Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital

Goslin, Brent; Sevak, Shruti; Siripong, Arida; Onesti, Jill K.; Wright, G. Paul; Melnik, Marianne K.; Chung, Mathew H.

doi:10.1016/j.amjsurg.2011.09.009

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…At our center, median OS was 68 months and median PFS was 37 months after median follow‐up of 64 months. Current survival data for nonacademic hospitals is limited to one publication, which reported a 4‐year OS of 65.4% in 34 patients with pseudomyxoma peritonei after a follow‐up of 1.2 years 16 . Another study of 1000 patients from a specialized hospital reported a median OS of 29.4 months.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, data on CRS/HIPEC safety at nonacademic American hospitals is limited and focused mainly on postoperative morbidity 15,16 . We evaluated surgical and oncological outcomes of patients who underwent CRS/HIPEC at our center and presented the essential components of a successful PSM program in a nonacademic setting.…”

Section: Introductionmentioning

confidence: 99%

“…While a CRS/HIPEC program in a nonacademic setting could expand access to treatment, its implementation may be challenging as it requires specialized surgeons and medical teams, auxiliary services such as interventional radiology (IR), a multidisciplinary team (MDT) to review cases, and a research department to support and assess this investigational modality 11‐13 . However, high‐volume hospitals with the above features could provide a safe and accessible option for patients with PSM 14‐16 …”

Section: Introductionmentioning

confidence: 99%

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Surgical and oncological outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a nonacademic center: 25‐year experience

Nikiforchin

Gushchin

King

et al. 2021

Journal of Surgical Oncology

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Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is predominantly performed and studied in academic centers. While developing CRS/HIPEC programs in nonacademic hospitals can increase accessibility, its safety and oncological efficacy remains unclear. We evaluated CRS/HIPEC outcomes in a nonacademic setting. Methods A single‐center descriptive study was conducted using a prospective database. Data of all CRS/HIPEC attempts in peritoneal surface malignancies (PSM) patients from October 1994 to November 2019 were extracted. Surgical and survival outcomes were measured. Center experience was assessed by quartiles of cases. Results Overall, 856 patients underwent 948 CRS/HIPEC attempts: 788 (83%) completed CRS/HIPECs, 144 (15%) aborted HIPECs, and 16 (2%) complete cytoreductions (CC‐0/1) without chemoperfusion. For completed CRS/HIPECs, median peritoneal cancer index was 24 (interquartile range: 10–33) and CC‐0/1 rate was 88%. Major complications occurred in 23.5% with 30‐ and 100‐day mortality of 1.0% and 2.3%, respectively. Median overall survival was 68 months (95% confidence interval [CI]: 50–86). Median progression‐free survival was 37 months (95%CI: 28–46). Incomplete cytoreduction and major complication rates decreased over time, while mortality remained low and constant. Conclusions CRS/HIPEC at a nonacademic center with advanced surgical and auxiliary services is a safe option to treat PSM with favorable surgical and oncological outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical and oncological outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a nonacademic center: 25‐year experience

Nikiforchin

Gushchin

King

et al. 2021

Journal of Surgical Oncology

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“…In addition to pathological type and surgical treatment, there are many factors related to the prognosis of PMP patients; for example, the extent of peritoneal seeding [which can be quantified by the Peritoneal Cancer Index (PCI)] and the use of chemotherapy, such as locoregional chemotherapy, including intraperitoneal chemotherapy (IPC) and HIPEC (33), has been studied and reported in many countries and regions around the world (34)(35)(36) and can improve the 5-year survival rates, although with higher mortality and morbidity (37,38). If there is no visible residual cancer or residual tumor deposits that measure <2.5 mm in size (CRR0 or CRR1) after surgery, chemotherapeutic drugs can penetrate into the cells and eradicate residual lesions (39,40).…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Impact of Pathology on Patients With Pseudomyxoma Peritonei Undergoing Debulking Surgery: A Systematic Review and Meta-Analysis of Retrospective Studies

Zhou

Zhao

2020

Front. Surg.

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Background: Pseudomyxoma peritonei (PMP) is a rare clinical condition with fatal outcomes, which is characterized by the progressive accumulation of mucinous ascites and peritoneal implants. Some studies have reported the effect of PMP biology on patient outcome. The objective of this study was to analyze published articles focusing on the impact of pathology on the prognosis of PMP patients undergoing debulking. Methods: Data from all studies regarding the prognosis of patients, with different pathologies, who underwent debulking surgery were analyzed. We searched PubMed, the Wiley Online Library, Ovid, and the Cochrane Library (through January 2020). Studies were confined to those articles written in English. Five studies were identified, and the differences in 5-year survival rates were analyzed according to the Kaplan–Meier survival curves. The hazard ratios (HRs) of the 5-year survival rates were calculated. Results: The mean and median 5-year survival rates of all patients were 39 and 40%, respectively. The median overall survival was 49.3 months. The mean 5-year survival rates of low-grade PMP was 45.2%. The five studies had sufficient data to calculate HRs from the 5-year survival rates data, and three had HRs lower than 1. The total HRs was 0.54, with a 95% CI between 0.33 and 0.89 ( P = 0.01). Conclusions: Among PMP patients receiving debulking surgery who are not able to undergo complete cytoreductive surgery, low-grade biological PMP had a better prognosis than high-grade PMP.

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“…However, it is important to note that academic facilities do not all necessarily have greater expertise in mesothelioma with a higher volume of CRS and HIPEC than all community facilities, with a couple single-institution studies reporting their success with CRS and HIPEC at a community center. 20,21 While acknowledging the importance of multidisciplinary care, it has been estimated that between 140 and 220 cases are needed to reach technical proficiency in CRS and HIPEC. 19 Furthermore, as previously mentioned, histology was classified as mesothelioma NOS for the majority of patients, which is a limitation because histologic subtype has important prognostic implications for this disease.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals

Welten

Fields

Malizia

et al. 2022

Journal of Gastrointestinal Surgery

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Background Malignant peritoneal mesothelioma is a rare disease with poor outcomes. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the cornerstone of therapy. We aim to compare outcomes of malignant peritoneal mesothelioma treated at academic versus community hospitals. Methods This was a retrospective cohort study using the National Cancer Database to identify patients with malignant peritoneal mesothelioma from 2004 to 2016. Patients were divided according to treating facility type: academic or community. Outcomes were assessed using log-rank tests, Cox proportional-hazard modeling, and Kaplan-Meier survival statistics. Results In total, 2682 patients with malignant peritoneal mesothelioma were identified. A total of 1272 (47.4%) were treated at an academic facility and 1410 (52.6%) were treated at a community facility. Five hundred forty-six (42.9%) of patients at academic facilities underwent debulking or radical surgery compared to 286 (20.2%) at community facilities. Three hundred sixty-six (28.8%) of patients at academic facilities received chemotherapy on the same day as surgery compared to 147 (10.4%) of patients at community facilities. Unadjusted 5-year survival was 29.7% (95% CI 26.7-32.7) for academic centers compared to 18.3% (95% CI 16.0-20.7) for community centers. In multivariable analysis, community facility was an independent predictor of increased risk of death (HR: 1.19, 95% CI 1.08-1.32, p = 0.001). Conclusions We demonstrate better survival outcomes for malignant peritoneal mesothelioma treated at academic compared to community facilities. Patients at academic centers underwent surgery and received chemotherapy on the same day as surgery more frequently than those at community centers, suggesting that malignant peritoneal mesothelioma patients may be better served at experienced academic centers.

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Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital

Cited by 6 publications

References 11 publications

Surgical and oncological outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a nonacademic center: 25‐year experience

Surgical and oncological outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a nonacademic center: 25‐year experience

The Prognostic Impact of Pathology on Patients With Pseudomyxoma Peritonei Undergoing Debulking Surgery: A Systematic Review and Meta-Analysis of Retrospective Studies

Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals

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