Peritoneal Surface Malignancies
Steven Ahrendt, MD
Professor
University of Colroado
Aurora, Colorado, United States
Steven Ahrendt, MD
Professor
University of Colroado
Aurora, Colorado, United States
Benedetto Mungo, MD
Assistant Professor of Surgery
University of Colorado, Department of Surgery, United States
.jpg "Robert J. Torphy, MD photo")
Robert J. Torphy, MD
Srgical Oncology Fellow
University of Colorado
Aurora, Colorado, United States
Cytoreductive surgery (CRS) is the only good treatment option for patients with massive pseudomyxoma peritonei (PMP), and long-term outcome is strongly dependent on achieving a complete cytoreduction. Short HIPEC duration has been ineffective in a phase III trial in colon cancer, and longer HIPEC duration adds significant time and risk to an already lengthy CRS. The purpose of this study is to determine whether the outcome of patients with massive PMP managed with CRS is negatively affected by omitting HIPEC.
Methods: Patients undergoing their initial CRS for pseudomyxoma peritonei at our institution with an operative time exceeding 12 hours were identified from our prospective database. HIPEC was used at the discretion of the surgeon based on the length of the procedure needed to complete the cytoreduction and patient condition at this time. Patients managed with and without HIPEC were analyzed to determine the effect of HIPEC on overall and progression-free survival.
Results:
Between 2017 and the present, 139 patients with PMP underwent CRS. CRS exceeded 12 hours in 33 patients [CRS with (n=21) or without (n=12) HIPEC]. Four patients that completed just the first of a planned two-stage approach were not included. Operative details and long-term results are shown in Table 1. A complete or near complete CRS was achieved in over 86% of patients in both groups. Four of five patients not receiving HIPEC at the initial CRS that developed disease recurrence were candidates for a repeat CRS and three of these patients received HIPEC during this procedure. Overall survival (OS) was similar between patient groups (three-year OS 60% (without HIPEC) versus 75% (HIPEC), p=0.88). Progression-free (PFS) was also similar (p=0.535; one-year PFS 77% (without HIPEC) versus 60% (HIPEC).
Conclusions:
Omitting HIPEC during CRS for massive PMP to achieve maximal cytoreduction provides optimal progression-free and overall survival in patients with massive PMP. The recurrence risk is high in patients with a high initial tumor burden, but HIPEC can be used during iterative procedures when the tumor burden is lower and operative procedures shorter.