Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Our plain-English summary of Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, by G. Glockzin, H.J. Schlitt, P. Piso (World Journal of Surgical Oncology, 2009).

The study

• Authors: G. Glockzin, H.J. Schlitt, P. Piso
• Journal: World Journal of Surgical Oncology
• Published: 2009;7:5
• Type of article: Review
• Cited by: 125 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Peritoneal tumor dissemination arising from colorectal cancer, appendiceal cancer, gastric cancer, gynecologic malignancies or peritoneal mesothelioma is a common sign of advanced tumor stage or disease recurrence and mostly associated with poor prognosis.

Methods And Results: In the present review article preoperative workup, surgical technique, postoperative morbidity and mortality rates, oncological outcome and quality of life after CRS and HIPEC are reported regarding the different tumor entities.

Conclusion: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) provide a promising combined treatment strategy for selected patients with peritoneal carcinomatosis that can improve patient survival and quality of life. The extent of intraperitoneal tumor dissemination and the completeness of cytoreduction are the leading predictors of postoperative patient outcome. Thus, consistent preoperative diagnostics and patient selection are crucial to obtain a complete macroscopic cytoreduction (CCR-0/1).

In plain English

This article was a review by surgeons at the University of Regensburg Medical Center, Germany, of published studies on cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), in which heated chemotherapy is circulated through the abdomen. The treatment was for cancer spread across the abdominal lining (peritoneal carcinomatosis) from colorectal, appendiceal, gastric and ovarian cancer and from diffuse malignant peritoneal mesothelioma (DMPM). It reported no new patient data and did not discuss asbestos. The authors cited published complication rates of 25% to 41% and death rates of 0% to 8%. For DMPM, they cited a systematic review by Yan et al. of seven studies. In those studies median survival ranged between 34 and 92 months and 5-year survival between 33% and 59%, and survival was better than in historical controls. The authors concluded that the treatment was a promising option for highly selected patients and that how completely the tumor was removed played a pivotal role in long-term survival. They noted that complications were not recorded in a standardized way and that randomized trials were lacking for most cancer types.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published studies (narrative review; no new patient data)
• Who was studied: Patients described in published studies who had peritoneal carcinomatosis arising from colorectal, appendiceal, gastric or gynecologic cancers, or who had peritoneal mesothelioma (diffuse malignant peritoneal mesothelioma, DMPM)
• Exposure: Not addressed. The article does not discuss asbestos or any fiber exposure. It reviews a treatment, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
• Main results:
  • Across the published literature the authors reviewed, complication (morbidity) rates after CRS and HIPEC ranged from 25% to 41%, and death (mortality) rates from 0% to 8%
  • In the seven DMPM studies covered by a systematic review by Yan et al., median survival ranged between 34 and 92 months and 5-year survival rates between 33% and 59%
  • All of those DMPM studies showed a significant improvement in survival compared with historical controls
  • In a prospective study by Yan et al. of 70 patients with DMPM, the grade III and grade IV complication rates were 27% and 14%, and the perioperative mortality rate was 3%
  • The authors stated that staging laparoscopy should not be done in patients with DMPM because of a high risk of tumor spread at the instrument entry (port) site
  • In a randomized trial of colorectal cancer reported by Verwaal et al., disease-specific survival was 22.2 months with added CRS and HIPEC versus 12.6 months with standard systemic treatment
  • The authors stated that the completeness of cytoreduction (how fully visible tumor was removed) plays a pivotal role in long-term survival
  • Regarding quality of life, the authors summarized that functional status returned to baseline in most patients during the first 4 months after surgery
• The authors' conclusion: The authors concluded that CRS and HIPEC provide a promising therapeutic option for highly selected patients with peritoneal carcinomatosis from cancers including colorectal, gastric and ovarian cancer and peritoneal mesothelioma
• Limitations the authors state:
  • The assessment of complications (morbidity) in existing studies is not standardized and is therefore often not comparable
  • For most tumor types, prospective randomized controlled trials comparing the best available therapy with and without CRS and HIPEC are still not available

Topics

Medical terms in this study, explained in our Lexicon: Quality of Life, Cytoreductive Surgery, HIPEC, Colorectal Cancer, Stomach Cancer, Peritoneal Mesothelioma, Prognosis.

Related studies

• Impact of Major Complications on Patients' Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — T.D. Hamilton, E.L. Taylor, et al. (2016)
• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Repeated cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with recurrent peritoneal carcinomatosis — N. Vassos, T. Förtsch, et al. (2016)
• Clinical course for patients with peritoneal carcinomatosis excluded from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — A.P. Rodt, R.O. Svarrer, et al. (2013)

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