pseudomyxoma: results of a systematic policy of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Br J Surg. 2008;95:1164–71. https://doi.org/10.1002/bjs.6235.CrossRefPubMed

13.

Witcamp AJ, de Bree E, Kag MM, van Slooten GW, van Coevorden F, Zoetmulder FAN. Extensive surgical cytoreduction and intraoperative intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg. 2001;88:458–63. https://doi.org/10.1046/j.1365-2161.2001.01701.x.CrossRef

14.

Jacquet P, Stephens AD, Averbach AM, Chang D, Ettinghausen SE, Dalton RR, Steves MA, Sugarbaker PH. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer. 1996;77:2622–9. https://doi.org/10.1002/(SICI)1097-0142(19960615)77:12%3c2622::AID-CNCR28%3e3.0.CO;2-T.CrossRefPubMed

15.

Stephens AD, Alderman R, Chang D, Edwards GD, Esquivel J, Sebbag G, Steves MA, Sugarbaker PH. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol. 1999;6:790–6.CrossRefPubMed

16.

Sugarbaker PH, Alderman R, Edwards G, Marquardt CE, Gushchin V, Esquivel J, Chang D. Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol. 2006;13:635–44. https://doi.org/10.1245/ASO.2006.03.079.CrossRefPubMed

17.

Smeenk RM, Verwaal VJ, Zoetmulder FA. Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg. 2007;94:1408–14.CrossRefPubMed

18.

Yan TD, Links M, Fransi S, Jacques T, Black D, Saunders V, Morris DL. Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy—a journey to becoming a nationally funded peritonectomy center. Ann Surg Oncol. 2007;14:2270–80. https://doi.org/10.1245/s10434-007-9406-8.CrossRefPubMed

19.

Sugarbaker PH, Chang D, Koslowe P. Prognostic features for peritoneal carcinomatosis in colorectal and appendiceal cancer patients when treated by cytoreductive surgery and intraperitoneal chemotherapy. In: Sugarbaker P, editor. Peritoneal carcinomatosis. Boston: Kluwer Academic Publishers; 1996. p. 89–104.CrossRef

20.

Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. In: Sugarbaker PH, editor. Peritoneal carcinomatosis: principles of management. Boston: Kluwer Academic Publishers; 1996. p. 359–74.CrossRef

21.

Sugarbaker PH, Zhu BW, Sese GB, Shmookler B. Peritoneal carcinomatosis from appendiceal cancer: results in 69 patients treated by cytoreductive surgery and intraperitoneal chemotherapy. Dis Colon Rectum. 1993;36:323–9.CrossRefPubMed

22.

Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7:69–76.CrossRefPubMed

23.

Quenet F, Elias D, Roca L, Goere D, Ghouti L, Pocard M, Facy O, Arvieux C, Lorimier G, Pezet D, Marchal F, Loi V, Meeus P, De Forges H, Stanbury T, Paineau J, Glehen O. A UNICANCER phase III trial of hyperthermic intra-peritoneal chemotherapy (HIPEC) for colorectal peritoneal carcinomatosis (PC): PRODIGE 7. Lancet Oncol. 2016;22:256–66. https://doi.org/10.1016/S1470-2045(20)30599-4.CrossRef

24.

Chua TC, Yan TD, Saxena A, Morris D. 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

25.

Ahmad SA, Kim J, Sussman JJ, Soldano DA, Pennington LJ, James LE, Lowy AM. Reduced morbidity following cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion. Ann Surg Oncol. 2004;11:387–92. https://doi.org/10.1245/ASO.2004.09.007.CrossRefPubMed

26.

Kusamura S, Baratti D, Hutanu I, Rossi P, Deraco M. The importance of the learning curve and surveillance of surgical performance in peritoneal surface malignancy programs. Surg Oncol Clin N Am. 2012;21:559–76.CrossRefPubMed

27.

Mohamed F, Moran BJ. Morbidity and mortality with cytoreductive surgery and intraperitoneal chemotherapy the importance of a learning curve. Cancer J. 2009;15:196–9.CrossRefPubMed

28.

Mielko J, Rawicz-Pruszyński K, Kwietniewska M, Polkowski WP. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: learning curve based on surgical and oncological outcomes. Cancers. 2020;12:2387. https://doi.org/10.3390/cancers12092387.CrossRefPubMedPubMedCentral

29.

Verwaal VJ, van Tinteren H, Ruth SV, Zoetmulder FA. Toxicity of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Oncol. 2004;85:65–7. https://doi.org/10.1002/jso.20013.CrossRef

30.

Piso P, Nedelcut SD, Rau B, Konigsrainer A, Glockzin G, Strohlein MA, Horbelt R, Pelz J. Morbidity and mortality following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: data from the DGAV StuDoQ registry with 2149 consecutive patients. Ann Surg Oncol. 2018. https://doi.org/10.1245/s10434-018-6992-6.CrossRefPubMedPubMedCentral

Title: Morbidity and mortality of patients with peritoneal malignancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Authors: Greta Hotza
Michael Karageorgos
Varvara Pastourmatzi
Nader Baniowda
Dimitrios Kyziridis
Apostolos Kalakonas
Nicolaos Chavouzis
Irene Hotza
Antonios-Apostolos Tentes
Publication date: 01-12-2024
Publisher: Springer US
Keywords: Peritonectomy
Cytostatic Therapy
Published in: Discover Oncology / Issue 1/2024
Print ISSN: 1868-8497
Electronic ISSN: 2730-6011
DOI: https://doi.org/10.1007/s12672-024-00968-4

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Shenqi Fuzheng injection hinders non-small cell lung cancer cell growth by regulating the Bax/Bcl-2 signaling pathway

The impact of different clinicopathologic factors and salvage therapies on cervical cancer patients with isolated para-aortic lymph node recurrence

Exploring the frontiers: tumor immune microenvironment and immunotherapy in head and neck squamous cell carcinoma

Suppression of the long non-coding RNA LINC01279 triggers autophagy and apoptosis in lung cancer by regulating FAK and SIN3A

P129, a pyrazole ring-containing isolongifolanone-derivate: synthesis and investigation of anti-glioma action mechanism

Integrating iron metabolism-related gene signature to evaluate prognosis and immune infiltration in nasopharyngeal carcinoma

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials