Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC
- 611 Downloads
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined treatment option for well-selected patients with peritoneal carcinomatosis (PC). The study aimed to identify factors influencing cancer-specific survival (CSS) and disease-free survival (DFS).
Data of 113 patients with colorectal or appendicular carcinomatosis from a single center operated between 2009 and 2014 were retrospectively collected and analyzed. Patients with high-grade tumors received standard perioperative chemotherapy, and patients with low-grade appendix tumors were directly operated. HIPEC was performed after radical CRS.
Patients had carcinomatosis from appendix neoplasms in 63% (71/113), including low-grade and high-grade tumors, and colorectal cancer in 37% (42/113). Complete cytoreduction and HIPEC were possible in 67% of patients. Major morbidity occurred in 10.6% of patients, and mean follow-up was 28 months. For colorectal PC, median CSS and DFS were 40 and 12 months, respectively. Median DFS was 19 months for high-grade appendix tumors, while median CSS has not been reached. All patients with diffuse peritoneal adenomucinosis were still alive at time of analysis; rate of DFS was 96% for these patients after 3 years. Major postoperative complications (Clavien-Dindo IIIB or higher) and positive nodal state were associated with impaired CSS and DFS, while a peritoneal cancer index score of >10 was independently associated with impaired CSS.
CRS/HIPEC offers a survival benefit in well-selected patients with PC. Major postoperative complications affect long-term oncologic outcome of these patients.
KeywordsOverall Survival Peritoneal Carcinomatosis Peritoneal Cancer Index Major Postoperative Complication Hyperthermic Intraperitoneal Chemotherapy
The authors thank Dr. René Vonlanthen and Prof. Dr. Philippe Gertsch for their support during the setup of the peritoneal surface malignancy program, and biostatisticians Dr. Dimitri Raptis and Dr. Beate Sick for excellent statistical input.
The authors declare no conflict of interest.
- 5.Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.CrossRefPubMedGoogle Scholar
- 9.Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM. Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei.” Am J Surg Pathol. 1995;19:1390–408.CrossRefPubMedGoogle Scholar
- 10.Kajdi ME, Beck-Schimmer B, Held U, Kofmehl R, Lehmann K, Ganter MT. Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience. World J Surg Oncol. 2014;12:136.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Bruin SC, Verwaal VJ, Vincent A, van’t Veer LJ, van Velthuysen MLF. A clinicopathologic analysis of peritoneal metastases of colorectal and appendiceal origin. Ann Surg Oncol. 2010;17:2330–40.Google Scholar
- 21.Glehen O, Gilly FN, Boutitie F, et al. Toward curative treatment of peritoneal carcinomatosis from non-ovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1290 patients. Cancer. 2010;116:5608–18.CrossRefPubMedGoogle Scholar
- 26.Ihemelandu C, Mavros MN, Sugarbaker P, Adverse events postoperatively had no impact on long-term survival of patients treated with cytoreductive surgery with heated intraperitoneal chemotherapy for appendiceal cancer with peritoneal metastases. Ann Surg Oncol. 2016;23(13):4231–7.CrossRefPubMedGoogle Scholar
- 31.Chua TC, Yan TD, Saxena A, Morris DL. Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? A systematic review of morbidity and mortality. Ann Surg. 2009;249:900–7.CrossRefPubMedGoogle Scholar
- 37.Melero JT, Ortega FG, Gonzalez AM, et al. Prognostic factor analysis of circulating tumor cells in peripheral blood of patients with peritoneal carcinomatosis of colon cancer origin treated with cytoreductive surgery plus an intraoperative hyperthermic intraperitoneal chemotherapy procedure (CRS + HIPEC). Surgery. 2016;159:728–35.CrossRefPubMedGoogle Scholar