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Laparoscopic cytoreductive surgery and HIPEC: a comparative matched analysis

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Abstract

Background

Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a procedure that has had encouraging results for peritoneal metastases (PM) from diverse tumour origins, but it is not exempt from high morbidity. Recently, the important role of laparoscopy in oncologic surgeries and its benefits have been evaluated for CRS + HIPEC in selected patients, which has yielded promising results. The aim of our study is to analyse the use of laparoscopy for CRS + HIPEC in patients with limited peritoneal disease.

Methods

We have conducted a retrospective study from a prospective database in our tertiary referral hospital within the period of January 2009 to July 2019, which includes 825 patients who had PM from varying tumour origins. We have compared the patients treated with the laparoscopic approach (L-CRS-HIPEC) to a matched population who have undergone the open approach (O-CRS-HIPEC) and fulfil the same selection criteria. We have analysed the postoperative outcomes and survival results.

Results

We have confirmed the homogeneity between the sample of the O-CRS + HIPEC (n = 42) and the L-CRS + HIPEC (n = 18) regarding preoperative and intraoperative features. The L-CRS + HIPEC group had shorter hospital stays, (median of 4 [2–10] days versus 9 [2–19] days) and reduced wait time to return to chemotherapy (median of 4 [3–7] weeks and a median of 8 [4–36] weeks) than the O-CRS + HIPEC group. No differences were found regarding the need for perioperative blood transfusion, surgery time or postoperative morbi-mortality. No early locoregional relapse occurred in the L-CRS + HIPEC group and short term disease-free survival did not differ between groups.

Conclusions

Laparoscopy for CRS + HIPEC is feasible and safe in highly selected patients, with no significant differences concerning postoperative morbi-mortality or early oncological results. We have found that patients who have undergone laparoscopic operations have shorter hospital stays and that they return to adjuvant chemotherapy sooner. Further investigation is required to confirm the benefits of minimally invasive procedures for the management of PM.

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References

  1. Arjona-Sanchez AR-PS, Sanchez-Hidalgo JM, Casado-Adam A, Cosano-Alvarez A, Briceño-Delgado J (2018) Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (HIPEC) by minimally invasive approach, an initial experience. World J Surg 42(10):3120–3124. https://doi.org/10.1007/s00268-018-4634-6

    Article  CAS  PubMed  Google Scholar 

  2. Mercier F, Jeremie G, Alyami M et al (2019) Long-term results of laparoscopic cytoreductive surgery and HIPEC for the curative treatment of low-grade pseudomyxoma peritonei and multicystic mesothelioma. Surg Endosc. https://doi.org/10.1007/s00464-019-07280-1

    Article  PubMed  Google Scholar 

  3. van Driel WJ, Koole SN, Sikorska K, Schagen van Leeuwen JH, 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 GS (2018) Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med 378(3):230–240. https://doi.org/10.1056/NEJMoa1708618

    Article  PubMed  Google Scholar 

  4. Sánchez-Hidalgo JM, Rodríguez-Ortiz L, Arjona-Sánchez Á, Rufián-Peña S, Casado-Adam Á, Cosano-Álvarez A, Briceño-Delgado J (2019) Colorectal peritoneal metastases: optimal management review. World J Gastroenterol 25(27):3484–3502. https://doi.org/10.3748/wjg.v25.i27.3484

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tempfer CB, Kern P, Dogan A, Hilal Z, Rezniczek GA (2019) Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for endometrial cancer-derived peritoneal metastases: a systematic review. Clin Exp Metastasis 36(4):321–329. https://doi.org/10.1007/s10585-019-09970-5

    Article  PubMed  Google Scholar 

  6. Ji ZH, Peng KW, Yu Y, Li XB, Yonemura Y, Liu Y, Sugarbaker PH, Li Y (2017) Current status and future prospects of clinical trials on CRS + HIPEC for gastric cancer peritoneal metastases. Int J Hyperthermia 33(5):562–570. https://doi.org/10.1080/02656736.2017.1283065

    Article  PubMed  Google Scholar 

  7. Chevallay M, Jung M, Berlth F, Seung-Hun C, Morel P, Mönig S (2019) Laparoscopic surgery for gastric cancer: the European point of view. J Oncol 2019:8738502. https://doi.org/10.1155/2019/8738502

    Article  PubMed  PubMed Central  Google Scholar 

  8. Song XJ, Liu ZL, Zeng R, Ye W, Liu CW (2019) A meta-analysis of laparoscopic surgery versus conventional open surgery in the treatment of colorectal cancer. Medicine (Baltimore) 98(17):e15347. https://doi.org/10.1097/MD.0000000000015347

    Article  Google Scholar 

  9. Martínez-Cecilia D, Cipriani F, Vishal S, Ratti F, Tranchart H, Barkhatov L, Tomassini F, Montalti R, Halls M, Troisi RI, Dagher I, Aldrighetti L, Edwin B, Abu HM (2017) Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients: a multicenter propensity score based analysis of short- and long-term outcomes. Ann Surg 265(6):1192–1200. https://doi.org/10.1097/SLA.0000000000002147

    Article  PubMed  Google Scholar 

  10. Kagawa Y, Yamada D, Yamasaki M, Miyamoto A, Mizushima T, Yamabe K, Imazato M, Fukunaga H, Kobayashi S, Shimizu J, Umeshita K, Ito T, Doki Y, Mori M (2019) The association between the increased performance of laparoscopic colon surgery and a reduced risk of surgical site infection. Surg Today 49(6):474–481. https://doi.org/10.1007/s00595-019-1760-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kwan Kit Chan D, Siu Yin Chan F, King Hung Tong D, Yu Hong Wong I, Lai Yin Wong C, Ting Law T, Ying Kit Law S (2018) Minimally invasive approach results in better outcome compared to open esophagectomy—a propensity score matched analysis. Dis Esophagus 31(13):1. https://doi.org/10.1093/dote/doy089.FA01.01

    Article  PubMed  Google Scholar 

  12. Tabrizian P, Jayakrishnan TT, Zacharias A, Aycart S, Johnston FM, Sarpel U, Labow DM, Turaga KK (2015) Incorporation of diagnostic laparoscopy in the management algorithm for patients with peritoneal metastases: a multi-institutional analysis. J Surg Oncol 111(8):1035–1040. https://doi.org/10.1002/jso.23924

    Article  PubMed  Google Scholar 

  13. Patriti A, Cavazzoni E, Graziosi L, Pisciaroli A, Luzi D, Gullà N, Donini A (2008) Successful palliation of malignant ascites from peritoneal mesothelioma by laparoscopic intraperitoneal hyperthermic chemotherapy. Surg Laparosc Endosc Percutan Tech 18(4):426–428. https://doi.org/10.1097/SLE.0b013e318173a61e

    Article  PubMed  Google Scholar 

  14. Arjona-Sanchez A, Esquivel J, Glehen O, Passot G, Turaga KK, Labow D, Rufian-Peña S, Morales R, van der Speeten K (2019) A minimally invasive approach for peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in limited peritoneal carcinomatosis: the American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution analysis. Surg Endosc 33(3):854–860. https://doi.org/10.1007/s00464-018-6352-4

    Article  CAS  PubMed  Google Scholar 

  15. Esquivel J, Averbach A, Chua TC (2011) Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with limited peritoneal surface malignancies: feasibility, morbidity and outcome in an early experience. Ann Surg 253:764–768

    Article  Google Scholar 

  16. Esquivel J, Averbach A (2012) Laparoscopic cytoreductive surgery and HIPEC in patients with limited pseudomyxoma peritonei of appendiceal origin. Gastroenterol Res Pract 2012:981245

    Article  Google Scholar 

  17. Passot G, Bakrin N, Isaac S, Decullier E, Gilly FN, Glehen O, Cotte E (2013) Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies. Eur J Surg Oncol 40:957–962

    Article  Google Scholar 

  18. Park SY, Choi GS, Park JS, Kim HJ et al (2014) Laparoscopic cytoreductive surgery and early postoperative intraperitoneal chemotherapy for patients with colorectal cancer peritoneal carcinomatosis: initial results from a single center. Surg Endosc 28(5):1555–1562

    Article  Google Scholar 

  19. Gallotta V, Conte C, Giudice MT, Nero C, Vizzielli G, Gueli Alletti S, Cianci S, Lodoli C, Di Giorgio A, De Rose AM, Fagotti A, Scambia G, Ferrandina G (2018) Secondary laparoscopic cytoreduction in recurrent ovarian cancer: a large, single-institution experience. J Minim Invasive Gynecol 25(4):644–650. https://doi.org/10.1016/j.jmig.2017.10.024

    Article  PubMed  Google Scholar 

  20. Liang H, Guo H, Zhang C, Zhu F, Wu Y, Zhang K, Li H, Han J (2017) Feasibility and outcome of primary laparoscopic cytoreductive surgery for advanced epithelial ovarian cancer: a comparison to laparotomic surgery in retrospective cohorts. Oncotarget 8(68):113239–113247. https://doi.org/10.18632/oncotarget.22573

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gueli Alletti S, Petrillo M, Vizzielli G, Bottoni C, Nardelli F, Costantini B, Quagliozzi L, Gallotta V, Scambia G, Fagotti A (2016) Minimally invasive versus standard laparotomic interval debulking surgery in ovarian neoplasm: a single-institution retrospective case-control study. Gynecol Oncol 143(3):516–520. https://doi.org/10.1016/j.ygyno.2016.10.017

    Article  CAS  PubMed  Google Scholar 

  22. Mahner S, Eulenburg C, Staehle A, Wegscheider K, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J, du Bois A (2013) Prognostic impact of the time interval between surgery and chemotherapy in advanced ovarian cancer: analysis of prospective randomised phase III trials. Eur J Cancer 49(1):142–149. https://doi.org/10.1016/j.ejca.2012.07.023

    Article  CAS  PubMed  Google Scholar 

  23. Salti GI, Naffouje SA (2019) Feasibility of hand-assisted laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancy. Surg Endosc 33(1):52–57. https://doi.org/10.1007/s00464-018-6265-2

    Article  PubMed  Google Scholar 

  24. Sugarbaker PH (2005) A curative approach to peritoneal carcinomatosis from colorectal cancer. Semin Oncol 32(6 Suppl 9):S68–73

    Article  Google Scholar 

  25. Abudeeb H, Selvasekar CR, O'Dwyer ST, Chakrabarty B, Malcolmson L, Renehan AG, Wilson MS, Aziz O (2020) Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for perforated low-grade appendiceal mucinous neoplasms. Surg Endosc. https://doi.org/10.1007/s00464-019-07349-x

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sánchez García S, Villarejo-Campos P, Padilla-Valverde D, Amo-Salas M, Martín-Fernández J (2016) Intraperitoneal chemotherapy hyperthermia (HIPEC) for peritoneal carcinomatosis of ovarian cancer origin by fluid and CO2 recirculation using the closed abdomen technique (PRS-1.0 Combat): a clinical pilot study. Int J Hyperthermia 32(5):488–495. https://doi.org/10.3109/02656736.2016.1152515

    Article  CAS  PubMed  Google Scholar 

  27. Alyami M, Hübner M, Grass F, Bakrin N, Villeneuve L, Laplace N, Passot G, Glehen O, Kepenekian V (2019) Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications. Lancet Oncol 20(7):e368–e377. https://doi.org/10.1016/S1470-2045(19)30318-3

    Article  PubMed  Google Scholar 

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Author notes

  1. L. Rodríguez-Ortiz and A. Arjona-Sánchez contributed equally to this work.

Authors and Affiliations

  1. Unit of Surgical Oncology, University Hospital Reina Sofia, Menéndez Pidal Av., Córdoba, Spain

    L. Rodríguez-Ortiz, A. Arjona-Sánchez, M. Ibañez-Rubio, J. Sánchez-Hidalgo, A. Casado-Adam, S. Rufián-Peña & J. Briceño-Delgado

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  1. L. Rodríguez-Ortiz
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  2. A. Arjona-Sánchez
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  3. M. Ibañez-Rubio
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Correspondence to A. Arjona-Sánchez.

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Drs. Rodríguez, Arjona, Ibañez, Sánchez, Casado, Rufián and Briceño have no conflicts of interest or financial ties to disclose.

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Rodríguez-Ortiz, L., Arjona-Sánchez, A., Ibañez-Rubio, M. et al. Laparoscopic cytoreductive surgery and HIPEC: a comparative matched analysis. Surg Endosc 35, 1778–1785 (2021). https://doi.org/10.1007/s00464-020-07572-x

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