Abstract
Background
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are used in the management of selected peritoneal malignancies. While most patients achieve long-term disease-free survival, there remains a group with early recurrence (ER). We aim to investigate the clinical factors associated with ER.
Methods
A retrospective review of a prospectively maintained database of CRS-HIPEC patients treated between April 2001 and Feb 2016 was performed. ER was defined as recurrence within 12 months of CRS-HIPEC. Patients were stratified according to time to recurrence and only patients with at least 12-month follow-up were included. Perioperative factors were investigated, and subgroup analyses of colorectal, ovarian and appendiceal groups were performed.
Results
Of the 144 patients included, 30.6% were colorectal, 36.8% ovarian and primary peritoneal, 24.3% appendiceal, 2.1% mesothelioma and 6.3% were of other origins. Thirty-nine patients (27%) suffered ER. Univariable and multivariable analyses revealed that primary tumour type (p = 0.02) and post-CRS adjuvant treatment (p = 0.04) were associated with ER. Appendiceal patients had a lower odds of ER compared to colorectal patients [OR = 0.15 (0.043–0.502) p < 0.002]. Patients who received post-CRS adjuvant treatment had a lower odds of ER than patients without adjuvant treatment [OR = 0.32; (0.128–0.818) p = 0.02].
Conclusion
There remains a 27% risk of ER after CRS-HIPEC. Better patient selection and the administration of adjuvant chemotherapy may help to reduce ER.
Similar content being viewed by others
References
Fagotti A, Gallotta V, Romano F et al (2010) Peritoneal carcinosis of ovarian origin. World J Gastrointest Oncol 2(2):102–108. https://doi.org/10.4251/wjgo.v2.i2.102
del Castillo CF, Warshaw L (1993) Peritoneal metastases in pancreatic carcinoma. Hepatogastroenterology 40(5):430–432
Welch JP, Donaldson GA (1979) The clinical correlation of an autopsy study of recurrent colorectal cancer. Ann Surg 189(4):496–502
Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88(2):358–363
Spiliotis J, Halkia E, de Bree E (2016) Treatment of peritoneal surface malignancies with hyperthermic intraperitoneal chemotherapy—current perspectives. Curr Oncol 23(3):e266-e275
Sugarbaker PH (1996) Peritoneal carcinomatosis: natural history and rational therapeutic interventions using intraperitoneal chemotherapy. Cancer Treat Res 81:149–168
de Bree E, Tsiftsis DD (2007) Principles of perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis. Recent Results Cancer Res 169:39–51
Sugarbaker PH (2006) New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol 7:69–76
Baratti D, Kusamura S, Cabras AD, Bertulli R, Hutanu I, Deraco M (2013) Diffuse malignant peritoneal mesothelioma: long-term survival with complete cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (hipec). Eur J Cancer 49:3140–3148
National Comprehensive Cancer Network (NCCN) (2016) Clinical Practice Guidelines in Oncology. Colon cancer. (v2.2016) March 14 2018. https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf
National Institute for Health and Care Excellence (NICE) (2010) Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis. (IPG 331), Feb 2010. https://www.nice.org.uk/guidance/ipg331/documents/cytoreduction-surgery-followed-by-hyperthermic-intraoperative-peritoneal-chemotherapy-for-peritoneal-carcinomatosis-interventional-procedures-consultation
Van Cutsem E, Cervantes A, Nordlinger B, Arnold D, on behalf of the ESMO Guidelines Working Group (2014) Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25 (suppl_3):iii1–iii9
Tan G, Chia C, Kumar M et al (2017) 201 consecutive cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in a single Asian tertiary centre. Int J of Hyperthermia 33(3):288–294
Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42
Sugarbaker PH, Ronnett BM, Archer A et al (1997) Pseudomyxoma peritonei syndrome. Adv Surg 30:233–280
Sugarbaker PH, Jablonsky KA (1995) Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 221:124–132
Sugarbaker PH (1999) Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol 43:S15–S25
Younan R, Kusamura S, Baratti D et al (2008) Morbidity, toxicity, and mortality classification systems in the local regional treatment of peritoneal surface malignancy. J Surg Oncol 98:253–257
van Oudheusden TR, Nienhuijs SW, Luyer MD et al (2015) Incidence and treatment of recurrent disease after cytoreductive surgery and intraperitoneal chemotherapy for peritoneally metastasized colorectal cancer: a systematic review. EJSO 41(10):1269–1277
Klaver YLB, Lemmens VEPP, Creemers GJ et al (2011) Population-based survival of patients with peritoneal carcinomatosis from colorectal origin in the era of increasing use of palliative chemotherapy. Ann Oncol 22(10):2250–2256
Chua TC, Liauw W, Morris DL (2012) Early recurrence of pseudomyxoma peritonei following treatment failure of cytoreductive surgery and perioperative intraperitoneal chemotherapy is indicative of a poor survival outcome. Int J Colorectal Dis 27:381–389
Simkens GA, van Oudheusden TR, Luyer MD et al (2015) Serious postoperative complications affect early recurrence after cytoreductive surgery and HIPEC for colorectal peritoneal carcinomatosis. Ann Surg Oncol 22:2656–2662
Trotti A, Colevas AD, Setser A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13(3):176–181
Ceelen W, Van Nieuwenhove Y, Putte DV, Pattyn P (2014) Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (hipec) for colorectal carcinomatosis. Ann Surg Oncol 21:3023–3028
Eveno C, Passot G, Goéré D et al (2014) Bevacizumab doubles the early postoperative complication rate after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol 21(6):1792–1800
Kepenekian V, Elias D, Passot G et al (2016) Diffuse malignant peritoneal mesothelioma: evaluation of systemic chemotherapy with comprehensive treatment through the RENAPE database: Multi-Institutional Retrospective Study. Eur J Cancer 65:69–79
Chen C-F, Huang C-J, Kang W-Y, Hsieh J-S (2008) Experience with adjuvant chemotherapy for pseudomyxoma peritonei secondary to mucinous adenocarcinoma of the appendix with oxaliplatin/fluorouracil/leucovorin (FOLFOX4). WJSO 6:118
Kuijpers AM, Mehta AM, Boot H et al (2014) Perioperative systemic chemotherapy in peritoneal carcinomatosis of lymph node positive colorectal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Oncol 25(4):864–869
Phipps AI, Buchanan DD, Makar KW et al (2013) KRAS-mutation status in relation to colorectal cancer survival: the joint impact of correlated tumour markers. Br J Cancer 108:1757–1764
Acknowledgements
Ms. Thakshayeni Skanthakumar, database manager.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare no conflict of interest or receive any funding for research.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Tan, G.H.C., Chia, C.S., Tan, S.H. et al. Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Int J Clin Oncol 23, 989–998 (2018). https://doi.org/10.1007/s10147-018-1301-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-018-1301-8