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Comparative Study
. 2018 Sep;44(9):1378-1383.
doi: 10.1016/j.ejso.2018.04.023. Epub 2018 Jun 19.

Cytoreductive Surgery and HIPEC Improve Survival Compared to Palliative Chemotherapy for Biliary Carcinoma With Peritoneal Metastasis: A Multi-Institutional Cohort From PSOGI and BIG RENAPE Groups

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Comparative Study

Cytoreductive Surgery and HIPEC Improve Survival Compared to Palliative Chemotherapy for Biliary Carcinoma With Peritoneal Metastasis: A Multi-Institutional Cohort From PSOGI and BIG RENAPE Groups

I Amblard et al. Eur J Surg Oncol. .

Abstract

Background: Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy.

Objective: To evaluate the impact on survival of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC.

Material and methods: A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test.

Results: Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the systemic chemotherapy group. In the surgical group, median peritoneal cancer index was 9 (range 3-26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the chemotherapy group (35% vs. 18%, p = 0.001). Median OS was 21.4 and 9.3 months for surgical and chemotherapy group, respectively (p=0.007). Three-year overall survival was 30% and 10% for surgical and chemotherapy group, respectively.

Conclusion: Treatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.

Keywords: Gallbladder; Hilar cholangiocarcinoma; Intra-hepatic cholangiocarcinoma; Klatskin.

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