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Should Cytoreductive Surgery Alone for Peritoneal Metastases of Colorectal Origin be Centralized? A National Study of 4159 Procedures

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

Abstract

Background

Addition of oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) in the treatment of peritoneal metastases of colorectal origin (CRPM) did not show any survival benefit in the PRODIGE 7 trial (P7). This study aimed to investigate whether perioperative outcomes after CRS alone for CRPM patients is mediated by hospital volume and to determine the effect of P7 on French practice for CRPM patients treated respectively with CRS alone and CRS/HIPEC.

Methods

Data from CRPM patients treated with CRS alone between 2013 and 2020 in France were collected through a national medical database. The study used a cutoff value of the annual CRS-alone caseload affecting the 90-day postoperative mortality (POM) determined from our previous study to define low-volume (LV) HIPEC and high-volume (HV) HIPEC centers. Perioperative outcomes were compared between no-HIPEC, LV-HIPEC, and HV-HIPEC centers. The trend between years and HIPEC rates was analyzed using the Cochrane-Armitage test.

Results

Data from 4159 procedures were analyzed. The patients treated in no-HIPEC and LV-HIPEC centers were older compared with HV-HIPEC centers (p < 0.0001) and had a higher Elixhauser comorbidity index (p < 0.0001) and less complex surgery (p < 0.0001). Whereas the major morbidity (MM) rate did not differ between groups (p = 0.79), the 90-day POM was lower in HV-HIPEC centers than in no-HIPEC and LV-HIPEC centers (5.4% vs 15% and 13.3%; p < 0.0001), with lower failure-to-rescue (FTR) (p < 0.0001). After P7, the CRS/HIPEC rate decreased drastically in Cancer centers (p < 0.001), whereas patients treated with CRS alone are still referred to expert centers.

Conclusions

Centralization of CRS alone should improve patient selection as well as FTR and POM. After P7, CRS/HIPEC decreased mostly in Cancer centers, without any impact on the number of CRS-alone cases referred to expert centers.

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References

  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.

    Article  PubMed  Google Scholar 

  2. Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88:358–63. https://doi.org/10.1002/(sici)1097-0142(20000115)88:2%3c358::aid-cncr16%3e3.0.co;2-o.

    Article  CAS  PubMed  Google Scholar 

  3. Lurvink RJ, Bakkers C, Rijken A, et al. Increase in the incidence of synchronous and metachronous peritoneal metastases in patients with colorectal cancer: a nationwide study. Eur J Surg Oncol. 2021;47:1026–33. https://doi.org/10.1016/j.ejso.2020.11.135.

    Article  CAS  PubMed  Google Scholar 

  4. Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomized trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17:1709–19. https://doi.org/10.1016/S1470-2045(16)30500-9.

    Article  PubMed  Google Scholar 

  5. Goéré D, Malka D, Tzanis D, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg. 2013;257:1065–71. https://doi.org/10.1097/SLA.0b013e31827e9289.

    Article  PubMed  Google Scholar 

  6. Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63–8. https://doi.org/10.1200/JCO.2009.23.9285.

    Article  PubMed  Google Scholar 

  7. Glehen O, Gilly FN, Boutitie F, et al. Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1290 patients. Cancer. 2010;116:5608–18. https://doi.org/10.1002/cncr.25356.

    Article  PubMed  Google Scholar 

  8. Quenet F, Goéré D, Mehta SS, et al. Results of two bi-institutional prospective studies using intraperitoneal oxaliplatin with or without irinotecan during HIPEC after cytoreductive surgery for colorectal carcinomatosis. Ann Surg. 2011;254:294–301. https://doi.org/10.1097/SLA.0b013e3182263933.

    Article  PubMed  Google Scholar 

  9. Piso P, Stierstorfer K, Gerken M, Klinkhammer-Schalke M. Benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in patients with isolated peritoneal metastases from colorectal cancer. Int J Colorectal Dis. 2018;33:1559–67. https://doi.org/10.1007/s00384-018-3146-z.

    Article  PubMed  Google Scholar 

  10. Quénet F, Elias D, Roca L, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomized, open-label, phase 3 trial. Lancet Oncol. 2021;22:256–66. https://doi.org/10.1016/S1470-2045(20)30599-4.

    Article  PubMed  Google Scholar 

  11. Baratti D, Kusamura S, Azmi N, Guaglio M, Montenovo M, Deraco M. Colorectal peritoneal metastases treated by perioperative systemic chemotherapy and cytoreductive surgery with or without mitomycin C-based HIPEC: a comparative study using the Peritoneal Surface Disease Severity Score (PSDSS). Ann Surg Oncol. 2020;27:98–106. https://doi.org/10.1245/s10434-019-07935-2.

    Article  PubMed  Google Scholar 

  12. van de Vlasakker VCJ, Lurvink RJ, Cashin PH, et al. The impact of PRODIGE 7 on the current worldwide practice of CRS-HIPEC for colorectal peritoneal metastases: a web-based survey and 2021 statement by Peritoneal Surface Oncology Group International (PSOGI). Eur J Surg Oncol. 2021;47:2888–92. https://doi.org/10.1016/j.ejso.2021.05.023.

    Article  PubMed  Google Scholar 

  13. Noiret B, Clement G, Lenne X, et al. Centralization and oncologic training reduce postoperative morbidity and failure-to-rescue rates after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: study on a 10-year national French practice. Ann Surg. 2020;272(5):847–854. https://doi.org/10.1097/SLA.0000000000004326

    Article  PubMed  Google Scholar 

  14. Agence technique de l’information sur l’hospitalisation. PMSI MCO Presentation: understanding the principles and background of this PMSI domain. Published 31 July 2018. https://www.atih.sante.fr/mco/presentation.

  15. El Amrani M, Lenne X, Clement G, et al. Specificity of procedure volume and its association with postoperative mortality in digestive cancer surgery: a nationwide study of 225,752 patients. Ann Surg. 2019;270:775–82. https://doi.org/10.1097/SLA.0000000000003532.

    Article  PubMed  Google Scholar 

  16. Quantin C, Benzenine E, Hägi M, et al. Estimation of national colorectal cancer incidence using claims databases. J Cancer Epidemiol. 2012;2012:1–7. https://doi.org/10.1155/2012/298369.

    Article  Google Scholar 

  17. Mehta HB, Sura SD, Adhikari D, et al. Adapting the Elixhauser comorbidity index for cancer patients. Cancer. 2018;124:2018–25. https://doi.org/10.1002/cncr.31269.

    Article  PubMed  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. JCO. 2004;22:3284–92. https://doi.org/10.1200/JCO.2004.10.012.

    Article  CAS  Google Scholar 

  20. Abboud K, André T, Brunel M, et al. Management of colorectal peritoneal metastases: expert opinion. J Visc Surg. 2019;156:377–9. https://doi.org/10.1016/j.jviscsurg.2019.08.002.

    Article  CAS  PubMed  Google Scholar 

  21. van Putten M, Nelen SD, Lemmens VEPP, et al. Overall survival before and after centralization of gastric cancer surgery in the Netherlands: centralization of gastric cancer surgery. Br J Surg. 2018;105:1807–15. https://doi.org/10.1002/bjs.10931.

    Article  PubMed  Google Scholar 

  22. Schlottmann F, Strassle PD, Charles AG, Patti MG. Esophageal cancer surgery: spontaneous centralization in the US contributed to reduce mortality without causing health disparities. Ann Surg Oncol. 2018;25:1580–7. https://doi.org/10.1245/s10434-018-6339-3.

    Article  PubMed  Google Scholar 

  23. Vonlanthen R, Lodge P, Barkun JS, et al. Toward a consensus on centralization in surgery. Ann Surg. 2018;268:712–24. https://doi.org/10.1097/SLA.0000000000002965.

    Article  PubMed  Google Scholar 

  24. Quantin C, Cottenet J, Vuagnat A, et al. Quality of perinatal statistics from hospital discharge data: comparison with civil registration and the 2010 National Perinatal Survey. J Gynecol Obstet Biol Reprod Paris. 2014;43:680–90. https://doi.org/10.1016/j.jgyn.2013.09.004.

    Article  CAS  PubMed  Google Scholar 

  25. Girard D, Antoine D, Che D. Epidemiology of pulmonary tuberculosis in France: Can the hospital discharge database be a reliable source of information? Med Mal Infect. 2014;44:509–14. https://doi.org/10.1016/j.medmal.2014.10.002.

    Article  CAS  PubMed  Google Scholar 

  26. Gisquet E, Aouba A, Ghosn W, Aubry R, Jougla E, Rey G. Où Meurt-on En France? Analyse Des Certificats de Décès (1993–2008). Bulletin Epidémiologique Hebdomadaire. 2012;48:547–51.

    Google Scholar 

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Authors and Affiliations

  1. Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France

    Barbara Noiret MD, Guillaume Piessen MD, PhD & Clarisse Eveno MD, PhD

  2. Department of Medical Information, Lille University Hospital, Lille, France

    Xavier Lenne MSc & Amélie Bruandet MD, PhD

  3. UMR-S1277–CANTHER “Cancer Heterogeneity, Plasticity and Resistance to Therapies” Laboratory, Lille, France

    Guillaume Piessen MD, PhD & Clarisse Eveno MD, PhD

Authors
  1. Barbara Noiret MD
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  2. Xavier Lenne MSc
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  3. Amélie Bruandet MD, PhD
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  4. Guillaume Piessen MD, PhD
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  5. Clarisse Eveno MD, PhD
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Correspondence to Clarisse Eveno MD, PhD.

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Guillaume Piessen, Medtronic, travel expenses BMS: consultant fees, MSD: consultant fees Astellas: consultant fees.

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Noiret, B., Lenne, X., Bruandet, A. et al. Should Cytoreductive Surgery Alone for Peritoneal Metastases of Colorectal Origin be Centralized? A National Study of 4159 Procedures. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15180-5

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