Outcomes with cytoreductive surgery and HIPEC for peritoneal metastasis

Abstract

Peritoneal metastasis (PM) has traditionally been approached with therapeutic nihilism. The evolution of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) over the last two decades, however, has caused a paradigm shift in treatment for PM. This modality is rapidly gaining acceptance as standard of care for PM from various cancers. This article reviews the current literature regarding the use of CRS/HIPEC for PM from the most common intra-abdominal malignancies.

Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center

“…Encouraging results have been reported with the use of CRS/ HIPEC for PC of CRC origin, with median OS rates ranging from 16 to 62.7 months in different series [24]. In our series, CRC patients undergoing extreme CRS/HIPEC had a limited median survival period of only 10.1 months, significantly shorter than that achieved in the reference group.…”

Postoperative complications affect long‐term outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis

“…These data are in line with those reported in the literature. In a systematic review of large series of CRS + HIPEC, overall postoperative morbidity rates ranged from 31 to 40% with major morbidity occurring in 23‐31% specifically in patients undergoing CRS + HIPEC for colorectal PC . Given the important effect of complications on oncologic outcomes after CRS + HIPEC, it is critical to be able to accurately identify these at‐risk patients.…”

“…Long‐term survival has improved in select patients with peritoneal carcinomatosis (PC) of colorectal origin with the aggressive application of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). Five‐year survival after CRS + HIPEC has been reported as high as 50%, although more conservative estimates range from 20% to 30% . Despite mounting evidence supporting its effectiveness to the point of its inclusion in national cancer guidelines in France, Germany, the United Kingdom, among others, the indications for CRS + HIPEC are not yet well defined nor widely accepted.…”

5‐fluorouracil combined with cisplatin and mitomycin C as an optimized regimen for hyperthermic intraperitoneal chemotherapy in gastric cancer

“…Gastric cancer (GC) with peritoneal metastasis continues to exhibit an extremely poor prognosis, and early postoperative peritoneal metastasis is a major problem for the treatment of advanced GC even with curative intent . Hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a promising procedure for the prevention and treatment of peritoneal metastasis during surgery for pseudomyxoma peritonei, malignant mesothelioma, ovarian cancer, colorectal cancer, and GC . However, some adverse effects have been reported regarding cytoreductive surgery and HIPEC.…”