Ahmet KARAYİĞİT, Hayrettin DİZEN, Ümit ÖZDEMİR, Dursun Burak ÖZDEMİR, İhsan Burak KARAKAYA, İlter OZER, Bülent ÜNAL, Murat ULAŞ

Hyperthermic Intraperitoneal Chemotherapy After Cytoreductive Surgery; Experience and Short Term Outcomes

Background: Cytoreductive surgery + hyperthermic intraperitoneal chemotherapy is an important treatment option in patients with a primary diagnosis of colorectal cancer, ovarian cancer, appendix cancer, gastric cancer(selected cases), malignant peritoneal mesothelioma, and peritoneal pseudomyxoma in the presence of peritoneal involvement and resectable lesions limited to the abdomen. In this study, it was aimed to discuss cytoreductive surgery(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) in the light of literature. Methods: The data of patients who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy between June 2017 and September 2020 at our institution were analyzed. The study was designed retrospectively, and all patients who were discussed at the oncology council and decided on CRS + HIPEC were included in the study. Results: 31 patients were included in the study. Primary diagnoses of the patients were colorectal cancer in 15 (48%), ovarian cancer in 9 (29%), stomach cancer in 3 (10%), mesothelioma in 2 (7%), appendix cancer in 1 (3%), and also peritoneal pseudomyxoma in 1 (3%). Therapeutic HIPEC was performed in 30 patients, and prophylactic HIPEC was performed in 1 patient. Cytoreduction score was 0 in all patients. The median peritoneal cancer index was 15 (7-29). the median number of resected organs was 3(1-6). Stoma formation was performed in 14 patients (45%). During the postoperative 30 days, mortality was observed in 1 patient (3%) and morbidity in 5 patients (16%). Conclusion: The early postoperative mortality and morbidity results reported in our study are compatible with those in the literature.

Keywords:

Peritoneal Carcinomatosis, Cytoreductive Surgery, Hyperthermic Intraperitoneal Chemotherapy.,

PDF

___

1. Topgül K, Çetinkaya MB, Arslan NÇ, Gül MK, Çan M, Gürsel MF, et al. Cytoreductive surgery (SRC) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinomatosis: Our initial experience and technical details. Ulus Cerrahi Derg. 2015;31(3):138-47.
2. Aksel B, Karaman N, Yüksel E, Kahraman YS, Doğan L, Gülçelik MA. Sindirim Sistemi Tümörlerinde Peritonitis Karsinomatoza Ne Kadar Öngörülebilir? Acta Oncol Tur.. 2017; 50(1): 7-11
3. Miura JT, Johnston FM, Gamblin TC, Turaga KK. Current trends in the management of malignant peritoneal mesothelioma. Ann Surg Oncol. 2014;21(12):3947-53.
4. Minareci Y, Sözen H, Tosun ÖA, Çelik E, Çeliksoy HY, Baktiroğlu M, et al. Practice of hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in gynecological cancers: Technical detail and short-term results. Türk Jinekolojik Onkoloji Dergisi.21(2):1-7.
5. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29-42.
6. Hsieh M-C, Lu C-Y, Chang W-W, Wu S-Y, Hsiao P-K, Liu T-J. Experiences with cytoreduction surgery plus hyperthermic intraperitoneal chemotherapy in Taiwan. Medicine. 2017;96(26).
7. Elias D, Goéré D, Dumont F, Honoré C, Dartigues P, Stoclin A, et al. Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases. Eur J Cancer. 2014;50(2):332-40.
8. Arjona-Sanchez A, Esquivel J, Glehen O, Passot G, Turaga K, Labow D, et al. A minimally invasive approach for peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in limited peritoneal carcinomatosis: The American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution analysis. Surg Endosc. 2019;33(3):854-860.
9. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):64955.
10. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359-74.
11. Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-96.
12. Roviello F, Marrelli D, Neri A, Cerretani D, de Manzoni G, Pedrazzani C, et al. treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP): postoperative outcome and risk factors for morbidity. World J Surg. 2006;30(11):2033-40.
13. Cascales-Campos P, López-López V, Torres-Melero J, Arjona A, Muñoz-Casares F, Barrios P, et al. Survival outcomes in patients aged 75 years and over with peritoneal colorectal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): multicenter study of the Spanish Group of Peritoneal Cancer Surgery (GECOP). Clin Transl Oncol. 2020;22(1):130-136.
14. López-López V, Cascales-Campos P, Schneider M, Gil J, Gil E, Gomez-Hidalgo NR, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in elderly patients. A systematic literature review. Surg Oncol. 2016;25(4):378-384.
15. Morano W, Aggarwal A, Love P, Richard S, Esquivel J, Bowne W. Intraperitoneal immunotherapy: historical perspectives and modern therapy. Cancer Gene Ther. 2016;23(11):373-381.
16. Moran B. Decision-making and technical factors account for the learning curve in complex surgery. J Public Health (Oxf). 2006;28(4):375-8.
17. Glehen O, Gilly FN, Arvieux C, Cotte E, Boutitie F, Mansvelt B, et al. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010;17(9):2370-7.
18. Glehen O, Kwiatkowski F, Sugarbaker P, Elias D, Levine E, De Simone M, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22(16):3284-92.
19. Koemans WJ, Lurvink RJ, Grootscholten C, Verhoeven RH, de Hingh IH, van Sandick JW. Synchronous peritoneal metastases of gastric cancer origin: incidence, treatment and survival of a nationwide Dutch cohort. Gastric cancer. 2021:1-10.
20. Gill RS, Al‐Adra DP, Nagendran J, Campbell S, Shi X, Haase E, et al. Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity. J Surg Oncol. 2011;104(6):692-8.
21. Morano WF, Khalili M, Chi DS, Bowne WB, Esquivel J. Clinical studies in CRS and HIPEC: Trials, tribulations, and future directions—Asystematic review. J Surg Oncol. 2018;117(2):245-59.
22. Ceelen W, Demuytere J, de Hingh I. Hyperthermic intraperitoneal chemotherapy: a critical review. Cancers. 2021;13(13):3114.
23. Spiliotis J, Halkia E, Lianos E, Kalantzi N, Grivas A, Efstathiou E, et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol. 2015;22(5):1570-5.
24. Van Driel WJ, Koole SN, Sikorska K, Schagen van Leeuwen JH, Schreuder HW, Hermans RH, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378(3):230-40.
25. Kusamura S, Barretta F, Yonemura Y, Sugarbaker PH, Moran BJ, Levine EA, et al. The Role of Hyperthermic Intraperitoneal Chemotherapy in Pseudomyxoma Peritonei After Cytoreductive Surgery. JAMA Surg. 2021;156(3):e206363.
26. Chua TC, Moran BJ, Sugarbaker PH, Levine EA, Glehen O, Gilly FN, et al. Early-and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449-56.
27. Feldman AL, Libutti SK, Pingpank JF, Bartlett DL, Beresnev TH, Mavroukakis SM, et al. analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. J Clin Oncol . 2003;21(24):4560-7.
28. Chua TC, Yan TD, Morris DL. Outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: the Australian experience. J Surg Oncol. 2009;99(2):109-13.
29. Aksel B, Sahin H, Sari ME. The Effectiveness of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Malignant Peritoneal Mesothelioma: A Tertiary Center Experience. UHOD. 2018;28(1).