Palliative Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Is It Safe and Effective? J Surg Res 2022 Oct;278:31-38
Date
05/20/2022Pubmed ID
35588572DOI
10.1016/j.jss.2022.04.012Scopus ID
2-s2.0-85130316020 (requires institutional sign-in at Scopus site) 1 CitationAbstract
INTRODUCTION: Palliation is a controversial indication for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Patients with peritoneal carcinomatosis (PC) are living longer, and the roles of palliative CRS and HIPEC are increasingly challenged. The purpose of this study is to evaluate indications, morbidity, and symptom improvement from CRS/HIPEC in advanced PC.
METHODS: A retrospective review of patients undergoing CRS and/or HIPEC with a palliative intent at a single institution from February 2008 to February 2018 was performed. Main end points included symptom improvement, symptom-free interval, and overall survival.
RESULTS: Two hundred and seventy seven patients were referred for CRS/HIPEC during the study period and 17 underwent 20 palliative procedures. Appendiceal (n = 6) and colorectal cancers (n = 6) were the most common malignancies. Ascites (n = 8) and bowel obstruction (n = 8) were the most common indications for intervention. The postoperative complication rate was 50% and major complication rate was 20%. Partial symptom improvement or resolution of symptoms was achieved in 18 (90%) cases. A durable symptom control at 90 d was achieved in 13 (65%) cases. The median time to symptom recurrence was 5.1 mo (interquartile range: 2-11.4), and the median overall survival was 11.6 mo (interquartile range: 3.8-28.5).
CONCLUSIONS: Palliative CRS and/or HIPEC achieve symptom improvement in patients with advanced PC. Risk assessment and expected time to recovery from surgery remain paramount for patient selection.
Author List
Strong EA, Livingston A, Gracz M, Peltier W, Tsai S, Christians K, Gamblin TC, Kersting K, Clarke CNAuthors
Kathleen K. Christians MD Professor in the Surgery department at Medical College of WisconsinCallisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Antineoplastic Combined Chemotherapy ProtocolsChemotherapy, Cancer, Regional Perfusion
Colorectal Neoplasms
Combined Modality Therapy
Cytoreduction Surgical Procedures
Humans
Hyperthermia, Induced
Peritoneal Neoplasms
Retrospective Studies
Survival Rate
