Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Alyami, Mohammad; Mercier, Frédéric; Siebert, Matthieu; Bonnot, Pierre Emmanuel; Laplace, Nathalie; Villeneuve, Laurent; Passot, Guillaume; Gléhen, Olivier; Bakrin, Naoual; Képénékian, Vahan

doi:10.1016/j.ejso.2019.06.028

Cited by 53 publications

(49 citation statements)

References 34 publications

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“…One potential benefit of adding intermittent local anti-cancer therapy is to bridge longer breaks of systemic chemotherapy and thus permit a prolonged overall duration of treatment without adding to systemic toxicity. While large randomized controlled trials are still lacking, several smaller observational studies suggest that PIPAC may promote histological tumor regression, attenuate development of ascites, improve survival, and might facilitate subsequent CRS and HIPEC (23,26,37).…”

Section: Discussionmentioning

confidence: 99%

“…Based on the concept of therapeutic pneumoperitoneum, which was first described by Reymond in 2000 (21), PIPAC has been shown to potentially stabilize PM and even lead to histologic tumor regression in some patients (22). Others have suggested PIPAC as a potential option to reduce the Peritoneal Carcinomatosis Index (PCI) in order to facilitate CRS and HIPEC, in a neoadjuvant setting (23). Most institutions perform PIPAC in alternation with first, second, third or even fourth line intravenous chemotherapy in an effort to achieve optimal control of disease using bidirectional (systemic plus regional) cytotoxic approach (24,25).…”

Section: Introductionmentioning

confidence: 99%

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Systemic Chemotherapy Including Ramucirumab in Combination With Pressurized Intra-Peritoneal Aerosol Chemotherapy Is a Safe Treatment Option for Peritoneal Metastasis of Gastric Cancer

et al. 2021

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BackgroundPressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopic technique for local chemotherapy. It has been used for treatment of peritoneal metastasis of gastric cancer (PM GC) in combination with systemic therapy. VEGFR2 antagonist ramucirumab is a second-line therapy for GC, and has been suspected to cause wound healing disorders.MethodsThis is a retrospective single center cohort study of patients with PM GC, who received PIPAC treatment in combination with systemic chemotherapy with and without ramucirumab. Data on patients’ characteristics and their perioperative courses were collected and complication rates were compared with regard to preoperative use of ramucirumab and time between last dose of systemic therapy and PIPAC treatment.ResultsFifty patients underwent 90 PIPAC treatments for PM GC in 3 years. Overall postoperative morbidity was 11% with 6% severe complications. The mean interval between systemic therapy and PIPAC was 20 days. Neither the length of interval nor the use of ramucirumab had an effect on complication rates.ConclusionOur study suggests that addition of ramucirumab to pre-PIPAC systemic therapy, irrespective of the length of the treatment-free interval before PIPAC, does not increase the risk of postoperative complications and is therefore a safe option for treatment of PM GC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systemic Chemotherapy Including Ramucirumab in Combination With Pressurized Intra-Peritoneal Aerosol Chemotherapy Is a Safe Treatment Option for Peritoneal Metastasis of Gastric Cancer

et al. 2021

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“…With regard to gynecological cancers, the results of recent studies suggest that secondary cytoreductive surgery (CRS) may be beneficial to survival in highly selected patients with recurrent ovarian cancer if complete cytoreduction can be achieved [8], but this benefit has not yet been demonstrated in unselected patient populations [9] or in patients with incomplete resection [8]. PC was regarded as a terminal condition [5] until the advent of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), a potentially curative option currently being evaluated in clinical trial [10,11] along with other recent developments such as pressurized intraperitoneal aerosol chemotherapy (PIPAC), which has produced promising results [12]. However, only a highly selected group of patients are candidates for CRS-HIPEC, which requires extensive and complex bowel work.…”

Section: Introductionmentioning

confidence: 99%

The Role of Total Parenteral Nutrition in Patients with Peritoneal Carcinomatosis: A Systematic Review and Meta-Analysis

Ong

Sultana

Tan

et al. 2021

Cancers

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Peritoneal carcinomatosis (PC) is often associated with malnutrition and an inability to tolerate enteral feeding. Although total parenteral nutrition (TPN) can be lifesaving for patients with no other means of nutritional support, its use in the management of PC patients remains controversial. Therefore, a systematic review and meta-analysis was performed to evaluate the benefit of TPN on the overall survival of PC patients, in accordance with PRISMA guidelines. A total of 187 articles were screened; 10 were included in this review and eight were included in the meta-analysis. The pooled median overall survival of patients who received TPN was significantly higher than patients who did not receive TPN (p = 0.040). When only high-quality studies were included, a significant survival advantage was observed in PC patients receiving TPN (p < 0.001). Subgroup analysis of patients receiving chemotherapy demonstrated a significant survival benefit (p = 0.008) associated with the use of TPN. In conclusion, TPN may improve survival outcomes in PC patients. However, further studies are needed to conclude more definitively on the effect of TPN.

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“…[1][2][3] In the treatment of peritoneal carcinomatosis, cytoreductive surgery (CRS) and HIPEC have been shown to be very effective in selected patients despite the high but acceptable mortality and morbidity rates. [1][2][3][4] Organ resections, especially small bowel and colon resections, are performed to achieve complete cytoreduction in CRS and HIPEC. 5 However, studies have shown that HIPEC treatment has an adverse effect on anastomosis by disrupting wound healing.…”

Section: Introductionmentioning

confidence: 99%

“…Peritoneal carcinomatosis is a malignancy that develops in the last stage of many diseases, such as colorectal and gastric cancers, pseudomyxoma peritonei, peritoneal mesothelioma and advanced‐stage ovarian cancers, and presents with a poor prognosis and short life expectancy 1–3 . In the treatment of peritoneal carcinomatosis, cytoreductive surgery (CRS) and HIPEC have been shown to be very effective in selected patients despite the high but acceptable mortality and morbidity rates 1–4 . Organ resections, especially small bowel and colon resections, are performed to achieve complete cytoreduction in CRS and HIPEC 5 .…”

Section: Introductionmentioning

confidence: 99%

Effect of platelet‐rich plasma on colon anastomosis in rats in which hyperthermic intra‐peritoneal chemotherapy was performed using 5‐fluorouracil

Göksu

Alakuş

Ertan

et al. 2020

ANZ Journal of Surgery

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Background: Hyperthermic intra-peritoneal chemotherapy (HIPEC) performed in patients with peritoneal carcinomatosis has a cytotoxic effect on tumour cells. This cytotoxic effect also adversely affects the wound healing of anastomosis, which is frequently undertaken in this patient group, and causes anastomotic leakage and intestinal fistulas. Platelet-rich plasma (PRP) gel has been used in wound healing and has shown efficacy. We investigated the effect of PRP gel on colon anastomosis healing in rats treated with 5-fluorouracil (5-FU). Methods: Twenty-four rats were divided into three groups, each containing eight rats: group 1 (control) underwent colon anastomosis alone; group 2 (5-FU) underwent a colon anastomosis and HIPEC; and group 3 (5-FU + PRP) underwent a colon anastomosis and HIPEC and received topical PRP gel. The rats were sacrificed on the post-operative day 7 and the anastomotic bursting pressure (ABP) was measured. Tissue samples were obtained to measure the hydroxyproline level and investigate the histopathological changes on the anastomosis line. Results: ABP was higher in the control and 5-FU + PRP groups than in the 5-FU group (P = 0.009, P = 0.047). The tissue hydroxyproline levels were higher in the control and 5-FU + PRP groups than in the 5-FU group (P = 0.001, P = 0.030). The histopathological findings of the 5-FU + PRP group were better than those of the 5-FU group. Conclusion: This study showed that the application of PRP gel to colon anastomoses increased ABP in rats treated with HIPEC using 5-FU. It also showed positive effects on anastomotic healing by increasing the tissue hydroxyproline levels on the anastomosis line and reducing the inflammatory response.

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Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Cited by 53 publications

References 34 publications

Systemic Chemotherapy Including Ramucirumab in Combination With Pressurized Intra-Peritoneal Aerosol Chemotherapy Is a Safe Treatment Option for Peritoneal Metastasis of Gastric Cancer

Systemic Chemotherapy Including Ramucirumab in Combination With Pressurized Intra-Peritoneal Aerosol Chemotherapy Is a Safe Treatment Option for Peritoneal Metastasis of Gastric Cancer

The Role of Total Parenteral Nutrition in Patients with Peritoneal Carcinomatosis: A Systematic Review and Meta-Analysis

Effect of platelet‐rich plasma on colon anastomosis in rats in which hyperthermic intra‐peritoneal chemotherapy was performed using 5‐fluorouracil

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