Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Int J Clin Oncol. 2018 Oct;23(5):989-998. doi: 10.1007/s10147-018-1301-8. Epub 2018 Jun 5.


Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are used in the management of selected peritoneal malignancies. While most patients achieve long-term disease-free survival, there remains a group with early recurrence (ER). We aim to investigate the clinical factors associated with ER.

Methods: A retrospective review of a prospectively maintained database of CRS-HIPEC patients treated between April 2001 and Feb 2016 was performed. ER was defined as recurrence within 12 months of CRS-HIPEC. Patients were stratified according to time to recurrence and only patients with at least 12-month follow-up were included. Perioperative factors were investigated, and subgroup analyses of colorectal, ovarian and appendiceal groups were performed.

Results: Of the 144 patients included, 30.6% were colorectal, 36.8% ovarian and primary peritoneal, 24.3% appendiceal, 2.1% mesothelioma and 6.3% were of other origins. Thirty-nine patients (27%) suffered ER. Univariable and multivariable analyses revealed that primary tumour type (p = 0.02) and post-CRS adjuvant treatment (p = 0.04) were associated with ER. Appendiceal patients had a lower odds of ER compared to colorectal patients [OR = 0.15 (0.043-0.502) p < 0.002]. Patients who received post-CRS adjuvant treatment had a lower odds of ER than patients without adjuvant treatment [OR = 0.32; (0.128-0.818) p = 0.02].

Conclusion: There remains a 27% risk of ER after CRS-HIPEC. Better patient selection and the administration of adjuvant chemotherapy may help to reduce ER.

Keywords: CRS and HIPEC; Peritoneal metastases; Recurrence.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / therapy
  • Chemotherapy, Adjuvant
  • Chemotherapy, Cancer, Regional Perfusion / adverse effects*
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / therapy
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / adverse effects*
  • Disease-Free Survival
  • Female
  • Humans
  • Hyperthermia, Induced / adverse effects*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy
  • Male
  • Mesothelioma / pathology
  • Mesothelioma / therapy
  • Mesothelioma, Malignant
  • Middle Aged
  • Neoplasm Recurrence, Local / etiology*
  • Neoplasm Recurrence, Local / pathology
  • Peritoneal Neoplasms / pathology
  • Peritoneal Neoplasms / therapy*
  • Prognosis
  • Prospective Studies
  • Reoperation
  • Retrospective Studies
  • Survival Rate
  • Young Adult