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. 2022 Jun;29(6):3436-3445.
doi: 10.1245/s10434-022-11441-3. Epub 2022 Mar 14.

Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis: A 30-year Institutional Experience

Cristian D Valenzuela  1 , Edward A Levine  1 , Christopher W Mangieri  1 , Rohin Gawdi  1 , Omeed Moaven  1 , Gregory Russell  2 , Megan E Lundy  1 , Kathleen C Perry  1 , Konstantinos I Votanopoulos  1 , Perry Shen  3
Affiliations

Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis: A 30-year Institutional Experience

Cristian D Valenzuela et al. Ann Surg Oncol. 2022 Jun.

Abstract

Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) improves survival in abdominal cancer patients with metastatic disease limited to the peritoneal cavity. Patients are increasingly being offered repeat CRS-HIPECs for peritoneal recurrence. However, in this rare clinical scenario, the survival benefit of performing repeat CRS-HIPEC operations remains unclear.

Methods: A retrospective review of the CRS-HIPEC database at Wake Forest Baptist Medical Center was performed over a 30-year timespan. From 1547 patients with appendix cancers, colorectal cancers, mesotheliomas, and other miscellaneous cancers, 156 received more than one CRS-HIPEC. Kaplan-Meier survival analysis was performed using overall survival (OS) from the time of surgery as the primary endpoint. Multi-variable Cox proportional hazards regression modelling was performed on pertinent clinical variables.

Results: Patients who received multiple CRS-HIPECs had significantly better median OS (10.7 years) versus those who received one CRS-HIPEC (2.5 years), with appendix cancers faring best (12.9 years). Resection status R2a or better was achieved in 76.4% of repeat CRS-HIPECs. There were no significant changes in complication rates after repeat CRS-HIPEC. On multivariate analysis of repeat CRS-HIPEC, patients with appendix and colorectal cancers, heart disease, and poor functional status were independently associated with poor OS. Factors not independently associated with OS were age, sex, body mass index, race, diabetes, lung disease, smoking history, and systemic chemotherapy between CRS-HIPECs.

Conclusions: Performing multiple CRS-HIPEC operations on appropriate surgical candidates may significantly prolong survival. Appendix cancers derived the greatest benefit. Satisfactory resection margins and complication rates are comparable to first cases and achievable in repeat CRS-HIPEC procedures.

Keywords: Cytoreductive surgery; HIPEC; Hyperthermic intraperitoneal chemotherapy; Peritoneal surface malignancy; Repeat HIPEC; Repeat cytoreductive surgery.

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Conflict of interest statement

DISCLOSURE The authors declare there are no relationships/conditions/circumstances that present a potential conflict of interest.

Figures

FIG. 1
FIG. 1
Resection status after repeat CRS-HIPEC by case category: appendix and colorectal cancers
FIG. 2
FIG. 2
A. OS from time of first CRS-HIPEC for patients receiving multiple CRS-HIPECs, by resection status at first CRS-HIPEC. B. OS from time of second CRS-HIPEC for patients receiving multiple CRS-HIPECs, by resection status
FIG. 3
FIG. 3
A. Overall survival of appendix and colorectal cancer patients with recurrences who received single or iterative CRS-HIPEC operations. B. Overall survival after iterative CRS-HIPECs, from time of first operation, in appendix cancers versus colorectal cancers
See this image and copyright information in PMC

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