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The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Offering iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for recurrence of peritoneal carcinomatosis (PC) poses a surgical dilemma. Safety of this repeated operation in the short and long term has not been largely investigated.

Methods

Patients with PC who underwent 377 CRS/HIPEC procedures between 2007 and 2018 at our institution were included from a prospectively maintained database. Outcomes for patients who had singular CRS/HIPEC were compared with those for patients who had repeated CRS/HIPEC.

Results

Overall, there were 325 singular and 52 iterative CRS/HIPEC procedures performed during this time period. Age, sex, and ASA class were comparable between cohorts (p = NS). Optimal cytoreduction, mean operative time, mean length of hospital stay, 90-day major morbidity, and 90-day mortality were also similar. At a median follow-up of 24 months, there was no significant difference in recurrence rate (%, 60 vs 63, p = 0.76), disease-free survival (mean months, 19 vs 15, p = 0.30), and overall survival (mean months, 32 vs 27, p = 0.69). The iterative CRS/HIPEC group had significantly higher rates of major late complications than the singular CRS/HIPEC group (%, 18 vs 40, p < 0.01).

Conclusion

Repeated CRS/HIPEC for PC has similar perioperative morbidity and mortality, as well as long-term oncological benefits, when compared with singular CRS/HIPEC. However, more than twice as many patients undergoing iterative CRS/HIPEC suffered from major late complications.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA

    Eliahu Bekhor MD, Jacquelyn Carr MD, Margaret Hofstedt BS, Brianne Sullivan MD, Natasha Leigh MD, Nathan Bolton MD, Benjamin Golas MD, Umut Sarpel MD, Daniel Labow MD & Deepa Magge MD

  2. Department of General Surgery, Rabin Medical Center, Petah Tikva, Israel

    Eliahu Bekhor MD & Daniel Solomon MD

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  1. Eliahu Bekhor MD
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Bekhor, E., Carr, J., Hofstedt, M. et al. The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis. Ann Surg Oncol 27, 1448–1455 (2020). https://doi.org/10.1245/s10434-019-08141-w

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