Over the past several years, there has been significant progress in the treatment of cancers that are spread within the peritoneal cavity. There is substantial clinical evidence and consensus that Cytoreductive Surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the preferred treatment for colorectal and, more recently, ovarian cancer patients. Below are three notable papers that support the use of HIPEC in peritoneal cancer treatment.
CRS and HIPEC Outcomes
Cytoreduction and HIPEC in The Netherlands: Nationwide Long-term Outcome Following the Dutch Protocol. Annals of Surgical Oncology (2013) DOI 10.1245/s10434-013-3145-9
Anke M. J. Kuijpers, MD, Boj Mirck, MD, Arend G. J. Aalbers, MD, Simon W. Nienhuijs, MD, PhD ,Ignace H. J. T. de Hingh, MD, PhD, Martinus J. Wiezer, MD, PhD, Bert van Ramshorst, MD, PhD, Robert J. van Ginkel, MD, PhD, Klaas Havenga, MD, PhD, Andreas J. Bremers, MD, PhD, Johannes H. W. de Wilt, MD, PhD , Elisabeth A. te Velde, MD, PhD, and Vic J. Verwaal, MD, PhD
This nationwide study evaluated results of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis of colorectal origin in the Netherlands following a national protocol.
Methods. In a multi-institutional study prospective databases of patients with peritoneal carcinomatosis (PC) from colorectal cancer and pseudomyxoma peritonei (PMP) treated according to the Dutch HIPEC protocol, a uniform approach for the CRS and HIPEC treatment, were reviewed. Primary end point was overall survival and secondary end points were surgical outcome and progression- free survival.
Nine-hundred sixty patients were included; 660 patients (69 %) were affected by PC of colorectal carcinoma and the remaining suffered from PMP (31 %). In 767 procedures (80 %), macroscopic complete cytoreduction was achieved. Three-hundred and thirty-one patients had grade III–V complications (34 %). Thirty-two patients died perioperatively (3 %). Median length of hospital stay was 16 days (range 0–166 days). Median follow-up period was 41 months (95 % confidence interval (CI), 36–46 months). Median progression-free survival was 15 months (95 % CI13–17 months) for CRC patients and 53 months (95 % CI40–66 months) for PMP patients. Overall me dian survival was 33 (95 % CI 28–38 months) months for CRC patients and 130 months (95 % CI 98–162 months) for PMP patients. Three-and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in cases of PMP patients.
The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP. It is assumed the uniform Dutch HIPEC protocol was beneficial.Read Full Article
CRS and HIPEC Consensus Statement – Society of Surgical Oncology
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Management of Peritoneal Surface Malignancies of Colonic Origin: A Consensus Statement. Annals of Surgical Oncology (2007) DOI: 10.1245/s10434-006-9185-7
J. Esquivel, R. Sticca, P. Sugarbaker, E. Levine, T. D. Yan, R. Alexander, D. Baratti, D. Bartlett, R. Barone, P. Barrios, S. Bieligk, P. Bretcha-Boix, C. K. Chang, F. Chu, Q. Chu, S. Daniel, E. deBree, M. Deraco, L. Dominguez-Parra, D. Elias,R. Flynn, J. Foster, A. Garofalo, F. N. Gilly, O. Glehen, A. Gomez-Portilla, L. Gonzalez-Bayon, S. Gonzalez-Moreno, M. Goodman, V. Gushchin, N. Hanna, J. Hartmann, L. Harrison, R. Hoefer, J. Kane, D. Kecmanovic, S. Kelley, J. Kuhn, J. LaMont, J. Lange, B. Li, B. Loggie, H. Mahteme, G. Mann, R. Martin, R. A. Misih, B. Moran, D. Morris, L. Onate-Ocana, N. Petrelli, G. Philippe, J. Pingpank, A. Pitroff, P. Piso, M. Quinones,L. Riley, L. Rutstein, S. Saha, S. Alrawi, A. Sardi, S. Schneebaum, P. Shen, D. Shibata, J. Spellman, A. Stojadinovic, J. Stewart, J. Torres-Melero, T. Tuttle, V. Verwaal, J. Villar, N. Wilkinson, R. Younan, H. Zeh, F. Zoetmulder, and G. Sebbag.
The surgical management of peritoneal surface malignancies of colonic origin with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) has been clearly defined and continues to improve. Better surgical techniques that include peritonectomy procedures, standardized methods to deliver intraoperative hyperthermic intraperitoneal chemotherapy and better patient selection criteria, have resulted in a significant improvement in survival and in morbidity and mortality of the surgical management of this particular group of stage IV colon cancer patients.