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Cytoreductive Surgery with HIPEC is a Safe and Effective Palliative Option in Chemorefractory Symptomatic Peritoneal Metastasis

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

The safety and efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal metastasis in palliative settings remain poorly investigated and understood. Chemotherapy-refractory patients often present with symptomatic disease. This study investigated the safety and survival outcomes of optimal CRS/HIPEC performed primarily for palliation.

Methods

Palliative CRS/HIPEC was defined as asymptomatic patients who did not respond to three or more lines of chemotherapy, progression on current chemotherapy, and/or any symptomatic disease progression, including ascites, bowel obstruction, and pain. Data collected included demographics, histology, length of stay (LOS), perioperative complications, perioperative mortality, adjuvant chemotherapy use, peritoneal recurrence, overall recurrence, and overall survival.

Results

The median number of lines of chemotherapy received prior to CRS/HIPEC was 3.2, and 81% of patients were symptomatic. There were no postoperative deaths and the major complication rate was 22%. Ostomy creation and abdominal wall reconstruction were performed in 24% and 21% of patients, respectively. The median LOS was 11 days and successful palliation was achieved in 97% of patients. Overall survival was 13.5 months and factors associated with prolonged survival included optimal CRS (R1/R2a; p < 0.01) and the use of adjuvant chemotherapy (p < 0.001). Synchronous liver metastasis in the colon cancer subset did not negatively impact survival.

Conclusion

CRS/HIPEC was performed safely in the palliative setting in patients with symptomatic progressive disease receiving multiple lines of chemotherapy. Median survival exceeded 1 year and factors associated with longer survival were optimal CRS and adjuvant chemotherapy. Liver metastasis did not preclude survival benefit in colon cancer patients. CRS/HIPEC can be considered for palliation but should be performed at high-volume centers.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

This work was supported by the Platon Foundation.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA

    Chunmeng Zhang MD, Dalton Hegeholz BS, Mallory Pottebaum MS, RD & Jason M. Foster MD

  2. Department of Surgical Oncology, Nebraska Methodist Hospital, Omaha, NE, USA

    Asish Patel MD

  3. Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA

    Krista Brown MBA, MPH

  4. Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA

    Valerie Shostrom MS

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  1. Chunmeng Zhang MD
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Correspondence to Jason M. Foster MD.

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Disclosures

Chunmeng Zhang, Asish Patel, Dalton Hegeholz, Krista Brown, Valerie Shostrom, Mallory Pottebaum, and Jason M. Foster have no financial conflicts of interest to disclose.

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Supplementary Information

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10434_2022_11323_MOESM1_ESM.tiff

Supplementary Fig. 1 Progression-free survival (PFS) by histology and by preoperative symptoms. CRC colorectal cancer, HG high grade, LG low grade, SBO small bowel obstruction (TIFF 13673 KB)

10434_2022_11323_MOESM2_ESM.tiff

Supplementary Fig. 2 Progression-free survival (PFS) by optimal CRS and adjuvant chemotherapy. CRS cytoreductive surgery (TIFF 13673 KB)

Supplementary file3 (DOCX 17 KB)

Supplementary file4 (DOCX 15 KB)

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Zhang, C., Patel, A., Hegeholz, D. et al. Cytoreductive Surgery with HIPEC is a Safe and Effective Palliative Option in Chemorefractory Symptomatic Peritoneal Metastasis. Ann Surg Oncol 29, 3337–3346 (2022). https://doi.org/10.1245/s10434-022-11323-8

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  • DOI: https://doi.org/10.1245/s10434-022-11323-8

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