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

Abstract

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.

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

“…The wide reported discrepancy in morbidity and mortality rates in the literature is mainly due to the different definitions and methods of classification used. In agreement with other authors, we believe that the NCI-CTCAE definition for types and grading of complications represents a legitimate metric of CRS-HIPEC quality, because it includes both medical and surgical conditions as well as many treatment-related complications and patients may die far beyond 30 days after surgery [ 1 , 3 , 4 , 5 , 16 , 26 , 27 , 28 ], as it occurred in approximately one third of our cases. Among the surgical complications, bleeding was the most frequent, followed by perforation and anastomotic leakage.…”

“…Our overall postoperative mortality rate also 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 ]. Respiratory complications and bleeding were the two most common causes accounting for 33% and 19% of deaths, respectively, as well as it happened for the occurrence of complications.…”

“…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 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 ].…”