Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases From a Small Bowel Adenocarcinoma: Multi-Institutional Experience

Abstract

BackgroundThe multi-institutional registry in this study evaluated the outcome after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal metastases (PM) from small bowel adenocarcinoma (SBA).MethodsA multi-institutional data registry including 152 patients with PM from SBA was established. The primary end point was overall survival (OS) after CRS plus HIPEC.ResultsBetween 1989 and 2016, 152 patients from 21 institutions received a treatment of CRS plus HIPEC. The median follow-up period was 20 months (range 1–100 months). Of the 152 patients, 70 (46.1%) were women with a median age of 54 years. The median peritoneal cancer index (PCI) was 10 (mean 12; range 1–33). Completeness of cytoreduction (CCR) 0 or 1 was achieved for 134 patients (88.2%). After CRS and HIPEC, the median OS was 32 months (range 1–100 months), with survival rates of 83.2% at 1 year, 46.4% at 3 years, and 30.8% at 5 years. The median disease-free survival after CCR 0/1 was 14 months (range 1–100 months). The treatment-related mortality rate was 2%, and 29 patients (19.1%) experienced grades 3 or 4 operative complications. The period between detection of PM and CRS plus HIPEC was 6 months or less (P = 0.008), and multivariate analysis identified absence of lymph node metastasis (P = 0.037), well-differentiated tumor (P = 0.028), and PCI of 15 or lower (P = 0.003) as independently associated with improved OS.ConclusionThe combined treatment strategy of CRS plus HIPEC achieved prolonged survival for selected patients who had PM from SBA with acceptable morbidity and mortality.

Efficacy of surgery and chemotherapy for stage IV small bowel adenocarcinoma: A population‐based analysis using Surveillance, Epidemiology, and End Result Program database

“…Recently, another retrospective research enrolled 34 stage IV SBA patients with surgery, and the median OS and RFS were 28.6 and 18.7 months respectively 12 . Consistent with former studies, 11,12 we found that surgery was an independent factor associated with better survival for stage IV SBA.…”

“…152 stage IV SBA patients with peritoneal metastases were enrolled in a restrospective study in 2018, prolonged survival have been archived using combined treatment strategy of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (median OS was 32 months with survival rates of 46.4% at 3 years). Multivariate analysis revealed that absence of lymph node metastasis, well‐differentiated tumor, and peritoneal cancer index of 15 or lower were factors independently associated with improved OS 11 . Recently, another retrospective research enrolled 34 stage IV SBA patients with surgery, and the median OS and RFS were 28.6 and 18.7 months respectively 12 .…”

“…At present, there is still lack of research on treatment for stage IV SBA. Only a few studies have attempted to explore the rational regimen for these patients, 10‐13 and the results were insecure partly due to the small sample sizes and disparate treatment regimens.…”

Prognostic significance of lymph node dissection on stage-specific survival for patients with primary small intestine tumor treated with enterectomy: A population-based study, 2004-2015

“…Surgery is the most commonly used treatment for small bowel tumors 2,15 , and adjuvant chemotherapy has also been shown to play a role in improving the survival outcome of patients 16 .Up to now, the therapeutic effect of LND is still discussed controversially. From 2004 to the present, the number of lymph node dissections used in small bowel tumor resection has increased slightly, but the proportion of lymph node dissection and extended lymph node dissection have not changed signi cantly (Figure S2-3).…”

An analysis of the influence of infection on overall survival rates, following modified posterior pelvic exenteration for advanced ovarian cancer

“…The extent of residual tumor tissue following surgery is directly related to patient survival outcomes [10][11][12]. For this reason, the aim of surgery is the removal of all neoplastic foci during the cytoreductive procedure, and the standard approach is to achieve no gross residual disease (NGR) [13].…”