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Evaluation of cytoreductive surgery and HIPEC for peritoneal surface malignancies: analysis of 384 consecutive cases

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Abstract

Background

Peritoneal surface malignancy (PSM) was historically associated with a poor survival. The adoption of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can now offer patients with PSM a favourable overall survival. Here, we report our single-institute outcomes following CRS and HIPEC for PSM and evaluate changes in our practice over time.

Methods

This is a retrospective review from 2009 to 2018 of all patients undergoing CRS and HIPEC for PSM at a statewide peritoneal disease centre. Cases were divided into the first half and second to compare changes in practice over time.

Results

Three hundred and eighty four CRS and HIPEC cases were performed during this time. The median age was 56 years with 59.6% female. The median peritoneal carcinomatosis index (PCI) was 11, with a reduction in PCI in the second cohort (9 v 15, p < 0.01). Complete cytoreduction rates were significantly higher in the second cohort (82.3% v 67.7%, p < 0.01). Overall, grade III/IV complications occurred in 101 cases (26.3%) with three (0.8%) perioperative mortalities. Median overall survival (OS) for the entire cohort was 85 months, with a 5-year survival of 52%. Median OS was 97 months for PMP, 34 months for colorectal peritoneal metastases and 27 months for other histologies. Completeness of cytoreduction, histology type, and PCI were factors independently associated with overall survival.

Conclusion

CRS and HIPEC can offer highly favourable outcomes for PSM with low morbidity. Successful complete cytoreduction rates improved significantly with greater experience and better patient selection.

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Authors and Affiliations

  1. Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Vignesh Narasimhan, Atandrila Das, Satish Warrier, Craig Lynch, Jacob McCormick, Robert Ramsay & Alexander Heriot

  2. Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Melbourne, Australia

    Vignesh Narasimhan, Atandrila Das, Robert Ramsay & Alexander Heriot

  3. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Jeanne Tie & Michael Michael

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  1. Vignesh Narasimhan
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  2. Atandrila Das
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  3. Satish Warrier
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  4. Craig Lynch
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  7. Michael Michael
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  9. Alexander Heriot
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Contributions

VN, JT, MM, RR and AH produced the study concept and design. VN and AD performed the scientific literature search and the data collection. VN performed all the statistical analysis. All authors were involved in refining the study design and data interpretation. VN, SW, CL, JM, MM, JT, RR and AH wrote the initial draft, with all authors involved in the editing process and final version of the manuscript. All authors have reviewed and approved the final manuscript. All authors agree to be accountable for all aspects of the work.

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Correspondence to Vignesh Narasimhan.

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All the authors have completed the Conflict of Interest Disclosure Form. This project satisfied Peter MacCallum Cancer Centre Ethics Committee and governance requirements and was granted ethical approval. Ethics approval number was 17/141R.

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The authors declare that they have no conflicts of interest.

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Narasimhan, V., Das, A., Warrier, S. et al. Evaluation of cytoreductive surgery and HIPEC for peritoneal surface malignancies: analysis of 384 consecutive cases. Langenbecks Arch Surg 404, 527–539 (2019). https://doi.org/10.1007/s00423-019-01805-x

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