The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy

Colorectal Dis. 2015 Sep;17(9):772-8. doi: 10.1111/codi.12975.

Abstract

Aim: The study determined the outcome of 1200 consecutive patients treated for peritoneal malignancy in one surgical unit over a 20-year period.

Method: A retrospective analysis was conducted of a custom designed prospective database of patients undergoing surgery for peritoneal malignancy since 1994. Patient demographics, tumour type, extent of surgery and outcome were recorded.

Results: Between 1994 and January 2014 (when the 1200th case had undergone surgery) 2956 patients were referred with a diagnosis of peritoneal malignancy. Pseudomyxoma peritonei of appendiceal origin was the pathology in 956/1200 (79.7%) patients. Other aetiologies included colorectal peritoneal metastases [89/1200 (7.4%)], abdominal mesothelioma [65/1200 (5.4%)] and miscellaneous [90/1200 (7.5%)]. Overall 863/1200 (71.9%) had complete cytoreduction, 294 (24.5%) had maximal tumour debulking and 43 (3.6%) had laparotomy only. The proportion undergoing complete cytoreduction per quartile of 300 patients was 60.7%, 65.0%, 77.0% and 80.3%. Laparotomy and biopsy fell from 6.4% in the first quartile to 2.7%, 1.7% and 1.3% in subsequent quartiles. The 30-day mortality in the four quartiles was 3.0%, 1.0%, 0.7% and 0.7%. The 5-year survival was 84% in the 636 patients with appendix tumours who had complete cytoreduction, 76% in the 38 with abdominal mesothelioma and 44% in the 60 with colorectal peritoneal metastases.

Conclusion: A centralized approach facilitated high volume experience in a single centre with an increase in the completeness of surgical excision rates and a reduction in mortality and morbidity over time.

Keywords: HIPEC; Peritoneal malignancy; cytoreductive surgery; pseudomyxoma peritonei.

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Appendiceal Neoplasms / pathology*
  • Cisplatin / administration & dosage
  • Colorectal Neoplasms / pathology*
  • Cytoreduction Surgical Procedures*
  • Doxorubicin / administration & dosage
  • Humans
  • Hyperthermia, Induced*
  • Infusions, Parenteral
  • Mesothelioma / secondary
  • Mesothelioma / therapy*
  • Mitomycin / administration & dosage
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Pseudomyxoma Peritonei / therapy*
  • Retrospective Studies
  • Survival Rate

Substances

  • Mitomycin
  • Doxorubicin
  • Cisplatin