Pelvic Exenteration with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC) for Rectal Cancer—Case Series with Review of Literature

Shinde, Rajesh; Acharya, Rajgopal; Kumar, Naveena A. N.; Solanki, Sohan Lal; Desouza, Ashwin; Saklani, Avanish

doi:10.1007/s13193-019-00882-0

Cited by 8 publications

(12 citation statements)

References 18 publications

(16 reference statements)

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“…The first report by Fujimoto et al in 1993 described a patient with advanced rectosigmoid cancer who underwent total PE with CRS and HIPEC [13]. Shinde and colleagues recently reported the outcomes of PE with CRS and HIPEC in three patients with locally advanced rectal cancer [14]. Similar to the current study, the patients in the Shinde series were young (22–38 years) with relatively low volume PCI (<7).…”

Section: Discussionsupporting

confidence: 76%

“…There was no inpatient, 30-day or 90-day mortality. Three patients (50%) experienced a Shinde and colleagues recently reported the outcomes of PE with CRS and HIPEC in three patients with locally advanced rectal cancer[14]. Similar to the current study, the patients in the Shinde series were young (22-38 years) with relatively low volume PCI (<7).…”

supporting

confidence: 79%

“…In patients with CPM, the involvement of extraperitoneal pelvic structures necessitating PE may occur with primary locally advanced cancers, infiltrative pelvic peritoneal disease or with pelvic peritoneal recurrence following disruption of the pelvic peritoneum during initial surgery for resection of rectosigmoid malignancies. Fujimoto and colleagues reported a case where PE was combined with CRS and HIPEC for rectal cancer [13] and the largest case series to date included three patients [14].…”

Section: Introductionmentioning

confidence: 99%

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Pelvic exenteration combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for advanced primary or recurrent colorectal cancer with peritoneal metastases

Brown

Ansari

Solomon³

et al. 2020

Colorectal Disease

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Aim The aim was to report early outcomes of six patients who underwent combined pelvic exenteration (PE), cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced or recurrent colorectal cancer with colorectal peritoneal metastases at a single centre. The literature contains limited data on the safety and oncological outcomes of patients who undergo this combined procedure. Methods Six patients who underwent combined PE, CRS and HIPEC at Royal Prince Alfred Hospital, Sydney, between January 2017 and February 2020 were identified and included. Data were extracted from prospectively maintained databases. Results Three patients underwent surgery for advanced primary rectal cancer, while two patients had recurrent sigmoid cancer and one had recurrent rectal cancer. All patients had synchronous peritoneal metastases. Two patients required total PE and two patients had a central (bladder‐sparing) PE. The median peritoneal carcinomatosis index was 6 (range 3–12) and all patients underwent a complete cytoreduction. The median operating time was 702 min (range 485–900) and the median blood loss was 1650 ml (range 700–12,000). The median length of intensive care unit and hospital stay was 4.5 and 25 days, respectively. There was no inpatient, 30‐day or 90‐day mortality. Three patients (50%) experienced a major (Clavien–Dindo III/IV) complication. At a median follow‐up of 11.5 months (range 2–18 months), two patients died with recurrent disease, one patient was alive with recurrence, while three patients remain alive and disease‐free. Of the three patients who developed recurrent disease, one had isolated pelvic recurrence, one had pelvic and peritoneal recurrences and one had bone metastases. Conclusion Early results from this initial experience with simultaneous PE, CRS and HIPEC suggest that this combined procedure is safe and feasible; however, the long‐term oncological and quality of life outcomes require further investigation.

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Section: Discussionsupporting

confidence: 76%

supporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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Pelvic exenteration combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for advanced primary or recurrent colorectal cancer with peritoneal metastases

Brown

Ansari

Solomon³

et al. 2020

Colorectal Disease

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“…[910] Some sporadic case series suggest an extended indication of CRS-HIPEC with pelvic exenteration for rectal cancers. [11]…”

Section: Surgical Factorsmentioning

confidence: 99%

Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

et al. 2019

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Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for primary peritoneal malignancies or peritoneal spread of malignant neoplasm is being done at many centres worldwide. Perioperative management is challenging with varied haemodynamic and temperature instabilities, and the literature is scarce in many aspects of its perioperative management. There is a need to have coalition of the existing evidence and experts' consensus opinion for better perioperative management. The purpose of this consensus practice guideline is to provide consensus for best practice pattern based on the best available evidence by the expert committee of the Society of Onco-Anaesthesia and Perioperative Care comprising perioperative physicians for better perioperative management of patients of CRS-HIPEC.

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“…Pelvic exenteration is an established treatment option for locally advanced primary rectal cancer (LARC) and locally recurrent rectal cancer (LRRC), but it is associated with significant morbidity; therefore, many investigators do not recommend CRS-HIPEC with pelvic exenteration. Since the majority of researchers consider it as an exclusion criterion, only a few case reports [ 7 , 8 , 9 ] have been published to date. Herein, we reported our experience with total pelvic exenteration (TPE) associated with CRS and HIPEC with a critical analysis.…”

Section: Introductionmentioning

confidence: 99%

Total Pelvic Exenteration, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy for Rectal Cancer with Associate Peritoneal Metastases: Surgical Strategies to Optimize Safety

Tuech

Pinson

Nouhaud

et al. 2020

Cancers

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Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a curative treatment option for patients with peritoneal carcinomatosis. Total pelvic exenteration (TPE) is an established treatment option for locally advanced pelvic malignancy. These two procedures have high mortality and morbidity, and therefore, their combination is not currently recommended. Herein, we reported our experience on TPE associated with CRS/HIPEC with a critical analysis for rectal cancer with associate peritoneal metastases. Methods: From March 2006 to August 2020, 319 patients underwent a CRS/HIPEC in our hospital. Among them, 16 (12 men and four women) underwent an associated TPE. The primary endpoints were perioperative morbidity and mortality. Results: There was locally recurrent rectal cancer in nine cases, six locally advanced primary rectal cancer, and a recurrent appendiceal adenocarcinoma. The median Peritoneal Cancer Index (PCI) was 8. (4–16). Mean duration of the surgical procedure was 596 min (420–840). Complete cytoreduction (CC0) was achieved in all patients, while clear resection (R0) margins on the resected pelvic organs were achieved in 81.2% of cases. The median hospital stay was 46 days (26–129), and nine patients (56.2%) experienced severe complications (grade III to V) that led to death in two cases (12.5%). The total reoperation rate for patients was 6/16 (37.5%) and 3/16 (18.75%) with percutaneous radiological-guided drainage. Conclusions: In summary, TPE/extended TPE (ETPE) associated with CRS/HIPEC may be a reasonable procedure in selected patients at expert centers. Pelvic involvement should not be considered a definitive contraindication for CRS/HIPEC in patients with resectable peritoneal surface diseases if a R0 resection could be achieved on all sites. However, the morbidity and the mortality are high with this combination of treatment, and further research is needed to assess the oncologic benefit and quality of life before such a radical approach can be recommended.

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Pelvic Exenteration with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC) for Rectal Cancer—Case Series with Review of Literature

Cited by 8 publications

References 18 publications

Pelvic exenteration combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for advanced primary or recurrent colorectal cancer with peritoneal metastases

Pelvic exenteration combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for advanced primary or recurrent colorectal cancer with peritoneal metastases

Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

Total Pelvic Exenteration, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy for Rectal Cancer with Associate Peritoneal Metastases: Surgical Strategies to Optimize Safety

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