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Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC)

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Abstract

Purpose

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a novel curative treatment option for selected patients with peritoneal carcinomatosis (PC). We aimed to report the mortality rate and the most frequent grade III–IV adverse events and to identify associated prognostic markers. We report oncological outcomes and major prognostic factors influencing overall survival (OS) and disease-free survival.

Methods

A total of 401 CRS plus HIPEC procedures were performed on 356 patients. Mortality, grade III–IV adverse events, OS, disease-free survival, and prognostic factors were studied.

Results

Based on Common Terminology Criteria for Adverse Events (CTCAE of the National Cancer Institute 2006), mortality rate was 1 % and overall rate of morbidity grade III–IV was 12.5 %. In multivariate analysis, only the number of digestive anastomoses (>1) significantly correlated with adverse events with an odds ratio of 2.8 (p = 0.032). OS was related to histological type of PC, with a median survival reaching 47.6 months for PC of ovarian cancer origin, 45.8 months for that of colorectal origin, 64.2 months for peritoneal mesothelioma, and 8.1 months for PC of gastric cancer origin. Over half the patients with pseudomyxoma are still alive. Major prognostic factors influencing survival were histological type, World Health Organization performance status (WHO PS) (hazard ratio (HR) = 3.56), operating time (HR = 0.45), previous chemotherapy (HR = 2.04), number of peritonectomies (HR = 2.03), and completeness of cytoreduction score (HR = 3.12). Disease-free survival across all groups was 16.8 months.

Conclusion

The low mortality rate and 12.5 % grade III–IV morbidity of CRS and HIPEC are acceptable when weighed against overall oncologic survival. This multimodal treatment appears feasible for selected patients and trained centers.

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Acknowledgments

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Conflicts of interest

None.

Author contributions

All authors performed the acquisition of data. JM Bereder made critical revisions. M Desantis was responsible for the study conception and design; acquisition, analysis, and interpretation of data; and drafting and critical revision of the manuscript.

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Authors and Affiliations

  1. Department of General Surgery and Gastrointestinal Oncology, Archet 2 CHU Nice, 151 route de St. Antoine de la Ginestière, 06200, Nice, France

    Mariangela Desantis, Jean-Louis Bernard, Vincent Casanova, Marianne Cegarra-Escolano, Emmanuel Benizri, Amine M. Rahili, Daniel Benchimol & Jean-Marc Bereder

  2. Department of General Surgery and Gastrointestinal Oncology, Clinique St Georges, 2 Avenue de Rimiez, 06100, Nice, France

    Mariangela Desantis

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  1. Mariangela Desantis
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  2. Jean-Louis Bernard
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Correspondence to Mariangela Desantis.

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Desantis, M., Bernard, JL., Casanova, V. et al. Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC). Langenbecks Arch Surg 400, 37–48 (2015). https://doi.org/10.1007/s00423-014-1253-z

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