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Current Delivery of Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery (CS/HIPEC) and Perioperative Practices: An International Survey of High-Volume Surgeons

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery and heated intraperitoneal chemotherapy (CS/HIPEC) is performed for selected indications at a limited number of specialized centers worldwide. Currently there is no standardized approach to the perioperative care process. We sought to capture current practices in the perioperative management of patients who undergo CS/HIPEC at high-volume centers.

Methods

Surgeon members of the American Society of Peritoneal Surface Malignancies working at high-volume CS/HIPEC centers (>10 cases/year) were invited to complete an online survey. The survey included questions relating to preoperative preparation of patients, intraoperative practices, and postoperative care.

Results

Ninety-seven surgeons from five continents completed the survey (response rate 55%). The majority (80%) practiced in academic environments. Most respondents (68%) indicated that a formal preoperative preparatory pathway for CS/HIPEC surgery existed at their centers, but few (26%) had used enhanced recovery protocols in this group of patients. Whereas the intraoperative technical practices of the CS/HIPEC procedure were relatively consistent across respondents, there was little agreement on pre- and postoperative care practices, including use of mechanical bowel preparation, nutritional supplementation, methods of perioperative analgesia, timing of physical therapy and ambulation, nasogastric tube and Foley removal, intravenous fluids, blood transfusion parameters, and postoperative use of deep-vein thrombosis prophylaxis and antibiotics.

Conclusions

Perioperative care practices for CS/HIPEC are widely variable nationally and internationally. Standardization of such practices offers an opportunity to incorporate evidence-based interventions and may enhance patient outcomes and improve care standards across all centers that offer this procedure.

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References

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Mirnezami R, Moran BJ, Harvey K, et al. Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal metastases. World J Gastroenterol. 2014;20(38):14018–32. doi:10.3748/wjg.v20.i38.14018.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cao C, Yan TD, Black D, Morris DL. A systematic review and meta-analysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2009;16(8):2152–65. doi:10.1245/s10434-009-0487-4.

    Article  PubMed  Google Scholar 

  4. Miner TJ, Shia J, Jaques DP, Klimstra DS, Brennan MF, Coit DG. Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg. 2005;241(2):300–8. doi:10.1097/01.sla.0000152015.76731.1f.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yan TD, Deraco M, Baratti D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27(36):6237–42. doi:10.1200/JCO.2009.23.9640.

    Article  PubMed  Google Scholar 

  6. Spiliotis J, Halkia E, Lianos E, et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol. 2015;22(5):1570–5. doi:10.1245/s10434-014-4157-9.

    Article  CAS  PubMed  Google Scholar 

  7. Seshadri RA, Glehen O. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer. World J Gastroenterol. 2016;22(3):1114–30. doi:10.3748/wjg.v22.i3.1114.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Braam HJ, Boerma D, Wiezer MJ, van Ramshorst B. Cytoreductive surgery and HIPEC in treatment of colorectal peritoneal carcinomatosis: experiment or standard care? A survey among oncologic surgeons and medical oncologists. Int J Clin Oncol. 2015;20(5):928–34. doi:10.1007/s10147-015-0816-5.

    Article  CAS  PubMed  Google Scholar 

  9. Tabrizian P, Overbey J, Carrasco-Avino G, Bagiella E, Labow DM, Sarpel U. Escalation of socioeconomic disparities among patients with colorectal cancer receiving advanced surgical treatment. Ann Surg Oncol. 2015;22(5):1746–50. doi:10.1245/s10434-014-4220-6.

    Article  PubMed  Google Scholar 

  10. 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(6):900–7. doi:10.1097/SLA.0b013e3181a45d86.

    Article  PubMed  Google Scholar 

  11. Moradi BN, Esquivel J. Learning curve in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Piso P, Nissan A, eds. J Surg Oncol. 2009;100(4):293–6. doi:10.1002/jso.21326.

  12. Kusamura S, Moran BJ, Sugarbaker PH, et al. Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. Br J Surg. 2014;101(13):1758–65. doi:10.1002/bjs.9674.

    Article  CAS  PubMed  Google Scholar 

  13. Esquivel J. Current status and future directions of hyperthermic intraperitoneal chemotherapy (HIPEC). Int Oncol. 2014;2(6):E45–52.

    Google Scholar 

  14. Kuijpers AMJ, Aalbers AGJ, Nienhuijs SW, et al. Implementation of a standardized HIPEC protocol improves outcome for peritoneal malignancy. World J Surg. 2015;39(2):453–60. doi:10.1007/s00268-014-2801-y.

    Article  PubMed  Google Scholar 

  15. Mohamed F, Moran BJ. Morbidity and mortality with cytoreductive surgery and intraperitoneal chemotherapy: the importance of a learning curve. Cancer J. 2009;15(3):196–9. doi:10.1097/PPO.0b013e3181a58d56.

    Article  PubMed  Google Scholar 

  16. Rajeev R, Klooster B, Turaga KK. Impact of surgical volume of centers on postoperative outcomes from cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion. J Gastrointest Oncol. 2016;7(1):122–8. doi:10.3978/j.issn.2078-6891.2015.099.

    PubMed  PubMed Central  Google Scholar 

  17. Esquivel J, Stojadinovic A, Levine EA. The American Society of Peritoneal Surface Malignancies (ASPSM). Ann Surg Oncol. 2011;18 Suppl 3(S3):S218–9. doi:10.1245/s10434-010-1402-8.

  18. Turaga K, Levine E, Barone R, et al. Consensus guidelines from The American Society of Peritoneal Surface Malignancies on standardizing the delivery of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer patients in the United States. Ann Surg Oncol. 2014;21(5):1501–5. doi:10.1245/s10434-013-3061-z.

    Article  CAS  PubMed  Google Scholar 

  19. Lv L, Shao Y-F, Zhou Y-B. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2012;27(12):1549–54. doi:10.1007/s00384-012-1577-5.

    Article  PubMed  Google Scholar 

  20. Zon RT, Frame JN, Neuss MN, et al. American society of clinical oncology policy statement on clinical pathways in oncology. J Oncol Pract. 2016;12(3):261–6. doi:10.1200/JOP.2015.009134.

    Article  PubMed  Google Scholar 

  21. Dillman D, Smyth JD, Christian LM. Nternet, phone, mail, and mixed-mode surveys: the tailored design method, 4th edn. Hoboken, NJ: Wiley; 2014.

    Google Scholar 

  22. National Comprehensive Cancer Network NCCN. NCCN Clinical Practice Guidelines in Oncology: Colon Cancer.

  23. Francescutti V, Skitzki JJ, Kane JM, Simunovic M. A comprehensive evaluation of barriers to referral of patients for Cytoreduction/Hyperthermic Intraperitoneal Chemotherapy (CS/HIPEC).

  24. Hamilton TD, Taylor EL, Cannell AJ, McCart JA, Govindarajan A. Impact of major complications on patients’ quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. April 2016. doi:10.1245/s10434-016-5231-2.

    Google Scholar 

  25. Wallet F, Maucort Boulch D, Malfroy S, et al. No impact on long-term survival of prolonged ICU stay and re-admission for patients undergoing cytoreductive surgery with HIPEC. Eur J Surg Oncol. 2016;42(6):855–60. doi:10.1016/j.ejso.2016.03.004.

    Article  CAS  PubMed  Google Scholar 

  26. Polanco PM, Ding Y, Knox JM, et al. Institutional learning curve of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for peritoneal malignancies. Ann Surg Oncol. 2015;22(5):1673–9. doi:10.1245/s10434-014-4111-x.

    Article  PubMed  Google Scholar 

  27. Tsimopoulou I, Pasquali S, Howard R, et al. Psychological prehabilitation before cancer surgery: a systematic review. Ann Surg Oncol. 2015;22(13):4117–23. doi:10.1245/s10434-015-4550-z.

    Article  PubMed  Google Scholar 

  28. Dineen SP, Robinson KA, Roland CL, et al. Feeding tube placement during cytoreductive surgery and heated intraperitoneal chemotherapy does not improve postoperative nutrition and is associated with longer length of stay and higher readmission rates. J Surg Res. 2016;200(1):158–63. doi:10.1016/j.jss.2015.08.003.

    Article  PubMed  Google Scholar 

  29. Huo MH, Muntz J. Extended thromboprophylaxis with low-molecular-weight heparins after hospital discharge in high-risk surgical and medical patients: a review. Clin Ther. 2009;31(6):1129–41. doi:10.1016/j.clinthera.2009.06.002.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA

    Allison H. Maciver MD, FRCSC, Eisar Al-Sukhni MD, FRCSC, Joseph J. Skitzki MD, FACS, John M. Kane III MD, FACS & Valerie A. Francescutti MD, FRCSC, FACS

  2. Cancer Treatment Centers of America, Philadelphia, PA, USA

    Jesus Esquivel MD, FACS

Authors
  1. Allison H. Maciver MD, FRCSC
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  2. Eisar Al-Sukhni MD, FRCSC
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  3. Jesus Esquivel MD, FACS
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  4. Joseph J. Skitzki MD, FACS
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  5. John M. Kane III MD, FACS
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  6. Valerie A. Francescutti MD, FRCSC, FACS
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Corresponding author

Correspondence to Valerie A. Francescutti MD, FRCSC, FACS.

Additional information

Allison H. Maciver and Eisar Al-Sukhni are coauthorship.

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Maciver, A.H., Al-Sukhni, E., Esquivel, J. et al. Current Delivery of Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery (CS/HIPEC) and Perioperative Practices: An International Survey of High-Volume Surgeons. Ann Surg Oncol 24, 923–930 (2017). https://doi.org/10.1245/s10434-016-5692-3

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  • DOI: https://doi.org/10.1245/s10434-016-5692-3

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