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Prospective Comparative Analysis of Total Versus Involved Field Parietal Peritonectomy During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC) for Peritoneal Surface Malignancies from Colorectal Cancer

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Abstract

Peritonectomy is the important component in management of peritoneal surface malignancies (PSM). The aim of this study was to assess the morbidity, recurrence pattern and oncological outcomes of extent of parietal peritonectomy done during CRS and HIPEC for colorectal carcinoma (CRC). Patients with PSM from CRC underwent total parietal peritonectomy (TPP) or IFP with CRS-HIPEC. Pre- and intra-operative data were analysed with main focus on postoperative morbidity, recurrence pattern and oncological outcomes. Of 40 patients in the study, 19 and 21 patients underwent TPP and IFP respectively. TPP group had longer duration of surgery (11 vs 9), more blood loss (1300 vs 835 ml), increased diaphragmatic resections (47.3% vs 9.5%) and multivisceral resection (47.3% vs 28.5%). Overall, G3–G5 morbidity TPP versus IFP was 47.3% versus 33.3% and surgical morbidity was 30.7% versus 23.8%. With a median follow-up of 30 months, DFS was significantly higher in the TPP group (12 months vs 8 months, p < 0.01) and a median overall survival was 21 months in the IFP group (yet to be achieved in the TPP group). The TPP group had most of the recurrences in visceral liver and lung (50.0%) followed by peritoneal (37.5%) and nodal (12.5%), whereas in IFP, it was peritoneum (42.8%), visceral (38.4%) and nodal (15.3%). The TPP group had significantly higher DFS and trend towards improved OS. This indicates aggressive surgical resection has benefit with manageable postoperative morbidity. However, longer follow-up and a prospective multi-institutional randomised study need to be designed for more evidence of the same.

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References

  1. Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363

    Article  CAS  PubMed  Google Scholar 

  2. American Cancer Society. Cancer Facts & Figures (2012) Available online: http://www.cancer.org

  3. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, Papamichael D, Le Bail N, Louvet C et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18:2938–2947

    Article  PubMed  Google Scholar 

  4. Adachi T, Hinoi T, Egi H, Shimomura M, Ohdan H (2015) Oxaliplatin and molecular-targeted drug therapies improved the overall survival in colorectal cancer patients with synchronous peritoneal carcinomatosis undergoing incomplete cytoreductive surgery. Surg Today 45:986–992

    Article  CAS  PubMed  Google Scholar 

  5. Franko J, Shi Q, Goldman CD, Pockaj BA, Nelson GD, Goldberg RM, Pitot HC, Grothey A, Alberts SR, Sargent DJ (2012) 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 30:263–267

    Article  PubMed  Google Scholar 

  6. Tomlinson JS, Jarnagin WR, DeMatteo RP et al (2007) Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 25(29):4575–4580

    Article  PubMed  Google Scholar 

  7. Spratt JS, Adcock RA, Muskovin M, Sherrill W, McKeown J (1980) Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res 40(2):256–260

    CAS  PubMed  Google Scholar 

  8. Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221(1):29–42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Cashin PH, Mahteme H, Spang N et al (2016) Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: a randomised trial. Eur J Cancer 53:155–162

    Article  CAS  PubMed  Google Scholar 

  10. Verwaal VJ, van Ruth S, de Bree E et al (2003) 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 21(20):3737–3743

    Article  PubMed  Google Scholar 

  11. Elias D, Gilly F, Boutitie F et al (2010) Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 28(1):63–68

    Article  PubMed  Google Scholar 

  12. Esquivel J, Lowy AM, Markman M et al (2014) The American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution evaluation of the peritoneal surface disease severity score (PSDSS) in 1,013 patients with colorectal cancer with peritoneal carcinomatosis. Ann Surg Oncol 21(13):4195–4201

    Article  PubMed  Google Scholar 

  13. Glehen O, Kwiatkowski F, Sugarbaker PH et al (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multiinstitutional study. J Clin Oncol 22(16):3284–3292

    Article  CAS  PubMed  Google Scholar 

  14. Kuijpers AM, Mirck B, Aalbers AG et al (2013) Cytoreduction and HIPEC in the Netherlands: nationwide longterm outcome following the Dutchprotocol. Ann Surg Oncol 20(13):4224–4230

    Article  PubMed  PubMed Central  Google Scholar 

  15. Li Y, Yu Y, Liu Y (2014) Report on the 9th international congress on peritoneal surface malig-nancies. Cancer Biol Med 11:281–284

    PubMed  PubMed Central  Google Scholar 

  16. Sugarbaker PH (1999) Management of peritoneal surface malignancy: the surgeon's role. Langenbeck's Arch Surg 384:576–587

    Article  CAS  Google Scholar 

  17. Glehen O, Mithieux F, Osinsky D, Beaujard AC, Freyer G, Guertsch P, Francois Y, Peyrat P, Panteix G, Vignal J, Gilly FN (2003) Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. J Clin Oncol 21:799–806

    Article  CAS  PubMed  Google Scholar 

  18. Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. In: Sugarbaker PH (ed) Peritoneal carcinomatosis: principles of management. Kluwer Academic publishers, Boston, pp 359–374

    Chapter  Google Scholar 

  19. Sugarbaker PH, Jablonski KA (1995) Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 221:124–132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Deraco M, Baratti D, Kusamura S et al (2009) Surgical technique of parietal and visceral peritonectomy for peritoneal surface malignancies. J Surg Oncol 100:321–328

    Article  PubMed  Google Scholar 

  21. Baratti D, Kusamura S, Cabras AD, Deraco M (2012) Cytoreductive surgery with selective versus complete parietal peritonectomy followed by hyperthermic intraperitoneal chemotherapy in patients with diffuse malignant peritoneal mesothelioma: a controlled study. Ann Surg Oncol 19:1416–1424

    Article  PubMed  Google Scholar 

  22. Dresen RC, Kusters M, Daniels-Gooszen AW et al (2010) Absence of tumor invasion into pelvic structures in locally recurrent rectal cancer: prediction with preoperative MR imaging. Radiology 256:143–150

    Article  PubMed  Google Scholar 

  23. Oogerd LSF, Hoogstins CES, Schaap DP, Kusters M et al (2018 Mar) Safety and effectiveness of SGM-101, a fluorescent antibody targeting carcinoembryonic antigen, for intraoperative detection of colorectal cancer: a dose-escalation pilot study. Lancet Gastroenterol Hepatol 3(3):181–191

    Article  Google Scholar 

  24. Somashekhar SP, Ashwin KR (2017) Rohit Kumar C, et al Standardization of Patient Selection and Hyperthermic Intraperitoneal Chemotherapy Protocol for Peritoneal Surface Malignancy in Indian Patients. Indian J Gynecol Oncolog

  25. Sugarbaker PH (2011) Evolution of cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis: are there treatment alternatives? Am J Surg 201:157–159

    Article  PubMed  Google Scholar 

  26. Kusamura S, Baratti D, Zaffaroni N et al (2010) Pathophysiology and biology of peritoneal carcinomatosis. World J Gastrointest Oncol 2(1):12–18

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yonemura Y, Endo Y, Obata T, Sasaki T (2007) Recent advances in the treatment of peritoneal dissemination of gastrointestinal cancers by nucleoside antimetabolites. Cancer Sci 98:11–18

    Article  CAS  PubMed  Google Scholar 

  28. Hynninen J, Lavonius M, Oksa S, Gren’man S, Carpe’n O, Auranen A (2013) Is perioperative visual estimation of intra-abdominal tumor spread reliable in ovarian cancer surgery after neoadjuvant chemotherapy? Gynecol Oncol 128(2):229–232

  29. Cotte E, Passot G, Gilly FN, Glehen O (2010) Selection of patients and staging of peritoneal surface malignancies. World J Gastrointest Oncol 2(1):31–35

  30. Laghi A, Bellini D, Rengo M, Accarpio F, et al. Diagnostic performance of computed tomography and magnetic resonance imaging for detecting peritoneal metastases: systematic review and meta-analysis. Radiol med https://doi.org/10.1007/s11547-016-0682-x

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Acknowledgements

The authors thank Dr. Arun Kumar N, Consultant Biostatistician, for the statistical analysis.

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Authors and Affiliations

  1. Department of Surgical Oncology, Manipal Hospital, Bangalore, India

    SP Somashekhar, C. Rohit Kumar, KR Ashwin & Y. Ramya

  2. Manipal Comprehensive Cancer Centre, Manipal Hospital, #98, HAL Airport road, Bangalore, 560017, India

    SP Somashekhar, C. Rohit Kumar, KR Ashwin, Y. Ramya & Amit Rautan

  3. Department of Medical Oncology, Manipal Hospital, Bangalore, India

    Amit Rautan

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  1. SP Somashekhar
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  2. C. Rohit Kumar
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Corresponding author

Correspondence to C. Rohit Kumar.

Ethics declarations

Institutional review board and ethical committee cleared, written informed consent taken. This study was a subgroup analysis of another major study done at the same institution as a part of one of DNB student’s thesis for CRS and HIPEC in general, so one more separate ethical committee clearance is not taken for this study individually. However, the surgical procedures being performed have been mentioned in the original study protocol and appropriate consent taken for the same, so only the original ethical committee letter has been attached here.

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Somashekhar, S., Kumar, C.R., Ashwin, K. et al. Prospective Comparative Analysis of Total Versus Involved Field Parietal Peritonectomy During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC) for Peritoneal Surface Malignancies from Colorectal Cancer. Indian J Surg 82, 566–572 (2020). https://doi.org/10.1007/s12262-019-02017-9

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  • DOI: https://doi.org/10.1007/s12262-019-02017-9

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