Interval Between Cytoreductions as a Marker of Tumor Biology in Selecting Patients for Repeat Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

J Surg Oncol. 2017 Nov;116(6):741-745. doi: 10.1002/jso.24703. Epub 2017 Jun 12.

Abstract

Background and objectives: Repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for recurrence of peritoneal surface malignancies is safe and effective. Patient selection and factors associated with a favorable outcome are still evolving.

Methods: A prospectively maintained institutional database consisting of 1314 CRS/HIPEC procedures performed between February 1993 and December 2015 was reviewed. Clinicopathologic data from 103 patients and 112 (8.5%) repeat CRS/HIPEC procedures were retrospectively analyzed.

Results: Primary tumors were appendiceal for 60 patients (58.3%), mesothelioma for 14 (13.6%), colorectal for 9 (8.7%), ovarian for 8 (7.8%). R0/R1 resection was achieved in 46 (46.5%) patients. The time interval between the initial and the repeat CRS/HIPEC was <1 year for 21 (20.4%), 1-2 years for 40 (38.8%), and >2 years for 42 patients (40.8%). Overall median survival was 4.3 years and correlated with the time interval (1.3 years for <1 years, 3.7 years for 1-2 years, and 7 years for >2 years; P < 0.001). In multivariate analysis, the R status (P = 0.005) and a time interval of more than 2 years (P = 0.0002) were strongly associated with survival with each additional month between the surgeries conferring a 2.6% reduction in the risk of death.

Conclusions: The current series validates time interval between cytoreductions as a major surrogate of tumor biology in selection of patients with recurrent peritoneal surface malignancies for repeat CRS/HIPEC. Complete repeat cytoreduction more than 2 years from the initial surgery is associated with a favorable outcome.

Keywords: hyperthermic intraperitoneal chemotherapy; repeat cytoreductions.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chemotherapy, Cancer, Regional Perfusion / methods*
  • Chemotherapy, Cancer, Regional Perfusion / statistics & numerical data
  • Cytoreduction Surgical Procedures / methods*
  • Cytoreduction Surgical Procedures / statistics & numerical data
  • Databases, Factual
  • Female
  • Humans
  • Hyperthermia, Induced / methods*
  • Hyperthermia, Induced / statistics & numerical data
  • Male
  • Middle Aged
  • Neoplasms / pathology
  • Neoplasms / therapy*
  • Reoperation
  • Retrospective Studies
  • Time Factors
  • Young Adult