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      Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases From a Small Bowel Adenocarcinoma: Multi-Institutional Experience

      , MD 1 , 2 , , MD, PhD , 1 , 2 , 3 , , MD, PhD 4 , , MD, PhD 5 , , MD, PhD 6 , , MD, PhD 6 , , MD, PhD 7 , , MD, FACS, FRCS 8 , , MD, PhD 9 , , MD, PhD 10 , , MD, PhD 11 , , MD, PhD 12 , , MD, PhD 13 , , MD, PhD 14 , , MD, PhD 15 , , MD, PhD 16 , , MD, PhD 17 , , MD, PhD 17 , , MD, PhD 18 , , MD, PhD 19 , , MD, PhD 20 , The BIG-RENAPE Group

      Annals of Surgical Oncology

      Springer International Publishing

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          Abstract

          Background

          The multi-institutional registry in this study evaluated the outcome after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal metastases (PM) from small bowel adenocarcinoma (SBA).

          Methods

          A multi-institutional data registry including 152 patients with PM from SBA was established. The primary end point was overall survival (OS) after CRS plus HIPEC.

          Results

          Between 1989 and 2016, 152 patients from 21 institutions received a treatment of CRS plus HIPEC. The median follow-up period was 20 months (range 1–100 months). Of the 152 patients, 70 (46.1%) were women with a median age of 54 years. The median peritoneal cancer index (PCI) was 10 (mean 12; range 1–33). Completeness of cytoreduction (CCR) 0 or 1 was achieved for 134 patients (88.2%). After CRS and HIPEC, the median OS was 32 months (range 1–100 months), with survival rates of 83.2% at 1 year, 46.4% at 3 years, and 30.8% at 5 years. The median disease-free survival after CCR 0/1 was 14 months (range 1–100 months). The treatment-related mortality rate was 2%, and 29 patients (19.1%) experienced grades 3 or 4 operative complications. The period between detection of PM and CRS plus HIPEC was 6 months or less ( P = 0.008), and multivariate analysis identified absence of lymph node metastasis ( P = 0.037), well-differentiated tumor ( P = 0.028), and PCI of 15 or lower ( P = 0.003) as independently associated with improved OS.

          Conclusion

          The combined treatment strategy of CRS plus HIPEC achieved prolonged survival for selected patients who had PM from SBA with acceptable morbidity and mortality.

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          Most cited references 17

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          Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study.

          PURPOSE Peritoneal carcinomatosis (PC) from colorectal cancer traditionally is considered a terminal condition. Approaches that combine cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) have been developed recently. The purpose of this study was to assess early and long-term survival in patients treated with that strategy. PATIENTS AND METHODS A retrospective-cohort, multicentric study from French-speaking countries was performed. All consecutive patients with PC from colorectal cancer who were treated with CRS and PIC (with or without hyperthermia) were included. Patients with PC of appendiceal origin were excluded. Results The study included 523 patients from 23 centers in four French-speaking countries who underwent operation between 1990 and 2007. The median follow-up was 45 months. Mortality and grades 3 to 4 morbidity at 30 days were 3% and 31%, respectively. Overall median survival was 30.1 months. Five-year overall survival was 27%, and five-year disease-free survival was 10%. Complete CRS was performed in 84% of the patients, and median survival was 33 months. Positive independent prognostic factors identified in the multivariate analysis were complete CRS, PC that was limited in extent, no invaded lymph nodes, and the use of adjuvant chemotherapy. Neither the grade of disease nor the presence of liver metastases had a significant prognostic impact. CONCLUSION This combined treatment approach against PC achieved low postoperative morbidity and mortality, and it provided good long-term survival in patients with peritoneal scores lower than 20. These results should improve in the future, because the different teams involved will gain experience. This approach, when feasible, is now considered the gold standard in the French guidelines.
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              Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience.

              This multi-institutional registry study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM). A multi-institutional data registry that included 405 patients with DMPM treated by a uniform approach that used CRS and HIPEC was established. The primary end point was overall survival. The secondary end point was evaluation of prognostic variables for overall survival. Follow-up was complete in 401 patients (99%). The median follow-up period for the patients who were alive was 33 months (range, 1 to 235 months). The mean age was 50 years (standard deviation [SD], 14 years). Three hundred eighteen patients (79%) had epithelial tumors. Twenty-five patients (6%) had positive lymph nodes. The mean peritoneal cancer index was 20. One hundred eighty-seven patients (46%) had complete or near-complete cytoreduction. Three hundred seventy-two patients (92%) received HIPEC. One hundred twenty-seven patients (31%) had grades 3 to 4 complications. Nine patients (2%) died perioperatively. The mean length of hospital stay was 22 days (SD, 15 days). The overall median survival was 53 months (1 to 235 months), and 3- and 5-year survival rates were 60% and 47%, respectively. Four prognostic factors were independently associated with improved survival in the multivariate analysis: epithelial subtype (P < .001), absence of lymph node metastasis (P < .001), completeness of cytoreduction scores of CC-0 or CC-1 (P < .001), and HIPEC (P = .002). The data suggest that CRS combined with HIPEC achieved prolonged survival in selected patients with DMPM.
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                Author and article information

                Contributors
                +81-072-445-9915 , y.yonemura@coda.ocn.ne.jp
                Journal
                Ann Surg Oncol
                Ann. Surg. Oncol
                Annals of Surgical Oncology
                Springer International Publishing (Cham )
                1068-9265
                1534-4681
                26 February 2018
                26 February 2018
                2018
                : 25
                : 5
                : 1184-1192
                Affiliations
                [1 ]NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Japan
                [2 ]ISNI 0000 0004 0377 9910, GRID grid.415384.f, Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, ; Osaka, Japan
                [3 ]Peritoneal Dissemination Center, Kusatsu General Hospital, Shiga, Japan
                [4 ]ISNI 0000 0004 0459 1231, GRID grid.412860.9, Wake Forest University Baptist Medical Center, ; Winston-Salem, NC USA
                [5 ]Centre Hospitalo-Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre, France
                [6 ]ISNI 0000 0001 2284 9388, GRID grid.14925.3b, Institut Gustave Roussy Cancer Center, ; Villejuif, France
                [7 ]University of New South Wales, St George Hospital, Sydney, Australia
                [8 ]ISNI 0000 0000 8585 5745, GRID grid.415235.4, Washington Cancer Institute, , Washington Hospital Center, ; Washington DC, USA
                [9 ]Centre Hospitalier de Rouen, Rouen, France
                [10 ]ISNI 0000 0004 1936 9457, GRID grid.8993.b, Department of Surgical Sciences, Colorectal Surgery, , Uppsala University, ; Uppsala, Sweden
                [11 ]Department of Surgical Oncology, Metaxa Cancer Memorial Hospital, Pireus, Greece
                [12 ]ISNI 0000 0004 0398 8384, GRID grid.413532.2, Catharina Hospital, ; Eindhoven, The Netherlands
                [13 ]ISNI 0000 0004 0626 3303, GRID grid.410566.0, Department of Gastrointestinal Surgery, , Ghent University Hospital, ; Ghent, Belgium
                [14 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, Division of Surgical Oncology of Moores Cancer Center, , University of California San Diego, ; San Diego, USA
                [15 ]Krankenhaus Barmherzige Brueder Regensburg, Regensburg, Germany
                [16 ]ISNI 0000 0001 0692 8246, GRID grid.163577.1, Cancer Care Promotion Center, Medical School Hospital, , University of Fukui, ; Fukui, Japan
                [17 ]ISNI 0000 0001 0807 2568, GRID grid.417893.0, Department of Surgery, , National Cancer Institute, ; Milan, Italy
                [18 ]ISNI 0000 0000 9725 279X, GRID grid.411296.9, Hopital Lariboisière, Assistance Publique Hôpitaux de Paris, ; Paris, France
                [19 ]ISNI 0000 0001 2175 1768, GRID grid.418189.d, Centre Val D’Aurelle, ; Montpellier, France
                [20 ]ISNI 0000 0001 2308 3329, GRID grid.9707.9, Department of Surgery, Kanazawa University Hospital, , Kanazawa University, ; Kanazawa, Japan
                Article
                6369
                10.1245/s10434-018-6369-x
                5891561
                29484565
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                Gastrointestinal Oncology
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                © Society of Surgical Oncology 2018

                Oncology & Radiotherapy

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