nach oben

Erschienen in:

01.01.2015 | Original Article

Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC)

verfasst von: Mariangela Desantis, Jean-Louis Bernard, Vincent Casanova, Marianne Cegarra-Escolano, Emmanuel Benizri, Amine M. Rahili, Daniel Benchimol, Jean-Marc Bereder

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 1/2015

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a novel curative treatment option for selected patients with peritoneal carcinomatosis (PC). We aimed to report the mortality rate and the most frequent grade III–IV adverse events and to identify associated prognostic markers. We report oncological outcomes and major prognostic factors influencing overall survival (OS) and disease-free survival.

Methods

A total of 401 CRS plus HIPEC procedures were performed on 356 patients. Mortality, grade III–IV adverse events, OS, disease-free survival, and prognostic factors were studied.

Results

Based on Common Terminology Criteria for Adverse Events (CTCAE of the National Cancer Institute 2006), mortality rate was 1 % and overall rate of morbidity grade III–IV was 12.5 %. In multivariate analysis, only the number of digestive anastomoses (>1) significantly correlated with adverse events with an odds ratio of 2.8 (p = 0.032). OS was related to histological type of PC, with a median survival reaching 47.6 months for PC of ovarian cancer origin, 45.8 months for that of colorectal origin, 64.2 months for peritoneal mesothelioma, and 8.1 months for PC of gastric cancer origin. Over half the patients with pseudomyxoma are still alive. Major prognostic factors influencing survival were histological type, World Health Organization performance status (WHO PS) (hazard ratio (HR) = 3.56), operating time (HR = 0.45), previous chemotherapy (HR = 2.04), number of peritonectomies (HR = 2.03), and completeness of cytoreduction score (HR = 3.12). Disease-free survival across all groups was 16.8 months.

Conclusion

The low mortality rate and 12.5 % grade III–IV morbidity of CRS and HIPEC are acceptable when weighed against overall oncologic survival. This multimodal treatment appears feasible for selected patients and trained centers.

Deraco M et al (2011) Advanced cytoreduction as surgical standard of care and hyperthermic intraperitoneal chemotherapy as promising treatment in epithelial ovarian cancer. Eur J Surg Oncol 37(1):4–9PubMedCrossRef

Gusani NJ et al (2008) Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center. Ann Surg Oncol 15(3):754–763PubMedCrossRef

Sugarbaker PH et al (1989) Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Semin Oncol 16(4 Suppl 6):83–97PubMed

Stephens AD et al (1999) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 6(8):790–796PubMedCrossRef

de Bree E et al (2006) Preoperative computed tomography and selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 32(1):65–71PubMedCrossRef

Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221(1):29–42PubMedCentralPubMedCrossRef

Sugarbaker PH (2003) Peritonectomy procedures. Surg Oncol Clin N Am 12(3):703–727, xiiiPubMedCrossRef

Sugarbaker PH et al (2006) Comprehensive management of diffuse malignant peritoneal mesothelioma. Eur J Surg Oncol 32(6):686–691PubMedCrossRef

Baratti D, Kusamura S, Deraco M (2008) The Fifth International Workshop on Peritoneal Surface Malignancy (Milan, Italy, December 4–6, 2006): methodology of disease-specific consensus. J Surg Oncol 98(4):258–262PubMedCrossRef

10.

Stuart OA et al (2002) Safety monitoring of the coliseum technique for heated intraoperative intraperitoneal chemotherapy with mitomycin C. Ann Surg Oncol 9(2):186–191PubMedCrossRef

11.

Sugarbaker PH, et al. (2011) Impact of surgical and clinical factors on the pharmacology of intraperitoneal doxorubicin in 145 patients with peritoneal carcinomatosis. Eur J Surg Oncol

12.

Glehen O et al (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10(8):863–869PubMedCrossRef

13.

Kusamura S et al (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 106(5):1144–1153PubMedCrossRef

14.

Levine EA et al (2007) Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. J Am Coll Surg 204(5):943–953, discussion 953–5PubMedCrossRef

15.

Kusamura S et al (2007) Incidence of postoperative pancreatic fistula and hyperamylasemia after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 14(12):3443–3452PubMedCrossRef

16.

Cavaliere F et al (2011) Prognostic factors and oncologic outcome in 146 patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: Italian multicenter study S.I.T.I.L.O. Eur J Surg Oncol 37(2):148–154PubMedCrossRef

17.

Feldman AL et al (2003) Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. J Clin Oncol 21(24):4560–4567PubMedCrossRef

18.

Deraco M et al (2006) Prognostic analysis of clinicopathologic factors in 49 patients with diffuse malignant peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Ann Surg Oncol 13(2):229–237PubMedCrossRef

19.

Hall JJ et al (2004) Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for advanced gastric cancer. J Gastrointest Surg 8(4):454–463PubMedCrossRef

20.

Elias D et al (2010) Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 28(1):63–68PubMedCrossRef

21.

Verwaal VJ et al (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21(20):3737–3743PubMedCrossRef

22.

Hagendoorn J et al (2009) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal and gastrointestinal origin shows acceptable morbidity and high survival. Eur J Surg Oncol 35(8):833–837PubMedCrossRef

23.

Glockzin G, Schlitt HJ, Piso P (2009) Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Surg Oncol 7:5PubMedCentralPubMedCrossRef

24.

Pomel C et al (2010) Hyperthermic intra-peritoneal chemotherapy using oxaliplatin as consolidation therapy for advanced epithelial ovarian carcinoma. Results of a phase II prospective multicentre trial. CHIPOVAC study. Eur J Surg Oncol 36(6):589–593PubMedCrossRef

25.

Quenet F et al (2011) Results of two bi-institutional prospective studies using intraperitoneal oxaliplatin with or without irinotecan during HIPEC after cytoreductive surgery for colorectal carcinomatosis. Ann Surg 254(2):294–301PubMedCrossRef

26.

Raft J et al (2010) Impact of the hyperthermic intraperitoneal chemotherapy on the fluid-electrolytes changes and on the acid-base balance. Ann Fr Anesth Reanim 29(10):676–681PubMedCrossRef

27.

Ceelen WP et al (2008) Safety and efficacy of hyperthermic intraperitoneal chemoperfusion with high-dose oxaliplatin in patients with peritoneal carcinomatosis. Ann Surg Oncol 15(2):535–541PubMedCrossRef

28.

Sugarbaker PH et al (2006) Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol 13(5):635–644PubMedCrossRef

29.

Hansson J et al (2009) Postoperative adverse events and long-term survival after cytoreductive surgery and intraperitoneal chemotherapy. Eur J Surg Oncol 35(2):202–208PubMedCrossRef

30.

Franko J et al (2008) Multivisceral resection does not affect morbidity and survival after cytoreductive surgery and chemoperfusion for carcinomatosis from colorectal cancer. Ann Surg Oncol 15(11):3065–3072PubMedCrossRef

31.

Elias D et al (2006) Treatment of synchronous peritoneal carcinomatosis and liver metastases from colorectal cancer. Eur J Surg Oncol 32(6):632–636PubMedCrossRef

32.

Cotte E et al (2010) Selection of patients and staging of peritoneal surface malignancies. World J Gastrointest Oncol 2(1):31–35PubMedCentralPubMedCrossRef

33.

Sugarbaker PH (1994) Dissection by electrocautery with a ball tip. J Surg Oncol 56(4):246–248PubMedCrossRef

34.

Smeenk RM, Verwaal VJ, Zoetmulder FA (2007) Learning curve of combined mortality treatment in peritoneal surface disease. Br J Surg 94:1408–1414PubMedCrossRef

35.

Levine EA, Stewart JH, Russel G et al (2007) Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. J Am Coll Surg 204:943–953, discussion 953–955PubMedCrossRef

36.

Bilimoria KY, Bentren DJ, Fienglass JM et al (2008) Directing surgical quality improvement initiatives: comparison of perioperative mortality and long-term survival for cancer surgery. J Clin Oncol 26:4626–4633PubMedCrossRef

37.

Glehen O et al (2010) Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients. Cancer 116(24):5608–5618PubMedCrossRef

38.

Saxena A, Yan TD, Morris DL (2010) Critical assessment of preoperative and operative risk factors for complications after iterative peritonectomy procedures. Eur J Surg Oncol 36(3):309–314PubMedCrossRef

39.

Elias D et al (2009) "Natural history" of complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 35(4):434–438PubMedCrossRef

40.

Elias D, Lefevre J, Chevalier J et al (2009) Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol 27:681–685PubMedCrossRef

Titel: Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC)
verfasst von: Mariangela Desantis
Jean-Louis Bernard
Vincent Casanova
Marianne Cegarra-Escolano
Emmanuel Benizri
Amine M. Rahili
Daniel Benchimol
Jean-Marc Bereder
Publikationsdatum: 01.01.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 1/2015
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1253-z

Neu im Fachgebiet Chirurgie

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC)