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The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy

Published on Sep 1, 2015in Colorectal Disease2.997
· DOI :10.1111/codi.12975
Brendan J Moran Frcsi54
Estimated H-index: 54
,
T. Cecil19
Estimated H-index: 19
+ 3 AuthorsA. K. Venkatasubramaniam2
Estimated H-index: 2
Abstract
Aim The study determined the outcome of 1200 consecutive patients treated for peritoneal malignancy in one surgical unit over a 20-year period. Method A retrospective analysis was conducted of a custom designed prospective database of patients undergoing surgery for peritoneal malignancy since 1994. Patient demographics, tumour type, extent of surgery and outcome were recorded. Results Between 1994 and January 2014 (when the 1200th case had undergone surgery) 2956 patients were referred with a diagnosis of peritoneal malignancy. Pseudomyxoma peritonei of appendiceal origin was the pathology in 956/1200 (79.7%) patients. Other aetiologies included colorectal peritoneal metastases [89/1200 (7.4%)], abdominal mesothelioma [65/1200 (5.4%)] and miscellaneous [90/1200 (7.5%)]. Overall 863/1200 (71.9%) had complete cytoreduction, 294 (24.5%) had maximal tumour debulking and 43 (3.6%) had laparotomy only. The proportion undergoing complete cytoreduction per quartile of 300 patients was 60.7%, 65.0%, 77.0% and 80.3%. Laparotomy and biopsy fell from 6.4% in the first quartile to 2.7%, 1.7% and 1.3% in subsequent quartiles. The 30-day mortality in the four quartiles was 3.0%, 1.0%, 0.7% and 0.7%. The 5-year survival was 84% in the 636 patients with appendix tumours who had complete cytoreduction, 76% in the 38 with abdominal mesothelioma and 44% in the 60 with colorectal peritoneal metastases. Conclusion A centralized approach facilitated high volume experience in a single centre with an increase in the completeness of surgical excision rates and a reduction in mortality and morbidity over time.
  • References (25)
  • Citations (35)
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References25
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#1Edward A. Levine (Wake Forest University)H-Index: 54
#2John H. Stewart (Wake Forest University)H-Index: 30
Last. Konstantinos I. Votanopoulos (Wake Forest University)H-Index: 21
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Background Peritoneal dissemination of abdominal malignancy (carcinomatosis) has a clinical course marked by bowel obstruction and death; it traditionally does not respond well to systemic therapy and has been approached with nihilism. To treat carcinomatosis, we use cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods A prospective database of patients has been maintained since 1992. Patients with biopsy-proven peritoneal surface disease were uniformly eval...
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Surgical resection cures selected patients with colorectal liver or lung metastases, or local recurrence. In contrast, peritoneal spread has been considered inevitably fatal. Emerging evidence suggests, however, that certain patients can now be cured by a combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)1. The concept of operable ‘colorectal peritoneal metastases (CPM)’, as opposed to ‘peritoneal carcinomatosis’, demands clear definition in order to...
15 CitationsSource
BACKGROUND:Pseudomyxoma peritonei is a diffuse peritoneal malignancy that generally originates form a perforated appendiceal tumor. Optimal treatment requires extensive surgical resection to achieve complete cytoreduction combined with hyperthermic intraperitoneal chemotherapy. In a proportion of pa
36 CitationsSource
#2Terence C. ChuaH-Index: 35
Last. Jörg PelzH-Index: 4
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Impact of peritoneal carcinomatosis in the disease history of colorectal cancer management: a longitudinal experience of 2406 patients over two decades
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#1Norman J. CarrH-Index: 8
#2Jenny FinchH-Index: 1
Last. Brendan J Moran FrcsiH-Index: 54
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Aims The classification of abdominal mucinous neoplasia is a controversial area. In 2010, WHO published a classification which divides pseudomyxoma peritonei (PMP) into low and high grades. The aim of the authors was to correlate this classification with the prognosis and site of primary neoplasm. Methods The authors reviewed 274 patients with PMP who had undergone surgery at a single institution and classified them according to WHO criteria. The findings were correlated with clinical informatio...
75 CitationsSource
#1Terence C. Chua (UNSW: University of New South Wales)H-Index: 35
#2Brendan J. Moran (National Health Service)H-Index: 2
Last. David L. Morris (St George's Hospital)H-Index: 65
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BACKGROUND: Pseudomyxoma peritonei syndrome is a clinical entity characterized by mucinous ascites usually originating from a perforated mucinous appendiceal tumor. Currently optimal therapy is considered complete macroscopic tumor removal (complete cytoreduction) combined with heated intraperitoneal chemotherapy. When complete cytoreduction is not achievable, major tumor debulking is undertaken. The long-term follow-up of patients undergoing surgery for perforated appendiceal tumors in a nation...
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#2Tristan D. Yan BSc Mbbs (UNSW: University of New South Wales)H-Index: 50
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Background: This study was undertaken to measure survival of patients with multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy through a multi-institutional collaboration. Methods: A multi-institutional data registry, established by the Peritoneal Surface Oncology Group, was used to identify patients with peritoneal mesothelioma and the subgroup with multicystic tumours, treated by cytoreductive surgery and hyperthermic intraperitone...
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#2François N. Gilly M.D. (Lyon College)H-Index: 3
Last. Dominique Elias (Institut Gustave Roussy)H-Index: 82
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BACKGROUND: Peritoneal carcinomatosis (PC) from nonovarian malignancies long has been regarded as a terminal disease. Over the past decade, new locoregional therapeutic approaches combining cytoreductive surgery with perioperative intraperitoneal chemotherapy (PIC) have evolved that have demonstrated improved survival. METHODS: A retrospective, multicenter cohort study was performed in French-speaking institutions to evaluate toxicity and principal prognostic factors after cytoreductive surgery ...
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#1S. AlvesH-Index: 2
#2F. MohamedH-Index: 9
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Abstract Background Pseudomyxoma peritonei (PMP) is characterized by mucinous ascites, predominantly arising form a perforated tumour of the appendix. This study aimed to assess Health-Related Quality of Life (HRQL) in patients following cytoreductive surgery and intraperitoneal chemotherapy for PMP. Methods Over a one year period, 49 consecutive patients (13 male, 36 females) with a median age of 55 (range 37–81 years) were enrolled. Patients were asked to complete the European Organization for...
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Abstract Background and objectives Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) offers selected patients with peritoneal surface malignancies (PSM) an improved survival. However, a substantial proportion of patients develop peritoneal recurrence. There is limited data on the efficacy of iterative CRS and HIPEC in such patients. This study evaluates the safety, efficacy and outcomes after re-do CRS and HIPEC for PSM at a tertiary institute. Methods Patients u...
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#1Shinichiro Sakata (National Health Service)
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Purpose Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have become standard of care for many peritoneal malignancies in selected patients. Nevertheless, this aggressive treatment strategy is associated with significant major morbidity. The aim of the present study is to analyze the re-operation rate and clinical outcome following CRS and HIPEC.
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Zytoreduktive Chirurgie (CRS) und hypertherme intraperitoneale Chemotherapie (HIPEC) sind fester Bestandteil der Therapie peritonealer Malignome. Eine vollstandige makroskopische Zytoreduktion ist die Grundlage einer erfolgreichen multimodalen Therapie. Der Stellenwert der intraperitonealen Chemotherapie ist weiterhin unklar. Diese Ubersichtsarbeit erklart die Prinzipien und die Bedeutung der HIPEC innerhalb des multimodalen Therapiekonzeptes.
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#1S. Hallam (University of Birmingham)
#2R. Tyler (University of Birmingham)
Last. H. Youssef (University Hospitals Birmingham NHS Foundation Trust)
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#1Lieselotte Lemoine (University of Hasselt)H-Index: 3
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Limburgs Kankerfonds; Agentschap voor Innovatie door Wetenschap en Technologie, Grant/Award Number: 141631; Limburg Sterk Merk
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#1Shili Ning (Dalian Medical University)
#2Yanliang Yang (Dalian Medical University)
Last. Fuwen Luo (Dalian Medical University)H-Index: 6
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Background Pseudomyxoma peritonei (PMP) is a disease involving the peritoneum characterized by the production of large quantities of mucinous ascites. PMP has a low incidence, is difficult to diagnose, and has a guarded prognosis. PMP induced by low-grade appendiceal mucinous neoplasm is extremely rare, and PMP accompanied by rectal cancer is even rarer.
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#1Snita Sinukumar (Jehangir Hospital)H-Index: 4
#2Sanket Mehta (Saifee Hospital)H-Index: 5
Last. Aditi BhattH-Index: 5
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To determine factors influencing failure-to-rescue in patients with complications following cytoreductive surgery and HIPEC. A retrospective analysis of patients enrolled in the Indian HIPEC registry was performed. Complications were graded according to the CTCAE classification version 4.3. The 30- and 90-day morbidity were both recorded. Three hundred seventy-eight patients undergoing CRS with/without HIPEC for peritoneal metastases from various primary sites, between January 2013 and December ...
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#1Pompiliu PisoH-Index: 35
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Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are performed for well-selected patients with peritoneal surface malignancies. This combined treatment is potentially associated with an increased rate of complications.
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