Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Long term oncologic outcomes from the international PSOGI registry

A Arjona-Sanchez; O Aziz; G Passot; G Salti; A Serrano; J Esquivel; K Van der Speeten; A Sommariva; M Kazi; U Shariff; F Martínez-Regueira; P Piso; Y Yonemura; K Turaga; O Sgarbura; A Avanish Saklani; M Tonello; L Rodriguez-Ortiz; M C Vazquez-Borrego; A Romero-Ruiz; O Glehen; International Laparoscopic PSOGI Registry

doi:10.1016/j.ejso.2023.107001

Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Long term oncologic outcomes from the international PSOGI registry

Eur J Surg Oncol. 2023 Oct;49(10):107001. doi: 10.1016/j.ejso.2023.107001. Epub 2023 Aug 3.

Authors

A Arjona-Sanchez¹, O Aziz², G Passot³, G Salti⁴, A Serrano⁵, J Esquivel⁶, K Van der Speeten⁷, A Sommariva⁸, M Kazi⁹, U Shariff¹⁰, F Martínez-Regueira¹¹, P Piso¹², Y Yonemura¹³, K Turaga¹⁴, O Sgarbura¹⁵, A Avanish Saklani⁹, M Tonello⁸, L Rodriguez-Ortiz¹⁶, M C Vazquez-Borrego¹⁶, A Romero-Ruiz¹⁶, O Glehen³; International Laparoscopic PSOGI Registry

Collaborators

International Laparoscopic PSOGI Registry:
Pablo Marti-Cruchaga¹¹, Gabriel Zozaya¹¹, Carlos Sánchez-Justicia¹¹

Affiliations

¹ Unit of Surgical Oncology, Reina Sofia University Hospital, Cordoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain. Electronic address: alvaroarjona@hotmail.com.
² Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.
³ Department of Surgical Oncology, Hospices Civils de Lyon, Lyon, France.
⁴ Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA; The University of Illinois, Chicago, USA.
⁵ Unit of Surgical Oncology, University Hospital Fuenlabrada, Madrid, Spain.
⁶ Beebe Healthcare Lewes, Delaware, USA.
⁷ Ziekenhuis Oost Limburg, Genk, Belgium.
⁸ Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.
⁹ Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Mumbai. Homi Bhabha National Institute, Mumbai. Advanced Centre for Treatment, Research, And Education in Cancer, India.
¹⁰ University Hospitals Birmingham NHS Foundation Trust and Birmingham Peritoneal Malignancy Unit, Good Hope Hospital, Birmingham, UK.
¹¹ Unit of Surgical Oncology, University Clinic of Navarra, Spain.
¹² Department for General and Visceral Surgery, Krankenhaus Barmherzige Brueder Regensburg, Germany.
¹³ Kishiwada Tokushukai Hospital, Japan.
¹⁴ Department of Surgery, Yale University School of Medicine, USA.
¹⁵ Unit of Surgical Oncology, Institut Du Cancer Montpellier, France.
¹⁶ Unit of Surgical Oncology, Reina Sofia University Hospital, Cordoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain.

PMID: 37579618
DOI: 10.1016/j.ejso.2023.107001

Abstract

The laparoscopic approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (L-CRS + HIPEC) in highly selected patients was previously reported from the PSOGI registry with a demonstrable reduction in length of stay and post-operative morbidity. This study aims to update this international PSOGI registry with a larger cohort of patients and a longer follow-up period.

Methods: An international registry was designed through a networking database (REDCAP®). All centers performing L-CRS + HIPEC were invited through PSOGI to submit data on their cases. Variables such as demographics, clinical outcomes, and survival were analyzed.

Results: A total of 315 L-CRS + HIPEC cases were provided by 14 worldwide centers. A total of 215 patients were included in the L-CRS + HIPEC group. The median peritoneal cancer index (PCI) was 3 (3-5). The median length of stay was 7 days (5-10) and the major morbidity (Clavien-Dindo ≥3) was 6.1% after 30 days. The 5-year disease-free survival (DFS) per tumor origin was: 94% for PMP-LG, 85% for PMP-HG, 100% for benign multicyst peritoneal mesothelioma (MPM), 37.4% for colonic origin, and 54%(at 3 years) for ovarian origin. The 5 years overall survival (OS) per tumor origin was: 100% for PMP-LG, PMP-HG and MPM; 61% for colonic origin, and 74% (at 3 years) for ovarian origin. In addition, a total of 85 patients were analyzed in the laparoscopic risk-reducing HIPEC (L-RR + HIPEC). The median length of stay was 5 days (4-6) and the major morbidity was 6% after 30 days. The 5-year DFS per tumor origin was: 96% for perforated low grade appendiceal mucinous neoplasm (LAMN II) and 68.1% for colon origin. The 5 years OS per tumor origin was: 98% for LAMN II and 83.5% for colonic origin.

Conclusions: Minimally invasive CRS + HIPEC is a safe procedure for selected patients with peritoneal carcinomatosis in specialized centers. It improves perioperative results while providing satisfactory oncologic outcomes. L-RR + HIPEC represents a promising strategy that could be evaluated in patients with high risk of developing peritoneal carcinomatosis into prospective randomized trials.