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Annals of Surgical Oncology

, Volume 22, Issue 4, pp 1236–1242 | Cite as

Peritoneal Cancer Patients Not Suitable for Cytoreductive Surgery and HIPEC During Explorative Surgery: Risk Factors, Treatment Options, and Prognosis

  • T. R. van OudheusdenEmail author
  • H. J. Braam
  • M. D. P. Luyer
  • M. J. Wiezer
  • B. van Ramshorst
  • S. W. Nienhuijs
  • I. H. J. T. de Hingh
Colorectal Cancer

Abstract

Background

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is currently the only curative option for patients with peritoneal carcinomatosis of colorectal origin. Despite meticulous preoperative assessment, CRS and HIPEC appear to be impossible in a subset of patients at the time of surgery. This study investigated which clinical factors may identify these patients before surgery and reported on factors influencing survival.

Methods

All patients with PC of colorectal origin between April 2005 and November 2013 who underwent exploratory surgery to determine whether cytoreduction and HIPEC was feasible were included in this study. Details concerning preoperative patient characteristics, perioperative outcomes, treatment and survival were compared.

Results

In total, 350 patients with PC were referred to evaluate the possibility of CRS + HIPEC of which 268 (76.6 %) underwent CRS and HIPEC and 82 (23.4 %) had an open-close procedure. The main reason for discontinuing surgery was widespread peritoneal disease (50 %). A preoperative ostomy and an ASA score of 3 were associated with an increased risk for “open and close” (O&C). Median survival was 11.2 months in patients treated with palliative chemotherapy (75 %) compared with 2.7 months with palliative care only.

Conclusions

CRS and HIPEC were deemed unsuitable in almost a quarter of all patients undergoing surgery. No strong clinical predictors for O&C were found, stressing the need for better preoperative imaging modalities. Survival in these patients is limited, but the majority could be treated with palliative chemotherapy resulting in survival of almost 1 year.

Keywords

Peritoneal Carcinomatosis Diagnostic Laparoscopy Palliative Chemotherapy Peritoneal Cancer Index Primary Tumor Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • T. R. van Oudheusden
    • 1
  • H. J. Braam
    • 2
  • M. D. P. Luyer
    • 1
  • M. J. Wiezer
    • 2
  • B. van Ramshorst
    • 2
  • S. W. Nienhuijs
    • 1
  • I. H. J. T. de Hingh
    • 1
  1. 1.Department of Surgery, Department of Surgical OncologyCatharina HospitalEindhovenThe Netherlands
  2. 2.Department of SurgerySt. Antonius HospitalNieuwegeinThe Netherlands

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