Mackenzie C Morris1, Jordan M Cloyd2, John Hays3, Sameer H Patel4. 1. Division of Surgical Oncology, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way (ML 0558), Cincinnati, OH, 45267-0558, USA. 2. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, USA. 3. Division of Medical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, USA. 4. Division of Surgical Oncology, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way (ML 0558), Cincinnati, OH, 45267-0558, USA. patel5se@ucmail.uc.edu.
Abstract
BACKGROUND: Peritoneal carcinomatosis, from a variety of gastrointestinal and gynecological malignancies, has been historically challenging to treat and there remains a wide range of biologic aggressiveness in these patients. Malignancies commonly associated with PC include those of colorectal, appendiceal, gastric, ovarian, sarcoma, small intestinal, and primary peritoneal origin among others. Advances in our understanding of this unique disease process have led to significant interest in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) as an emerging treatment option. The goal of CRS-HIPEC is to remove all visible macroscopic disease while preserving organ function, and then treat microscopic disease through perfusion of the peritoneal cavity with heated chemotherapy. PURPOSE: Although recent reviews have focused on the management of peritoneal carcinomatosis secondary to colorectal cancer given the publication of several recent randomized controlled trials, the purpose of the current review is to summarize the evidence on CRS-HIPEC for non-colorectal peritoneal surface malignancies, including appendiceal neoplasms, malignant peritoneal mesothelioma, gastric cancer, and ovarian cancer. RESULTS: While retrospective studies have clarified the importance of prognostic factors such as the peritoneal carcinomatosis index, completeness of cytoreduction, histopathological characteristics, and lymph node positivity, the lack of convincing level 1 evidence for the use of CRS-HIPEC has led to it remaining a highly controversial topic. CONCLUSION: The decision to utilize CRS-HIPEC should involve a multidisciplinary team approach and evaluation of prognostic factors to balance the short-term morbidity of the operation with maximum long-term benefits. Large, multi-institutional groups and ongoing trials hold promise for clarifying the role of CRS-HIPEC in peritoneal surface malignancies.
BACKGROUND:Peritoneal carcinomatosis, from a variety of gastrointestinal and gynecological malignancies, has been historically challenging to treat and there remains a wide range of biologic aggressiveness in these patients. Malignancies commonly associated with PC include those of colorectal, appendiceal, gastric, ovarian, sarcoma, small intestinal, and primary peritoneal origin among others. Advances in our understanding of this unique disease process have led to significant interest in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) as an emerging treatment option. The goal of CRS-HIPEC is to remove all visible macroscopic disease while preserving organ function, and then treat microscopic disease through perfusion of the peritoneal cavity with heated chemotherapy. PURPOSE: Although recent reviews have focused on the management of peritoneal carcinomatosis secondary to colorectal cancer given the publication of several recent randomized controlled trials, the purpose of the current review is to summarize the evidence on CRS-HIPEC for non-colorectal peritoneal surface malignancies, including appendiceal neoplasms, malignant peritoneal mesothelioma, gastric cancer, and ovarian cancer. RESULTS: While retrospective studies have clarified the importance of prognostic factors such as the peritoneal carcinomatosis index, completeness of cytoreduction, histopathological characteristics, and lymph node positivity, the lack of convincing level 1 evidence for the use of CRS-HIPEC has led to it remaining a highly controversial topic. CONCLUSION: The decision to utilize CRS-HIPEC should involve a multidisciplinary team approach and evaluation of prognostic factors to balance the short-term morbidity of the operation with maximum long-term benefits. Large, multi-institutional groups and ongoing trials hold promise for clarifying the role of CRS-HIPEC in peritoneal surface malignancies.
Authors: Eliza W Beal; Ahmed Ahmed; Travis Grotz; Jennifer Leiting; Keith F Fournier; Andrew J Lee; Sean Dineen; Sophie Dessureault; Joel M Baumgartner; Jula Veerapong; Callisia Clarke; Erin Strong; Shishir K Maithel; Mohammad Y Zaidi; Sameer Patel; Vikrom Dhar; Ryan Hendrix; Laura Lambert; Fabian Johnston; Nadege Fackche; Mustafa Raoof; Christopher LaRocca; Sean Ronnekleiv-Kelly; Courtney Pokrzywa; Timothy M Pawlik; Sherif Abdel-Misih; Jordan M Cloyd Journal: Am J Surg Date: 2019-09-19 Impact factor: 2.565