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Implementation of a Standardized HIPEC Protocol Improves Outcome for Peritoneal Malignancy

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Abstract

Background

Experience with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in a pioneer hospital resulted in a treatment protocol that has become the standard in the Netherlands. Outcome of CRS and HIPEC was reviewed to assure differences between the pioneer phase and the period wherein the Dutch HIPEC protocol was clinically implemented.

Methods

The first consecutive 100 CRS and HIPEC procedures performed in the Netherlands were included as pioneer cohort (1995–1999). Two-hundred and seventy-two procedures that were performed in three participating HIPEC centres after the implementation of the Dutch HIPEC protocol were included as the implementation cohort (2005–2012). Another 100 recent patients of the first centre were included as a control group (2009–2011). Indications for the CRS and HIPEC treatment were peritoneal carcinomatosis (PC) from colorectal carcinoma and pseudomyxoma peritonei (PMP).

Results

Of the 472 included procedures, 327 (69 %) procedures were performed for PC from colorectal carcinoma and 145 for PMP (31 %). Compared with the implementation phase, the pioneer phase was characterized by more affected abdominal regions (mean 4.3 vs. 3.5, p < 0.001), more resections (mean 3.8 vs. 3.4, p < 0.001), less macroscopic radical cytoreductions (66 vs. 86 %, p < 0.001) and more patients with major morbidity (grade III–V) (64 vs. 32 %, p < 0.001). Other determinants of morbidity were high tumour load and multiple organ resections. Outcome of the implementation phase was similar to the control group.

Conclusions

This study determined that outcome had improved ever since the Dutch HIPEC protocol has been implemented based on completeness of cytoreduction and decreasing morbidity.

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Abbreviations

PC:

peritoneal carcinomatosis

CRC:

colorectal cancer

PMP:

pseudomyxoma peritonei

CRS:

cytoreductive surgery

HIPEC:

hyperthermic intraperitoneal chemotherapy

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Conflict of interest

The authors declare that there are no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Anke M. J. Kuijpers, Arend G. J. Aalbers & Victor J. Verwaal

  2. Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Wilma D. Heemsbergen & Michael Hauptmann

  3. Department of Surgery, Catharina Hospital , Eindhoven, The Netherlands

    Simon W. Nienhuijs & Ignace H. J. T. de Hingh

  4. Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands

    Marinus J. Wiezer & Bert van Ramshorst

  5. Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands

    Robert J. van Ginkel & Klaas Havenga

Authors
  1. Anke M. J. Kuijpers
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  2. Arend G. J. Aalbers
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  3. Simon W. Nienhuijs
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  4. Ignace H. J. T. de Hingh
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  7. Robert J. van Ginkel
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  8. Klaas Havenga
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  9. Wilma D. Heemsbergen
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  11. Victor J. Verwaal
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Corresponding author

Correspondence to Anke M. J. Kuijpers.

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Kuijpers, A.M.J., Aalbers, A.G.J., Nienhuijs, S.W. et al. Implementation of a Standardized HIPEC Protocol Improves Outcome for Peritoneal Malignancy. World J Surg 39, 453–460 (2015). https://doi.org/10.1007/s00268-014-2801-y

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  • DOI: https://doi.org/10.1007/s00268-014-2801-y

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