I Amblard1, F Mercier2, D L Bartlett3, S A Ahrendt3, K W Lee3, H J Zeh3, E A Levine4, D Baratti5, M Deraco5, P Piso6, D L Morris7, B Rau8, A A K Tentes9, J-J Tuech10, F Quenet11, E Akaishi12, M Pocard13, Y Yonemura14, G Lorimier15, D Delroeux16, L Villeneuve17, O Glehen1, G Passot18. 1. Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon; University of Lyon 1, EMR 37-38, France. 2. Department of Surgical Oncology, University of Montreal, Montreal, Canada. 3. Department of Surgery, University of Pittsburgh Medical Center Shaydyside Hospital, Pittsburg, USA. 4. Department of Surgical Sciences-Oncology, Wake Forest Baptist Medical Center, Winston Salem, USA. 5. Department of Surgery, Peritoneal Malignancy Program, National Cancer Institute, Milan, Italy. 6. Department of Surgical Oncology, Barmherzige Brüder Krankenhaus Regensburg, Germany. 7. Department of Surgery, University of New South Wales, Sidney, Australia. 8. Department of Surgical Oncology, Charite Campus Virchow Klinikum University of Berlin, Germany. 9. Department of Surgery, Didimotichon General Hospital, Athens/Didimotichon, Greece. 10. Department of Surgical Oncology, CHU Charles Nicolle, Rouen, France. 11. Department of Surgical Oncology, Institut du Cancer de Montpellier, France. 12. Department of Surgical Oncology, Centro de Oncologia Hospital Sirio Libanes, Sao Paulo, Brazil. 13. Department or Surgical Oncology, Hopital Lariboisière, Paris, France. 14. Department of Surgical Oncology, Organization to Support Peritoneal Dissemination Treatment, Osaka, Japan. 15. Department of Surgical Oncology, ICO-Paul Papin, Angers, France. 16. Department of Surgical Oncology, CHU de Besançon, France. 17. University of Lyon 1, EMR 37-38, France; Hospices Civils de Lyon, Unité de Recherche Clinique, Pôle Information Medicale Evaluation Recherche, Lyon, France. 18. Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon; University of Lyon 1, EMR 37-38, France. Electronic address: guillaume.passot@chu-lyon.fr.
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.
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.