Abstract
Introduction
The combined approach of cytoreductive surgery (CRS) with hyperthermic intraperitoneal
chemotherapy (HIPEC) has achieved encouraging outcomes for patients with PMCA with
peritoneal dissemination. However, there is little evidence for the use of EPIC in
addition to HIPEC in this group of patients.
Patients and methods
This was a retrospective study of prospectively collected data of consecutive patients
with PMCA who underwent CRS and perioperative intraperitoneal chemotherapy by one
surgical team at St George Hospital in Sydney, Australia between Jan 1996 and Aug
2016.
Results
A total of 185 patients formed the cohort of this study. However, there was no significant
difference in terms of hospital mortality (p = 0.632), major morbidity rate (i.e.
Grade III/IV) (p = 0.444), intensive unit care stay (p = 0.638) and total hospital
stay (p = 0.0.078). However, patients who received HIPEC and EPIC had a significant
longer stay in high dependency unit (p < 0.001). Multivariate analysis showed combined
HIPEC with EPIC is an independent prognostic factor for better overall survival (Hazard
ratio (HR) = 0.42, 95% confidence interval (CI) = 0.19–0.92, P = 0.030) and disease
free survival (HR = 0.66, 95%CI = 0.44–0.99, p = 0.045), adjusted for age, sex, peritoneal
cancer index, completeness of cytoreduction score, CEA ≥ 6.5 mg/L, CA19-9 ≥ 24.0 U/mL
and CA125 ≥ 32.0 U/mL.
Conclusions
In summary, the combination of HIPEC and EPIC could potentially provide additional
survival benefit for patients with PMCA with peritoneal spread as compared to HIPEC
alone without increasing postoperative morbidity and mortality. More studies are warranted
to further confirm the potential benefits of EPIC in PMCA and address the question
of optimal drug and/or duration of EPIC.
Keywords
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Article info
Publication history
Published online: September 26, 2017
Accepted:
September 1,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
