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Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis: A 30-year Institutional Experience

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) improves survival in abdominal cancer patients with metastatic disease limited to the peritoneal cavity. Patients are increasingly being offered repeat CRS-HIPECs for peritoneal recurrence. However, in this rare clinical scenario, the survival benefit of performing repeat CRS-HIPEC operations remains unclear.

Methods

A retrospective review of the CRS-HIPEC database at Wake Forest Baptist Medical Center was performed over a 30-year timespan. From 1547 patients with appendix cancers, colorectal cancers, mesotheliomas, and other miscellaneous cancers, 156 received more than one CRS-HIPEC. Kaplan-Meier survival analysis was performed using overall survival (OS) from the time of surgery as the primary endpoint. Multi-variable Cox proportional hazards regression modelling was performed on pertinent clinical variables.

Results

Patients who received multiple CRS-HIPECs had significantly better median OS (10.7 years) versus those who received one CRS-HIPEC (2.5 years), with appendix cancers faring best (12.9 years). Resection status R2a or better was achieved in 76.4% of repeat CRS-HIPECs. There were no significant changes in complication rates after repeat CRS-HIPEC. On multivariate analysis of repeat CRS-HIPEC, patients with appendix and colorectal cancers, heart disease, and poor functional status were independently associated with poor OS. Factors not independently associated with OS were age, sex, body mass index, race, diabetes, lung disease, smoking history, and systemic chemotherapy between CRS-HIPECs.

Conclusions

Performing multiple CRS-HIPEC operations on appropriate surgical candidates may significantly prolong survival. Appendix cancers derived the greatest benefit. Satisfactory resection margins and complication rates are comparable to first cases and achievable in repeat CRS-HIPEC procedures.

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Funding

The Smith Family Fund, Wake Forest University Comprehensive Cancer Center Biostatistics shared resource funded via the NCI grant award P30CA012197.

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Authors and Affiliations

  1. Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA

    Cristian D. Valenzuela MD, Edward A. Levine MD, Christopher W. Mangieri MD, Rohin Gawdi BA, Omeed Moaven MD, Megan E. Lundy MD, Kathleen C. Perry BS, Konstantinos I. Votanopoulos MD PhD & Perry Shen MD

  2. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Gregory Russell BS MS

Authors
  1. Cristian D. Valenzuela MD
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  2. Edward A. Levine MD
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  3. Christopher W. Mangieri MD
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  5. Omeed Moaven MD
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  6. Gregory Russell BS MS
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  8. Kathleen C. Perry BS
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  9. Konstantinos I. Votanopoulos MD PhD
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  10. Perry Shen MD
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Correspondence to Perry Shen MD.

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Valenzuela, C.D., Levine, E.A., Mangieri, C.W. et al. Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis: A 30-year Institutional Experience. Ann Surg Oncol 29, 3436–3445 (2022). https://doi.org/10.1245/s10434-022-11441-3

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  • DOI: https://doi.org/10.1245/s10434-022-11441-3

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