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Erschienen in: Updates in Surgery 1/2020

15.11.2019 | Original Article

Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy used as treatment of colo-rectal carcinomatosis: a multicentric study

verfasst von: Antonio Macrì, Vincenzo Arcoraci, Valerio Belgrano, Marina Caldana, Ludovica Carbonari, Tommaso Cioppa, Franco De Cian, Giovanni De Manzoni, Michele De Simone, Claudia Giardina, Francesca Muffatti, Elena Orsenigo, Manuela Robella, Franco Roviello, Edoardo Saladino, Paolo Sammartino, Marco Vaira

Erschienen in: Updates in Surgery | Ausgabe 1/2020

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Abstract

The aim of this study is to assess the morbidity and mortality related to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colo-rectal carcinomatosis. A retrospective multi-institutional study from seven Italian Centers was performed. One hundred and seventy-two patients, submitted to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) to treat carcinomatosis of colorectal origin, were recorded. Postoperative morbidity was evaluated in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Post-operative mortality was evaluated as patients’ death within 60 days from surgical procedures. Predictors of morbidity were evaluated with univariate and multivariate analyses. Post-operative morbidity occurred in 83 patients (48.3%): grades 1–2 in 29 cases (16.9%), and grades 3–4 in 54 (31.4%). Mortality occurred in four cases (2.3%). Number of anastomoses (OR 1.45; 95% CI 1.05–2.00; p = 0.024), number of blood transfusions (OR 1.31; 95% CI 1.11–1.54; p = 0.001) and chemotherapy regimen [Oxaliplatin (OX): OR 2.87; 95% CI 1.22–6.75; p = 0.015] remained, in multivariate analysis, in a statistically significant correlation with overall morbidity. The only variable that was proven to have statistically significant correlation with 3–4 morbidity was the number of blood transfusions (OR 1.25; 95% CI 1.07–1.46; p = 0.005). Morbidity and mortality do not preclude the use of CRS plus HIPEC in the treatment of peritoneal carcinomatosis of colorectal origin.
Literatur
4.
Zurück zum Zitat Dawson LE, Russell AH, Tong D, Wisbeck WM (1983) Adenocarcinoma of the sigmoid colon: sites of initial dissemination and clinical patterns of recurrence following surgery alone. J Surg Oncol 22:95–99CrossRef Dawson LE, Russell AH, Tong D, Wisbeck WM (1983) Adenocarcinoma of the sigmoid colon: sites of initial dissemination and clinical patterns of recurrence following surgery alone. J Surg Oncol 22:95–99CrossRef
5.
Zurück zum Zitat Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC (1989) Peritoneal carcinomatosis in nongynecologic malignancy. a prospective study of prognostic factors. Cancer 63:364–367CrossRef Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC (1989) Peritoneal carcinomatosis in nongynecologic malignancy. a prospective study of prognostic factors. Cancer 63:364–367CrossRef
6.
Zurück zum Zitat Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Porcheron J, Peix JL, François Y, Vignal J, Gilly FN (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363CrossRef Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Porcheron J, Peix JL, François Y, Vignal J, Gilly FN (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363CrossRef
7.
Zurück zum Zitat Glehen O, Osinsky D, Beaujard AC, Gilly FN (2003) Natural history of peritoneal carcinomatosis from nongynecologic malignancies. Surg Oncol Clin N Am 12:729–739CrossRef Glehen O, Osinsky D, Beaujard AC, Gilly FN (2003) Natural history of peritoneal carcinomatosis from nongynecologic malignancies. Surg Oncol Clin N Am 12:729–739CrossRef
9.
Zurück zum Zitat Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP (2006) Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg 243:212–222CrossRef Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP (2006) Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg 243:212–222CrossRef
10.
Zurück zum Zitat Yan TD, Morris DL, Shigeki K, Dario B, Marcello D (2008) Preoperative investigations in the management of peritoneal surface malignancy with cytoreductive surgery and peri-operative intraperitoneal chemotherapy: expert consensus statement. J Surg Oncol 98:224–227. https://doi.org/10.1002/jso.21069 CrossRefPubMed Yan TD, Morris DL, Shigeki K, Dario B, Marcello D (2008) Preoperative investigations in the management of peritoneal surface malignancy with cytoreductive surgery and peri-operative intraperitoneal chemotherapy: expert consensus statement. J Surg Oncol 98:224–227. https://​doi.​org/​10.​1002/​jso.​21069 CrossRefPubMed
12.
Zurück zum Zitat Sugarbaker PH (1998) Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 14:254–261CrossRef Sugarbaker PH (1998) Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 14:254–261CrossRef
13.
Zurück zum Zitat Sugarbaker PH (1999) Management of peritoneal surface malignancy: the surgeon’s role. Langenbecks Arch Surg 384:576–587CrossRef Sugarbaker PH (1999) Management of peritoneal surface malignancy: the surgeon’s role. Langenbecks Arch Surg 384:576–587CrossRef
14.
Zurück zum Zitat Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, Zoetmulder FA (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 21:3737–3743CrossRef Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, Zoetmulder FA (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 21:3737–3743CrossRef
15.
Zurück zum Zitat Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, Barone R, Yonemura Y, Cavaliere F, Quenet F, Gutman M, Tentes AA, Lorimier G, Bernard JL, Bereder JM, Porcheron J, Gomez-Portilla A, Shen P, Deraco M, Rat P (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi- institutional study. J Clin Oncol 22:3284–3292CrossRef Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, Barone R, Yonemura Y, Cavaliere F, Quenet F, Gutman M, Tentes AA, Lorimier G, Bernard JL, Bereder JM, Porcheron J, Gomez-Portilla A, Shen P, Deraco M, Rat P (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi- institutional study. J Clin Oncol 22:3284–3292CrossRef
16.
Zurück zum Zitat Macrì A, Maugeri I, Trimarchi G, Caminiti R, Saffioti MC, Incardona S, Sinardi A, Irato S, Altavilla G, Adamo V, Versaci A, Famulari C (2009) Evaluation of quality of life of patients submitted to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinosis of gastrointestinal and ovarian origin and identification of factors influencing outcome. Vivo 23(1):147–150 Macrì A, Maugeri I, Trimarchi G, Caminiti R, Saffioti MC, Incardona S, Sinardi A, Irato S, Altavilla G, Adamo V, Versaci A, Famulari C (2009) Evaluation of quality of life of patients submitted to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinosis of gastrointestinal and ovarian origin and identification of factors influencing outcome. Vivo 23(1):147–150
18.
Zurück zum Zitat Macrì A, Saladino E, Trimarchi G, Bartolo V, Rossitto M, Cannaò A, Rizzo A, Famulari C (2011) Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in elderly patients. Vivo 25(4):687–690 Macrì A, Saladino E, Trimarchi G, Bartolo V, Rossitto M, Cannaò A, Rizzo A, Famulari C (2011) Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in elderly patients. Vivo 25(4):687–690
20.
Zurück zum Zitat Macrì A, Arcoraci V, Belgrano V, Caldana M, Cioppa T, Costantini B, Cucinotta E, De Cian F, De Iaco P, De Manzoni G, Di Giorgio A, Fleres F, Muffatti F, Orsenigo E, Pinna AD, Roviello F, Sammartino P, Scambia G, Saladino E (2014) Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: preliminary analysis of a multicentre study. Anticancer Res 34:5689–5693PubMed Macrì A, Arcoraci V, Belgrano V, Caldana M, Cioppa T, Costantini B, Cucinotta E, De Cian F, De Iaco P, De Manzoni G, Di Giorgio A, Fleres F, Muffatti F, Orsenigo E, Pinna AD, Roviello F, Sammartino P, Scambia G, Saladino E (2014) Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: preliminary analysis of a multicentre study. Anticancer Res 34:5689–5693PubMed
22.
Zurück zum Zitat Jaquet P, Sugarbaker (1996) Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res 15:49–58 Jaquet P, Sugarbaker (1996) Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res 15:49–58
26.
Zurück zum Zitat Saladino E, Fleres F, Mazzeo C, Pruiti V, Scollica M, Rossitto M, Cucinotta E, Macrì A (2014) The role of prophylactic hyperthermic intraperitoneal chemotherapy in the management of serosal involved gastric cancer. Anticancer Res 34(4):2019–2022PubMed Saladino E, Fleres F, Mazzeo C, Pruiti V, Scollica M, Rossitto M, Cucinotta E, Macrì A (2014) The role of prophylactic hyperthermic intraperitoneal chemotherapy in the management of serosal involved gastric cancer. Anticancer Res 34(4):2019–2022PubMed
27.
Zurück zum Zitat Kusamura S, Younan R, Costanzo Baratti D, Favaro PM, Gavazzi C, Deraco M (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 106:1144–1153CrossRef Kusamura S, Younan R, Costanzo Baratti D, Favaro PM, Gavazzi C, Deraco M (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 106:1144–1153CrossRef
28.
Zurück zum Zitat Glehen O, Osinsky D, Cotte E, Kwiatkowski F, Freyer G, Isaac S, Trillet-Lenoir V, Sayag-Beaujard AC, François Y, Vignal J, Gilly FN (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of periotneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10:863–869CrossRef Glehen O, Osinsky D, Cotte E, Kwiatkowski F, Freyer G, Isaac S, Trillet-Lenoir V, Sayag-Beaujard AC, François Y, Vignal J, Gilly FN (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of periotneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10:863–869CrossRef
32.
Zurück zum Zitat Di Giorgio A, De Iaco P, De Simone M, Garofalo A, Scambia G, Pinna AD, Verdecchia GM, Ansaloni L, Macrì A, Cappellini P, Ceriani V, Giorda G, Biacchi D, Vaira M, Valle M, Sammartino P (2017) Cytoreduction (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer: retrospective Italian multicenter observational study of 511 cases. Ann Surg Oncol 24(4):914–922. https://doi.org/10.1245/s10434-016-5686-1 CrossRefPubMed Di Giorgio A, De Iaco P, De Simone M, Garofalo A, Scambia G, Pinna AD, Verdecchia GM, Ansaloni L, Macrì A, Cappellini P, Ceriani V, Giorda G, Biacchi D, Vaira M, Valle M, Sammartino P (2017) Cytoreduction (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer: retrospective Italian multicenter observational study of 511 cases. Ann Surg Oncol 24(4):914–922. https://​doi.​org/​10.​1245/​s10434-016-5686-1 CrossRefPubMed
33.
Zurück zum Zitat Smeenk RM, Verwaal VJ, Zoetmulder FA (2007) Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg 94:1408–1414CrossRef Smeenk RM, Verwaal VJ, Zoetmulder FA (2007) Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg 94:1408–1414CrossRef
Metadaten
Titel
Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy used as treatment of colo-rectal carcinomatosis: a multicentric study
verfasst von
Antonio Macrì
Vincenzo Arcoraci
Valerio Belgrano
Marina Caldana
Ludovica Carbonari
Tommaso Cioppa
Franco De Cian
Giovanni De Manzoni
Michele De Simone
Claudia Giardina
Francesca Muffatti
Elena Orsenigo
Manuela Robella
Franco Roviello
Edoardo Saladino
Paolo Sammartino
Marco Vaira
Publikationsdatum
15.11.2019
Verlag
Springer International Publishing
Erschienen in
Updates in Surgery / Ausgabe 1/2020
Print ISSN: 2038-131X
Elektronische ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-019-00691-8

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