Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi‐institutional experience

Alzahrani, Nayef; Valle, Sarah J.; Fisher, Oliver M.; Sugarbaker, Paul H.; Yonemura, Yutaka; Gléhen, Olivier; Goéré, D.; Honoré, Charles; Brigand, Cécile; Hingh, Ignace H. J. T. de; Verwaal, Victor J.; Deraco, Marcello; Baratti, Dario; Kusamura, Shigeki; Pocard, M; Piso, Pompiliu; Maerz, Loreen; Marchal, Frédéric; Moran, Brendan; Levine, Edward A.; Dumont, Frédéric; Pezet, Denis; Abboud, Karine; Kozman, Mathew A.; Liauw, Winston; Morris, David L.

doi:10.1002/jso.25277

Cited by 35 publications

(17 citation statements)

References 40 publications

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“…The morbidity and mortality of these surgeries are similar to those of the first procedure in high volume centers[82]. Furthermore, this active approach to recurrent abdominal disease has reported a median survival from 39 to 42.9 mo, a clearly better long-term survival compared to that obtained with systemic treatment alone[82-84]…”

Section: Reiterative Cytoreductive Proceduresmentioning

confidence: 97%

Colorectal peritoneal metastases: Optimal management review

Sánchez-Hidalgo

Rodríguez‐Ortiz

Arjona‐Sánchez

et al. 2019

WJG

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The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.

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Section: Reiterative Cytoreductive Proceduresmentioning

confidence: 97%

Colorectal peritoneal metastases: Optimal management review

Sánchez-Hidalgo

Rodríguez‐Ortiz

Arjona‐Sánchez

et al. 2019

WJG

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“…A large retrospective analysis found that patients who underwent repeat CRS had significantly higher 5‐year and overall survival rates than those who did not, with no significant difference in major morbidity or in‐hospital mortality. Other reports have supported these findings, although the literature is still limited.…”

Section: Introductionmentioning

confidence: 70%

“…In a past study, disease progression was the only independent risk factor for reduced overall survival (OS) in patients with PSM from appendiceal neoplasms. Repeat CRS–HIPEC has been shown to be a viable treatment alternative for these patients. A large retrospective analysis found that patients who underwent repeat CRS had significantly higher 5‐year and overall survival rates than those who did not, with no significant difference in major morbidity or in‐hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

Repeat cytoreductive surgery with or without intraperitoneal chemotherapy for recurrent epithelial appendiceal neoplasms

et al. 2020

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Background: With recurrence rates after primary cytoreductive surgery (CRS) in excess of 50 per cent, repeat CRS is being performed increasingly, but survival outcomes have not been reported widely. This study examined the outcomes following repeat CRS for appendiceal cancer with peritoneal surface malignancy (PSM), and evaluated its feasibility and safety.Methods: A retrospective cohort of patients who had surgery between 1996 and 2018 were analysed. Patients who underwent a single CRS procedure with or without heated intraperitoneal chemotherapy (HIPEC) were compared with those who had multiple procedures with or without HIPEC. Perioperative morbidity and survival outcomes were analysed.Results: Some 462 patients were reviewed, 102 of whom had repeat procedures. For high-grade tumours, patients who had a single CRS procedure had significantly reduced overall survival (OS) compared with those who had repeat CRS (55⋅6 versus 90⋅7 months respectively; P = 0⋅016). For low-grade tumours, there was no difference in OS (P = 0⋅153). When patients who had a single procedure were compared with those who had multiple procedures, there was no significant difference in major morbidity (P = 0⋅441) or in-hospital mortality (P = 0⋅080). For multiple procedures, no differences were found in major morbidity (P = 0⋅262) or in-hospital mortality (P = 0⋅502) when the first procedure was compared with the second. For low-grade cancers, the peritoneal carcinomatosis index was a significant prognostic factor for OS (hazard ratio (HR) 1⋅11, 95 per cent c.i. 1⋅05 to 1⋅17; P < 0⋅001), whereas for high-grade cancers repeat CRS (HR 0⋅57, 0⋅33 to 0⋅95; P = 0⋅033), complete cytoreduction score (HR 1⋅55, 1⋅01 to 2⋅40; P = 0⋅046) and presence of signet ring cells (HR 2⋅77, 1⋅78 to 4⋅30; P < 0⋅001) were all significant indicators of long-term survival. Conclusion:In selected patients presenting with PSM from epithelial appendiceal neoplasms, repeat CRS performed in high-volume centres could provide survival benefits.

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“…Die Komplikationsrate und die Letalität waren vergleichbar mit denen nach der 1. CRS und HIPEC [15]. ger als bisher angenommen entdeckt wird.…”

Section: Rezidive: Lokalisation Und Indikationen Zu Re-crs Und Hipecunclassified

Aktuelle Entwicklungen in der regionalen Behandlung von peritonealen und pleuralen Tumoren (inkl. HIPEC und HITOC)

Piso

Hofmann

2019

Zentralbl Chir

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ZusammenfassungDie multimodale Therapie von begrenzten peritonealen Metastasen kann bei ausgewählten Tumorentitäten die Prognose der Patienten günstig beeinflussen, sollte eine komplette Resektion erfolgen (Pseudomyxoma peritonei, malignes peritoneales Mesotheliom, kolorektales Karzinom, Magenkarzinom und Ovarialkarzinom). Oft wird additiv eine hypertherme intraperitoneale Chemotherapie (HIPEC) intraoperativ durchgeführt. Wenn die Behandlung in erfahrenen (und zertifizierten) Zentren durchgeführt wird, ist diese mit einer niedrigen Letalität verbunden. Die intrakavitäre hypertherme Perfusionschemotherapie (HITOC) in der Pleura kann zur Behandlung bösartiger Pleuratumoren eingesetzt werden. Wesentliche Indikationen sind das Pleuramesotheliom oder der sekundäre Pleurabefall durch ein Thymom (Stadium IV a). Die HITOC wird in Einzelfällen auch bei Patienten mit einer Pleurakarzinose durchgeführt. Beide Verfahren (HIPEC und HITOC) sind komplex und der genaue Stellenwert der lokoregionalen hyperthermen Chemotherapie muss durch weitere prospektiv randomisierte Studien geklärt werden.

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Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi‐institutional experience

Cited by 35 publications

References 40 publications

Colorectal peritoneal metastases: Optimal management review

Colorectal peritoneal metastases: Optimal management review

Repeat cytoreductive surgery with or without intraperitoneal chemotherapy for recurrent epithelial appendiceal neoplasms

Aktuelle Entwicklungen in der regionalen Behandlung von peritonealen und pleuralen Tumoren (inkl. HIPEC und HITOC)

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