Clinical course for patients with peritoneal carcinomatosis excluded from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Abstract

BackgroundCytoreductive surgery combined with 'Hyperthermic IntraPEritoneal Chemotherapy’ (HIPEC) represents the only potentially curative treatment available for carcinomatosis secondary to colorectal cancer (CRC), pseudomyxoma peritonei (PMP), malignant peritoneal mesothelioma (MM) and goblet cell carcinoma (GCC). Despite preoperative investigation some patients are excluded perioperatively because of unacceptably massive tumor extent. The data available on the clinical course of these patients are sparse. The aim of this study was to investigate mortality, morbidity and clinical course for patients who were excluded.MethodsThis was a retrospective observational study based on records from 35 patients (21 men, 14 women) treated in a national center (Surgical Department P, Aarhus University Hospital) from June 2006 to August 2011 and excluded from the cytoreductive surgery perioperatively. The study population included patients aged 18 to 70 years with CRC (n = 19), PMP (n = 11), MM (n = 3) or GCC (n = 2). Vital status was obtained by 29 November 2012. Three patients were lost to follow-up.ResultsThe 30-day mortality rate was 0%. Postoperative complications within 30 days occurred in three patients (9.4%). In all, 19 patients (54%) had palliative surgery during exploratory laparotomy. In total, 28 patients (88%) received postoperative palliative chemotherapy. The median survival for CRC and PMP patients was 12.7 (95% CI 4.0 to 21.4) and 26.9 (95% CI 25.7 to 28.1) months, respectively.ConclusionsExploratory laparotomy for intended curative treatment of peritoneal carcinomatosis did not imply major morbidity or mortality for patients excluded from treatment due to advanced stage of disease.

Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival for peritoneal carcinomatosis from colorectal cancer: a systematic review and meta-analysis of current evidence

“…19.5%, respectively. The summarized HIPEC-related mortality and morbidity in 48 articles (the total number of patients, n = 4,809) [ 12 , 16 , 20 , 35 , 36 , 38 , 39 , 46 , 48 - 50 , 52 - 54 , 56 , 58 - 62 , 64 - 69 , 71 , 73 , 75 , 76 , 79 , 80 , 82 - 90 , 92 , 100 - 104 ] were 2.8% (SD, ± 2.9%; range, 0-12%) and 33.0% (SD, ± 13.4%; range, 4-60%), respectively. Some large-sample retrospective studies and population-based analysis found a series of approximate results that the range of mortality was 2%-5.6% and morbidity was 25%-34% [ 93 - 97 ].…”

Outcome and factors associated with aborted cytoreduction for peritoneal carcinomatosis

“…Given the poor prognosis for those undergoing aborted procedures, one would expect patients to suffer a rapidly progressive clinical course. Rodt and colleagues noted, however, that a nontherapeutic laparotomy did not negatively impact the clinical course of those found to have advanced disease precluding successful completion of CRS/HIPEC (14). In their series, the median survival was 12.7 months for colorectal cancer patients and 88% of patients received palliative chemotherapy.…”

Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC)-directed treatment of peritoneal metastasis in end-stage colo-rectal cancer patients

“…The primary reason behind aborted CRS is widespread abdominal disease, why one can expect those patients to suffer a rapidly progressive and lethal clinical course [22]. In the series by Rodt et al, the median survival in corresponding situations was 12.7 months, whereas others have reported that only about half of the patients who underwent aborted CRS procedures went on to receive palliative chemotherapy associated with a survival of only 8 months [23]. The Dutch group likewise observed that similar patients fared a dismal prognosis with a median survival of 11.2 months in these situations even for patients treated with palliative chemotherapy compared to only 2.7 months for those with best supportive care alone [21].…”