Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy |
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| Authors: | Olivier Glehen MD PhD François N Gilly MD PHD Florent Boutitie Jean M Bereder MD François Quenet MD Lucas Sideris MD Baudouin Mansvelt MD Gérard Lorimier MD Simon Msika MD PhD Dominique Elias MD PhD |
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| Institution: | 1. Surgical Oncology Department, Lyon Civil Hospices, South Lyon University Hospital Center, Lyon, FranceFax: (011) 33‐478‐863‐343;2. Surgical Oncology Department, Lyon Civil Hospices, South Lyon University Hospital Center, Lyon, France;3. Biostatistics Service, Lyon Civil Hospices, Lyon, France;4. Surgical Oncology Department, l'Archet Hospital, Nice University Hospital Center, Nice, France;5. Surgical Oncology Department, Val d'Aurelle Center, Montpellier, France;6. Surgical Oncology Department, Maisonneuve‐Rosemont Hospital, Montreal, Canada;7. Surgical Oncology Department, Jolimont Hospital, Haine St. Paul, Belgium;8. Surgical Oncology Department, Paul Papin Center, Angers, France;9. Surgical Oncology Department, Louis Mourier Hospital, Collombes, France;10. Surgical Oncology Department, Institut Gustave Roussy, Villejuif, France |
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| Abstract: | BACKGROUND: Peritoneal carcinomatosis (PC) from nonovarian malignancies long has been regarded as a terminal disease. Over the past decade, new locoregional therapeutic approaches combining cytoreductive surgery with perioperative intraperitoneal chemotherapy (PIC) have evolved that have demonstrated improved survival. METHODS: A retrospective, multicenter cohort study was performed in French‐speaking institutions to evaluate toxicity and principal prognostic factors after cytoreductive surgery and PIC (hyperthermic intraperitoneal chemotherapy HIPEC] and/or early postoperative intraperitoneal chemotherapy EPIC]) for PC from nongynecologic malignancies. RESULTS: The study included 1290 patients from 25 institutions who underwent 1344 procedures between February 1989 and December 2007. HIPEC was performed in 1154 procedures. The principal origins of PC were colorectal adenocarcinoma (N = 523), pseudomyxoma peritonei (N = 301), gastric adenocarcinoma (N = 159), peritoneal mesothelioma (N = 88), and appendiceal adenocarcinoma (N = 50). The overall morbidity and mortality rates were 33.6% and 4.1%, respectively. In multivariate analysis, patient age, the extent of PC, and institutional experience had a significant influence on toxicity. The overall median survival was 34 months; and the median survival was 30 months for patients with colorectal PC, not reached for patients with pseudomyxoma peritonei, 9 months for patients with gastric PC, 41 months for patients with peritoneal mesothelioma, and 77 months for patients with PC from appendiceal adenocarcinoma. Independent prognostic indicators in multivariate analysis were institution, origin of PC, completeness of cytoreductive surgery, extent of carcinomatosis, and lymph node involvement. CONCLUSIONS: A therapeutic approach that combined cytoreductive surgery with PIC was able to achieve long‐term survival in a selected group of patients who had PC of nonovarian origin and had acceptable morbidity and mortality. The current results indicated that this treatment should be centralized to institutions with expertise in the management of PC. Cancer 2010. © 2010 American Cancer Society. |
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| Keywords: | peritoneal carcinomatosis intraperitoneal chemotherapy hyperthermia cytoreductive surgery peritonectomy |
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