Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies: Learning Curve Based on Surgical and Oncological Outcomes

Abstract

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex, highly specialized procedure used to treat peritoneal surface malignancies (PSM) [...]

Complications and Mortality Rate of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: Italian Peritoneal Surface Malignancies Oncoteam Results Analysis

“…Our overall postoperative morbidity rate was in line with that reported from high-volume centers [ 1 , 2 , 3 , 4 , 5 , 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 26 , 27 , 28 , 29 , 30 ]. The wide reported discrepancy in morbidity and mortality rates in the literature is mainly due to the different definitions and methods of classification used.…”

“…Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has been increasingly considered an effective treatment for peritoneal surface malignancies (PSMs). Although it can significantly improve survival in selected patients with malignant mesothelioma and pseudomixoma peritoneii (PMP), the role in carcinomatosis originating from gastrointestinal and gynecological tumors is very promising but still under study [ 1 , 2 , 3 , 4 , 5 , 6 ]. The procedure has been widely criticized by the opponents due to the associated significant postoperative morbidity and mortality, thus preventing possibility of cure for many patients and clinical trials development.…”

“…A systematic review reported in 2009 showed morbidity and mortality rates up to 52% and 17%, respectively [ 7 ]. Since the need for a steep learning curve including approximately 100 procedures each year has been clearly demonstrated [ 2 , 5 , 6 , 8 , 9 ], postoperative outcomes following CRS-HIPEC are similar to other major surgical procedures if performed in high-volume center [ 10 , 11 , 12 , 13 , 14 ]. A recent comparison with other high-risk surgical oncology procedures evaluating 34.114 patients showed that overall, 30-day mortality was lower in CRS/HIPEC (1.1%), compared with Whipple (2.5%), major hepatectomy (2.9–3.9%), esophagectomy (3.0%) [ 11 ].…”

“…A recent comparison with other high-risk surgical oncology procedures evaluating 34.114 patients showed that overall, 30-day mortality was lower in CRS/HIPEC (1.1%), compared with Whipple (2.5%), major hepatectomy (2.9–3.9%), esophagectomy (3.0%) [ 11 ]. The current morbidity and mortality rates vary from 22% to 45% and from 0.8% to 4%, respectively [ 1 , 2 , 3 , 4 , 5 , 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Hyperthermia-Based Anti-Cancer Treatments

“…Ten original research and review papers have been included until now (status 9 March 2021). Again a range of relevant topics is covered, including technical design and innovations for improved hyperthermia treatment delivery [24][25][26][27][28], a novel small animal model for preclinical HIPEC research [29], as well as clinical application of mild hyperthermia, thermal ablation and HIPEC for bladder cancer, prostate cancer, hepatocellular carcinoma, and peritoneal surface malignancies [30][31][32][33].…”