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Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry

Published:December 01, 2020DOI:https://doi.org/10.1016/j.ejso.2020.11.140

      Abstract

      Introduction

      A laparoscopic approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (L-CRS+HIPEC) in highly selected patients has been reported in small cohorts with a demonstrable reduction in length of stay and post-operative morbidity. This study aims to analyse individual patient data from these international centres collected through the Peritoneal Surface Oncology Group International (PSOGI) L-CRS+HIPEC registry.

      Methods

      An international registry was designed through a networking database (REDCAP®). All centres performing L-CRS+HIPEC were invited through PSOGI to submit data on their cases. Patient’s characteristics, postoperative outcomes and survival were analysed.

      Results

      Ten international centres contributed a total of 143 L-CRS+HIPEC patients during the study period. The most frequent indication was low grade pseudomyxoma peritonei in 79/143 (55%). Other indications were benign multicyst mesothelioma in 21/143(14%) and peritoneal metastasis from colon carcinoma in 18/143 (12,5%) and ovarian carcinoma in 13/143 (9%). The median PCI was 3 (2-5). The median length of stay was 6 (5-10) days, with 30-day major morbidity rate of 8.3% and 30-day mortality rate of 0.7%. At a median follow-up of 37 (16-64) months 126/143 patients (88.2%) were free of disease.

      Conclusions

      Analysis of these data demonstrates that L-CRS+HIPEC is a safe and feasible procedure in highly selected patients with limited peritoneal disease when performed at experienced centres. While short to midterm outcomes are encouraging in patients with less invasive histology, longer follow up is required before recommending it for patients with more aggressive cancers with peritoneal dissemination.
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      References

        • Newton A.D.
        • Barlett EK
        • Karakousis GC
        • et al.
        Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a review of factors contributing to morbidity and mortality.
        J Gastrointest Oncol. 2016; 7: 99-111
        • Foster J.
        • Sleightholm M.
        • Patel A.
        • et al.
        Morbidity and mortality rates following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy compared with other high-risk surgical oncology procedures.
        JAMA Netw Open. 2019; 2e186847
        • van der Pas M.H.
        • Haglind E.
        • Cuesta M.A.
        • et al.
        Colorectal cancer laparoscopic or open resection II (COLOR II) study group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short term outcomes of a randomized phase 3 trial.
        Lancet Oncol. 2013; 14: 210-218
        • Sommariva A.
        • Zagonel V.
        • Rossi C.R.
        Rossi CR the role of laparoscopy in peritoneal surface malignancies selected for hyperthermic intraperitoneal chemotherapy (HIPEC).
        Ann Surg Oncol. 2012; 19: 3737-3744
        • Rodriguez-Ortiz L.
        • Arjona-Sanchez A.
        • Ibañez-Rubio M.
        • et al.
        Laparoscopic cytoreductive surgery and HIPEC: a comparative matched analysis.
        Surg Endosc. Apr 2020; https://doi.org/10.1007/s00464-020-07572-x
        • Esquivel J.
        • Averbach A.
        • Chua T
        Chua TC Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with limited peritoneal surface malignancies: feasibility, morbidity and outcome in an early experience.
        Ann Surg. 2011; 253: 764-768
        • Arjona-Sanchez A.
        • Duran-Martinez M.
        • Sanchez-Hidalgo J.M.
        Peritoneal carcinomatosis from ovarian carcinoma treated by interval laparoscopic complete cytoreduction and HIPEC with extraction through natural orifice.
        Surg Oncol. 2019; 31: 14-15
      1. Laparoscopic cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (L-CRS/HIPEC) for perforated low-grade Appendiceal mucinous neoplasm (LAMN II).
        Ann Surg Oncol. 2019; 26: 2285
        • Abudeeb H.S.C.
        • O’Dwyer S.T.
        • et al.
        Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for perforated low-grade appendiceal mucinous neoplasms.
        Surg Endosc. 2020;
        • Frederic Mercier G.J.
        • Alyami M.
        • et al.
        Long-term results of laparoscopic cytoreductive surgery and HIPEC for the curative treatment of low-grade pseudomyxoma peritonei and multicystic mesothelioma.
        Surg Endosc. 2019;
        • Arjona-Sanchez A.
        • Esquivel J.
        • Glehen O.
        • et al.
        A minimally invasive approach for peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in limited peritoneal carcinomatosis: the American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution analysis.
        Surg Endosc. 2019; 33: 854-860
        • Fagotti A.
        • Alleti S.G.
        • Corrado G
        • et al.
        The INTERNATIONAL MISSION study: minimally invasive surgery in ovarian neoplasms after neoadjuvant chemotherapy.
        Int J Gynecol Canc. 2019; 29: 5-9
        • Amin M.B.
        • Edge S.B.
        • Greene F.L.
        • et al.
        AJCC cancer staging manual.
        eighth ed. Springer, New York2017
        • Honoré C.
        • Goere D.
        • Souadka A.
        • et al.
        Definition of patients presenting a high risk of developing peritoneal carcinomatosis after curative surgery for colorectal cancer: a systematic review.
        Ann Surg Oncol. 2013; 20: 183-192
        • Carr N.J.C.T.
        • Mohamed F.
        • et al.
        A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia: the results of the peritoneal surface oncology group international (PSOGI) modified Delphi process.
        Am J Surg Pathol. 2016; 40: 14-26
        • van Driel W.J.
        • Ksn
        • Sikorska K.
        • et al.
        Hyperthermic intraperitoneal chemotherapy in ovarian cancer.
        N Engl J Med. 2018; 378: 230-240
        • Kusamura S.K.V.
        • Villeneuve L.
        • et al.
        Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up.
        Eur J Surg Oncol. 2020; 12
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        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
        • Jacquet P.
        • Sugarbaker P
        Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis.
        Canc Treat Res. 1996; 82: 359-374
        • Arjona-Sánchez A.
        • Barrios P
        • Boldo E
        • et al.
        HIPECT4: multicentre, randomized clinical trial to evaluate safety and efficacy of Hyperthermic intra-peritoneal chemotherapy (HIPEC) with Mitomycin C used during surgery for treatment of locally advanced colorectal carcinoma.
        BMC Canc. 2018; 18: 183
        • Alyami M.
        • Hübner M.
        • Grass F.
        • et al.
        Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications.
        Lancet Oncol. 2019; 20: e368-e377
        • Sánchez-Hidalgo J.M.
        • Rodriguez-Ortiz L.
        • Arjona-Sanchez A.
        • et al.
        Colorectal peritoneal metastases: optimal management review.
        World J Gastroenterol. 2019; 25: 3484
        • Elias Dominique
        • Boutitie Florent
        • et al.
        Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study.
        J Clin Oncol. 2009; 28: 63-68
        • du Bois A.
        • Reuss A.
        • Pujade-Lauraine E.
        • et al.
        Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux pour les Etudes des Cancers de l’Ovaire (GINECO).
        Cancer. 2015; 115: 1234-1244
        • Kehoe S.
        • Hook J.
        • Nankivell M.
        • et al.
        Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial.
        Lancet. 2015; 386: 249-257
        • Vergote I.
        • Trope C.
        • Amant F.
        • et al.
        Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer.
        N Engl J Med. 2010; 363: 943-953
        • Gallotta V.
        • Ghezzi F.
        • et al.
        Laparoscopic management of ovarian cancer patients with localized carcinomatosis and lymph node metastases: results of A retrospective multi-institutional series.
        J Minim Invasive Gynecol. 2016;
        • Fagotti A.
        • Petrillo M.
        • Costantini B.
        Minimally invasive secondary cytoreduction plus HIPEC for recurrent ovarian cancer: a case series.
        Gynecol Oncol. 2014; 132: 303-306
        • Passot G.
        • Goéré D.
        • et al.
        Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE).
        BJS. 2018; 105: 663-667