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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Surgical Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Clinicopathologic and prognostic features in patients with peritoneal metastasis from mucinous adenocarcinoma, adenocarcinoma with signet ring cells, and adenocarcinoid of the appendix treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy.Ann Surg Oncol. 2016; 23: 1474-1480
- Hyperthermic intraperitoneal chemotherapy+ early postoperative intraperitoneal chemotherapy versus hyperthermic intraperitoneal chemotherapy alone: assessment of survival outcomes for colorectal and high-grade appendiceal peritoneal carcinomatosis.Am J Surg. 2015; 210: 424-430
- Early-and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.J Clin Oncol. 2012; 30: 2449-2456
- Gastrointestinal malignancy: rationale for adjuvant therapy using early postoperative intraperitoneal chemotherapy.Br J Surg. 1989; 76: 1082-1090
- Pharmacokinetics of the perioperative use of cancer chemotherapy in peritoneal surface malignancy patients.Gastroenterol Res Pract. 2012; 2012
- HIPEC+ EPIC versus HIPEC-alone: differences in major complications following cytoreduction surgery for peritoneal malignancy.J Surg Oncol. 2013; 107: 591-596
- Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis.Peritoneal carcinomatosis: principles of management. Springer, 1996: 359-374
- Peritonectomy procedures.Ann Surg. 1995; 221: 29-42
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy.J Am Coll Surg. 2012; 215: 412-417
- Early postoperative intraperitoneal chemotherapy as an adjuvant therapy to surgery for peritoneal carcinomatosis from gastrointestinal cancer: pharmacological studies.Cancer Res. 1990; 50: 5790-5794
- Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer.Semin Oncol. 1989; 16: 83-97
- Does early post-operative intraperitoneal chemotherapy (EPIC) for patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) make a difference?.Int J Hyperth. 2016; : 1-8
- Comparative analysis of perioperative intraperitoneal chemotherapy regimen in appendiceal and colorectal peritoneal carcinomatosis.Int J Clin Oncol. 2013; 18: 439-446
- Early postoperative intraperitoneal chemotherapy for low-grade appendiceal mucinous neoplasms with pseudomyxoma peritonei: is it beneficial?.Ann Surg Oncol. 2016; : 1-8
- Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure?: a systematic review of morbidity and mortality.Ann Surg. 2009; 249: 900-907
Published online: September 26, 2017
Accepted: September 1, 2017
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.