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Graf, W., Ghanipour, L., Birgisson, H. & Cashin, P. (2024). Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases from Colorectal Cancer-An Overview of Current Status and Future Perspectives. Cancers, 16(2), Article ID 284.
Open this publication in new window or tab >>Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases from Colorectal Cancer-An Overview of Current Status and Future Perspectives
2024 (English)In: Cancers, ISSN 2072-6694, Vol. 16, no 2, article id 284Article, review/survey (Refereed) Published
Abstract [en]

Simple Summary The concept of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy perfusion for the treatment of colorectal cancer peritoneal metastases has been debated based on the results of recent controlled trials. In this review, we describe the development of this "package" treatment and discuss various aspects of the selection and indications, as well as future fields of research.Abstract Peritoneal metastases (PM) are observed in approximately 8% of patients diagnosed with colorectal cancer, either synchronously or metachronously during follow-up. PM often manifests as the sole site of metastasis. PM is associated with a poor prognosis and typically shows resistance to systemic chemotherapy. Consequently, there has been a search for alternative treatment strategies. This review focuses on the global evolution of the combined approach involving cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the management of PM. It encompasses accepted clinical guidelines, principles for patient selection, surgical and physiological considerations, biomarkers, pharmacological protocols, and treatment outcomes. Additionally, it integrates the relevant literature and findings from previous studies. The role of CRS and HIPEC, in conjunction with other therapies such as neoadjuvant and adjuvant chemotherapy, is discussed, along with the management of patients presenting with oligometastatic disease. Furthermore, potential avenues for future development in this field are explored.

Place, publisher, year, edition, pages
MDPI, 2024
Keywords
colorectal cancer, peritoneal metastases, locoregional therapy
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-523054 (URN)10.3390/cancers16020284 (DOI)001148857600001 ()38254775 (PubMedID)
Available from: 2024-02-16 Created: 2024-02-16 Last updated: 2024-02-16Bibliographically approved
Ghanipour, L., Jansson Palmer, G., Nilsson, P. J., Nordenvall, C., Frödin, J.-E., Bexe Lindskog, E., . . . Cashin, P. H. (2024). Efficacy of hyperthermic intraperitoneal chemotherapy in colorectal cancer: A phase I and III open label randomized controlled registry-based clinical trial protocol. PLOS ONE, 19(3), Article ID e0294018.
Open this publication in new window or tab >>Efficacy of hyperthermic intraperitoneal chemotherapy in colorectal cancer: A phase I and III open label randomized controlled registry-based clinical trial protocol
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2024 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 3, article id e0294018Article in journal (Refereed) Published
Abstract [en]

Standard treatment for patient with peritoneal metastases from colorectal cancer is cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). In recent years, the efficacy of oxaliplatin-based HIPEC has been challenged. An intensified HIPEC (oxaliplatin+irinotecan) in combination with early postoperative intraperitoneal chemotherapy (EPIC) has shown increased recurrence-free survival in retrospective studies. The aim of this trial is to develop a new HIPEC/EPIC regimen and evaluate its effect on morbidity, oncological outcome, and quality-of-life (QoL). This study is designed as a combined phase I/III multicenter randomized trial (RCT) of patients with peritoneal metastases from colorectal cancer eligible for CRS-HIPEC. An initial phase I dose escalation study, designed as a 3+3 stepwise escalation, will determine the maximum tolerable dose of 5-Fluorouracil (5-FU) as 1-day EPIC, enrolling a total of 15–30 patients in 5 dose levels. In the phase III efficacy study, patients are randomly assigned intraoperatively to either the standard treatment with oxaliplatin HIPEC (control arm) or oxaliplatin/irinotecan-HIPEC in combination with single dose of 1-day 5-FU EPIC (experimental arm). 5-FU is administered intraoperatively after CRS-HIPEC and closure of the abdomen. The primary endpoint is 12-month recurrence-free survival. Secondary endpoints include 5-year overall survival, 5-year recurrence-free survival (registry based), postoperative complications, and QoL up to 3 years after study treatment. This phase I/III trial aims to identify a more effective treatment of colorectal peritoneal metastases by combination of HIPEC and EPIC.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2024
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-527231 (URN)10.1371/journal.pone.0294018 (DOI)001182492200002 ()38437211 (PubMedID)
Funder
Swedish Research Council
Available from: 2024-04-30 Created: 2024-04-30 Last updated: 2024-04-30Bibliographically approved
Fisher, O. M., Brown, C., Esquivel, J., Larsen, S. G., Liauw, W., Alzahrani, N. A., . . . Cashin, P. (2024). Hyperthermic intraperitoneal chemotherapy in colorectal cancer. BJS Open, 8(3), Article ID zrae017.
Open this publication in new window or tab >>Hyperthermic intraperitoneal chemotherapy in colorectal cancer
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2024 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 8, no 3, article id zrae017Article in journal (Refereed) Published
Abstract [en]

Background: This study evaluated the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer with peritoneal metastases (pmCRC) in a large international data set of patients.

Patients and Methods: Patients with pmCRC from 39 centres who underwent cytoreductive surgery with HIPEC between 1991 and 2018 were selected and compared for the HIPEC protocols received-oxaliplatin-HIPEC versus mitomycin-HIPEC. Following analysis of crude data, propensity-score matching (PSM) and Cox-proportional hazard modelling were performed. Outcomes of interest were overall survival (OS), recurrence-free survival (RFS) and the HIPEC dose-response effects (high versus low dose, dose intensification and double drug protocols) on OS, RFS and 90-day morbidity. Furthermore, the impact of the treatment time period was assessed.

Results: Of 2760 patients, 2093 patients were included. Median OS was 43 months (95% c.i. 41 to 46 months) with a median RFS of 12 months (95% c.i. 12 to 13 months). The oxaliplatin-HIPEC group had an OS of 47 months (95% c.i. 42 to 53 months) versus 39 months (95% c.i. 36 to 43 months) in the mitomycin-HIPEC group (P = 0.002), aHR 0.77, 95% c.i. 0.67 to 0.90, P < 0.001. The OS benefit persisted after PSM of the oxaliplatin-HIPEC group and mitomycin-HIPEC group (48 months (95% c.i. 42 to 59 months) versus 40 months (95% c.i. 37 to 44 months)), P < 0.001, aHR 0.78 (95% c.i. 0.65 to 0.94), P = 0.009. Similarly, matched RFS was significantly higher for oxaliplatin-HIPEC versus others (13 months (95% c.i. 12 to 15 months) versus 11 months (95% c.i. 10 to 12 months, P = 0.02)). High-dose mitomycin-HIPEC protocols had similar OS compared to oxaliplatin-HIPEC. HIPEC dose intensification within each protocol resulted in improved survival. Oxaliplatin + irinotecan-HIPEC resulted in the most improved OS (61 months (95% c.i. 51 to 101 months)). Ninety-day mortality in both crude and PSM analysis was worse for mitomycin-HIPEC. There was no change in treatment effect depending on the analysed time period.

Conclusions: Oxaliplatin-based HIPEC provided better outcomes compared to mitomycin-based HIPEC. High-dose mitomycin-HIPEC was similar to oxaliplatin-HIPEC. The 90-day mortality difference favours the oxaliplatin-HIPEC group. A trend for dose-response between low- and high-dose HIPEC was reported.

Place, publisher, year, edition, pages
Oxford University Press, 2024
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-528674 (URN)10.1093/bjsopen/zrae017 (DOI)001216641700001 ()38722737 (PubMedID)
Funder
Bengt Ihres Foundation
Available from: 2024-05-27 Created: 2024-05-27 Last updated: 2024-05-27Bibliographically approved
Cashin, P., Söderström, M., Blom, K., Artursson, S., Andersson, C., Larsson, R. & Nygren, P. (2023). Ex vivo assessment of chemotherapy sensitivity of colorectal cancer peritoneal metastases. British Journal of Surgery, 110(9), 1080-1083
Open this publication in new window or tab >>Ex vivo assessment of chemotherapy sensitivity of colorectal cancer peritoneal metastases
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2023 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 110, no 9, p. 1080-1083Article in journal (Refereed) Published
Abstract [en]

Patients with peritoneal metastasis from colorectal cancer (PMCRC) may have a chance of cure when treated with cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC)1–5.

Choice of chemotherapy for HIPEC has been based on knowledge of its systemic effects, pharmacokinetics, technical feasibility, hyperthermic efficacy enhancement, and tolerance6–8. Selection of cancer drugs for treatment based on phenotypical assessment of patient cancer cell drug sensitivity ex vivo is one approach to personalized cancer treatment. One technique for this is the fluorometric microculture cytotoxicity assay (FMCA) that has been used in drug development and for the development of personalized cancer medicine9–16.

This study investigated whether ex vivo assessment of drug sensitivity by the FMCA provides predictive information in terms of peritoneal recurrence-free survival (PRFS) and overall survival (OS) in patients treated with CRS and HIPEC for isolated PMCRC.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:uu:diva-522422 (URN)10.1093/bjs/znad066 (DOI)000949793400001 ()36918737 (PubMedID)
Available from: 2024-02-12 Created: 2024-02-12 Last updated: 2024-02-12Bibliographically approved
Kozman, M. A., Fisher, O. M., Liauw, W., Morris, D. L. & Cashin, P. H. (2023). External validation of prognostic scores and comparison of predictive accuracy for patients with colorectal cancer with peritoneal metastases considered for cytoreductive surgery and intraperitoneal chemotherapy. Journal of Surgical Oncology, 128(7), 1150-1159
Open this publication in new window or tab >>External validation of prognostic scores and comparison of predictive accuracy for patients with colorectal cancer with peritoneal metastases considered for cytoreductive surgery and intraperitoneal chemotherapy
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2023 (English)In: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098, Vol. 128, no 7, p. 1150-1159Article in journal (Refereed) Published
Abstract [en]

Background and Objectives

Prognostic scores are developed to facilitate the selection of patients with colorectal cancer peritoneal metastases (CRPM) for treatment with cytoreductive surgery (CRS) ± intraperitoneal chemotherapy (IPC). Three prominent prognostic scores are the Peritoneal Surface Disease Severity Score (PSDSS), the Colorectal Peritoneal Metastases Prognostic Surgical Score (COMPASS), and the modified COloREctal-Pc (mCOREP). We externally validate these scores and compare their predictive accuracy.

Methods

Data from consecutive CRPM patients who underwent CRS/IPC from 1996 to 2018 was used to externally validate COMPASS, PSDSS, and mCOREP. Analysis evaluated the efficacy of each score in predicting (1) open–close laparotomy—those found at laparotomy to not be eligible for curative intent CRS/IPC, (2) surgical futility—those who underwent open–close laparotomy, palliative debulking surgery, or had an overall survival of less than 12 months, and (3) overall and recurrence-free survival (OS, RFS).

Results

Prognostic scores were calculated for the 174-patient external validation cohort. COMPASS was most accurate in predicting open–close laparotomy, futile surgery, and survival (OS and RFS). Area under the curve (AUC) for open–close prediction was 0.78 (95% confidence interval, CI: 0.68–0.87), representing useful discrimination. However, AUC for futility prediction was 0.62 (95% CI: 0.52–0.71), and C-statistic for OS was 0.65 indicating only possibly helpful discrimination. C-statistic for RFS was 0.59 indicating poor discrimination.

Conclusion

While COMPASS showed the best statistical behavior, accuracy for several clinically relevant outcomes remains low, and thus applicability to clinical practice limited.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
colorectal neoplasm, cytoreductive surgery, intraperitoneal chemotherapy, peritoneal metastases, prognosis
National Category
Surgery Cancer and Oncology Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-528368 (URN)10.1002/jso.27416 (DOI)001051326300001 ()37602499 (PubMedID)
Available from: 2024-05-21 Created: 2024-05-21 Last updated: 2024-05-21Bibliographically approved
Cashin, P., Esquivel, J., Larsen, S. G., Liauw, W., Alzahrani, N. A., Morris, D. L., . . . Fisher, O. M. (2023). Perioperative chemotherapy in colorectal cancer with peritoneal metastases: A global propensity score matched study. eClinicalMedicine, 55, Article ID 101746.
Open this publication in new window or tab >>Perioperative chemotherapy in colorectal cancer with peritoneal metastases: A global propensity score matched study
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2023 (English)In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 55, article id 101746Article in journal (Refereed) Published
Abstract [en]

Background: There is a paucity of studies evaluating perioperative systemic chemotherapy in conjunction with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colorectal cancer peritoneal metastases (CRCPM). The aim was to evaluate neoadjuvant and/or adjuvant systemic therapy in CRCPM.

Methods: Patients with CRCPM from 39 treatment centres globally from January 1, 1991, to December 31, 2018, who underwent CRS+HIPEC were identified and stratified according to neoadjuvant/adjuvant use. Crude data analysis, propensity score matching (PSM) and Cox-proportional hazard modelling was performed.

Findings: Of 2093 patients, 1613 were included in neoadjuvant crude evaluation with 708 in the PSM cohort (354 patients/arm). In the adjuvant evaluation, 1176 patients were included in the crude cohort with 778 in the PSM cohort (389 patients/arm). The median overall survival (OS) in the PSM cohort receiving no neoadjuvant vs neoadjuvant therapy was 37.0 months (95% CI: 32.6-42.7) vs 34.7 months (95% CI: 31.2-38.8, HR 1.08 95% CI: 0.88-1.32, p = 0.46). The median OS in the PSM cohort receiving no adjuvant therapy vs adjuvant therapy was 37.0 months (95% CI: 32.9-41.8) vs 45.7 months (95% CI: 38.8-56.2, HR 0.79 95% CI: 0.64-0.97, p = 0.022). Recurrence-free survival did not differ in the neoadjuvant evaluation but differed in the adjuvant evaluation - HR 1.04 (95% CI: 0.87-1.25, p = 0.66) and 0.83 (95% CI: 0.70-0.98, p = 0.03), respectively. Multivariable Cox-proportional hazard modelling in the crude cohorts showed hazard ratio 1.08 (95% CI: 0.92-1.26, p = 0.37) for administering neoadjuvant therapy and 0.86 (95% CI: 0.72-1.03, p = 0.095) for administering adjuvant therapy.

Interpretation: Neoadjuvant therapy did not confer a benefit to patients undergoing CRS+HIPEC for CRCPM, whereas adjuvant therapy was associated with a benefit in this retrospective setting.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Colorectal cancer, Peritoneal metastases, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Neoadjuvant chemotherapy, Adjuvant chemotherapy
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-495873 (URN)10.1016/j.eclinm.2022.101746 (DOI)000898807700021 ()36457647 (PubMedID)
Available from: 2023-02-03 Created: 2023-02-03 Last updated: 2023-07-13Bibliographically approved
Wang, M., Xu, Y., Shi, J., Zhuang, C., Zhuang, Y., Li, J. & Cashin, P. H. (2023). The effect of cognitive behavioral therapy on chemotherapy-induced side effects and immune function in colorectal cancer patients undergoing chemotherapy: study protocol for a randomized controlled trial. Journal of Gastrointestinal Oncology, 14(4), 1869-1877
Open this publication in new window or tab >>The effect of cognitive behavioral therapy on chemotherapy-induced side effects and immune function in colorectal cancer patients undergoing chemotherapy: study protocol for a randomized controlled trial
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2023 (English)In: Journal of Gastrointestinal Oncology, ISSN 2078-6891, E-ISSN 2219-679X, Vol. 14, no 4, p. 1869-1877Article in journal (Refereed) Published
Abstract [en]

Background: Colorectal cancer (CRC) was one of the most widely diagnosed cancers in the United States in 2021. CRC patients may experience significant psychological stress and are susceptible to depression and anxiety. Previous studies have shown that cognitive behavioral therapy (CBT) can reduce fatigue and improve quality of life among breast cancer patients. However, as a non-pharmaceutical treatment, it remains unclear whether CBT improves chemotherapy-induced side effects and immune function in CRC patients. In this study, we will conduct a randomized controlled trial (RCT) among CRC patients undergoing chemotherapy to determine whether CBT can reduce the side effects of chemotherapy and improve the immune function of CRC patients. Methods: The study will be a single-center RCT. CRC patients undergoing chemotherapy will receive either eight sessions of group-based CBT (every 2-3 weeks) or usual care (usual oncology care). Each participant will undergo assessments at baseline (T0), immediately post-intervention (T1), 3 months postintervention (T2), and 6 months post-intervention (T3). The primary outcome will include chemotherapyinduced side effects in CRC patients. The secondary outcome will be immune function (measured by levels of inflammatory cytokines). Other outcomes will include the levels of tumor markers, assessments of psychological status (perception of stress, depression and anxiety, self-efficacy, sleep quality, quality of life, social support condition, and cognitive function), and necessary laboratory examinations (biochemical index and blood cell counts) among CRC patients undergoing chemotherapy. Discussion: Our study will provide clinical evidence regarding whether CBT should be generalized in clinical treatment and the extent to which CBT reduces chemotherapy- induced side effects for CRC patients.

Place, publisher, year, edition, pages
AME Publishing Company, 2023
Keywords
Cognitive behavioral therapy (CBT), chemotherapy, immune function, colorectal cancer (CRC)
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-518350 (URN)10.21037/jgo-23-625 (DOI)001082846900014 ()37720456 (PubMedID)
Available from: 2023-12-19 Created: 2023-12-19 Last updated: 2024-01-12Bibliographically approved
Dranichnikov, P., Semenas, E., Graf, W. & Cashin, P. (2023). The Impact on Postoperative Outcomes of Intraoperative Fluid Management Strategies During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. European Journal of Surgical Oncology, 49(8), 1474-1480
Open this publication in new window or tab >>The Impact on Postoperative Outcomes of Intraoperative Fluid Management Strategies During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
2023 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, no 8, p. 1474-1480Article in journal (Refereed) Published
Abstract [en]

Background 

The impact of intraoperative fluid management during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on postoperative outcomes has been poorly investigated. This study aimed to investigate the impact of intraoperative fluid management strategy on postoperative outcomes and survival focusing on postoperative hemorrhage. 

 Methods 

509 patients undergoing CRS and HIPEC at Uppsala University Hospital/Sweden 2004-2017 were categorized into two groups according to the intraoperative fluid management strategy: pre-goal directed therapy (pre-GDT) and goal directed therapy (GDT), where a hemodynamic monitor (CardioQ or FloTrac/Vigileo) was used to optimize fluids management. Impact on morbidity, postoperative hemorrhage, length-of-stay and survival was analyzed.

 Results

The pre-GDT group received higher intraoperative fluid volume compared to the GDT group (mean 19.9 vs. 16.2 ml/kg/h, p<0.001). Overall postoperative morbidity Grade III-V was higher in the GDT group (30% vs. 22%, p=0.03). Multivariable adjusted odds ratio (OR) for Grade III-V morbidity was 1.80 (95%CI 1.10-3.10, p=0.02) in the GDT group. Numerically, more cases of postoperative hemorrhage were found in the GDT group (9% vs. 5%, p=0.09), but no correlation was observed in the multivariable analysis 1.37 (95%CI 0.64-2.95, p=0.40). An oxaliplatin regimen was a significant risk factor for postoperative hemorrhage (p=0.03). Mean length of stay was shorter in the GDT group (17 vs. 26 days, p<0.0001). Survival did not differ between the groups.

Conclusion

While GDT management increased the risk for postoperative morbidity, it was associated with shortened hospital stay. Intraoperative fluid management during CRS and HIPEC did not affect the postoperative risk for hemorrhage, while the use of an oxaliplatin regimen did.  

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Intraoperative fluid management, CRS, HIPEC, goal-directed therapy (GDT), postoperative hemorrhage, overall survival.
National Category
Surgery Cancer and Oncology Anesthesiology and Intensive Care
Research subject
Surgery; Oncology
Identifiers
urn:nbn:se:uu:diva-469636 (URN)10.1016/j.ejso.2023.03.003 (DOI)001062760100001 ()36898899 (PubMedID)
Funder
Bengt Ihres FoundationSwedish Cancer Society, 170206
Available from: 2022-03-11 Created: 2022-03-11 Last updated: 2023-10-17Bibliographically approved
Mercier, F., Passot, G., Bonnot, P.-E., Cashin, P., Ceelen, W., Decullier, E., . . . Glehen, O. (2022). An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World Journal of Surgery, 46(6), 1336-1343
Open this publication in new window or tab >>An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
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2022 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, no 6, p. 1336-1343Article in journal (Refereed) Published
Abstract [en]

Purpose Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry.

Methods A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed.

Results The analysis included 83 patients. After a median follow-up of 47 months, the median overall survival (OS) was 34.6 months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications.

Conclusion CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are needed to confirm CRS and HIPEC as the gold standard in this pathology.

Place, publisher, year, edition, pages
Springer, 2022
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-485884 (URN)10.1007/s00268-022-06498-w (DOI)000768638700001 ()35286418 (PubMedID)
Available from: 2022-09-29 Created: 2022-09-29 Last updated: 2022-09-29Bibliographically approved
Dranichnikov, P., Graf, W. & Cashin, P. (2022). Morbidity following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases with or without early postoperative intraperitoneal chemotherapy: A propensity score matched study. European Journal of Surgical Oncology, 48(7), 1598-1605
Open this publication in new window or tab >>Morbidity following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases with or without early postoperative intraperitoneal chemotherapy: A propensity score matched study
2022 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 48, no 7, p. 1598-1605Article in journal (Refereed) Published
Abstract [en]

Background: Combining hyperthermic intraperitoneal chemotherapy (HIPEC) treatment with early postoperative intraperitoneal chemotherapy (EPIC) may increase postoperative morbidity. This study aims to investigate postoperative morbidity after HIPEC+EPIC compared with HIPEC alone in patients with peritoneal metastases (PM).

Materials and methods: This is a retrospective propensity score matched cohort study. All patients undergoing PM treatment at Uppsala University Hospital between February 2004 and December 2014 were included. Propensity score matching with a 1:1 ratio was performed using sex, primary tumor site, preoperative chemotherapy, peritoneal cancer index, completeness of cytoreduction score, and HIPEC regimen. Length of hospital stay, morbidity, reoperation rate, and readmission rate within 6 months were selected as endpoints.

Results: A total of 390 consecutive patients were divided in two arms: HIPEC+EPIC (n = 115) and HIPEC alone (n = 275). The propensity score matching (n = 190) was successful with balanced covariates: 95 patients/arm. The length of stay (LOS) was longer in the HIPEC + EPIC group in the total cohort (30 vs 24 days, p < 0.001), with a trend towards significance in the propensity matched group (29 vs 25 days, p = 0.062). No other differences in endpoints were found.

Conclusion: HIPEC+EPIC is associated with a prolonged hospital stay, but with no statistically significant relevant increase in postoperative morbidity, reoperation rate or incidence of readmission.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2022
Keywords
Early postoperative intraperitoneal chemotherapy (EPIC); HIPEC; Morbidity; Peritoneal metastasis (PM); Propensity score matching (PSM).
National Category
Surgery Cancer and Oncology
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-469192 (URN)10.1016/j.ejso.2022.02.004 (DOI)000833485100019 ()35177313 (PubMedID)
Funder
Swedish Cancer Society, 170206
Available from: 2022-03-07 Created: 2022-03-07 Last updated: 2024-01-15Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3474-9450

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