Repeat Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Using Open and Closed Abdomen Techniques for Colorectal Peritoneal Metastases and Peritoneal Pseudomyxoma Recurrences: Results from Six French Expert Centers.

Autor: Tidadini F; Department of Digestive and Emergency Surgery, Grenoble-Alpes University Hospital, Grenoble, France. FTidadini@chu-grenoble.fr.; Lyon Center for lnnovation in Cancer, Lyon 1 University, Lyon, France. FTidadini@chu-grenoble.fr., Arvieux C; Department of Digestive and Emergency Surgery, Grenoble-Alpes University Hospital, Grenoble, France.; Lyon Center for lnnovation in Cancer, Lyon 1 University, Lyon, France., Glehen O; Lyon Center for lnnovation in Cancer, Lyon 1 University, Lyon, France.; Surgical Department, Lyon Sud University Hospital, Lyon, France., Sourrouille I; Department of Surgical Oncology, Gustave Roussy Cancer Center, Villejuif, France., Marchal F; Department of Digestive Surgery, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France., Abba J; Department of Digestive and Emergency Surgery, Grenoble-Alpes University Hospital, Grenoble, France., Malgras B; Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France., Quesada JL; Department of Digestive and Emergency Surgery, Grenoble-Alpes University Hospital, Grenoble, France., Pocard M; Department of Digestive Surgery, La Pitié Salpêtrière Hospital, Paris, France.; INSERM, U965 CART Unit, Paris, France., Ezanno AC; Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France. ezanno.annececile@gmail.com.; INSERM, Univ Rennes, OSS (Oncogenesis, Stress, Signaling) Laboratory, UMR_S 1242, Rennes, France. ezanno.annececile@gmail.com.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2025 Jan; Vol. 32 (1), pp. 209-220. Date of Electronic Publication: 2024 Nov 04.
DOI: 10.1245/s10434-024-16407-1
Abstrakt: Background: Standard treatment for resectable peritoneal metastases (PM) combines cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC); however, the rate of recurrence remains high and repeat CRS/HIPEC may be considered in well-selected patients. We describe our postoperative and oncological outcomes.
Methods: Between 1994 and 2024, data from 132 repeat CRS/HIPEC procedures were analyzed in this retrospective multicenter study. Morbimortality, overall survival (OS) and recurrence-free survival (RFS) were evaluated for colorectal peritoneal metastases (CRPM) and peritoneal pseudomyxoma (PMP).
Results: Overall, 63 patients, including 55 patients with CRPM (87.3%) and 8 patients with PMP (12.7%), underwent CRS/HIPEC. Of these patients, 58 (92%) underwent CRS/HIPEC twice, 4 (6.3%) underwent CRS/HIPEC three times, and 1 (1.6%) underwent CRS/HIPEC four times. Peritoneal Carcinomatosis Index (PCI) score, operating room occupancy, complication and readmission rates at day 90, and length of intensive care unit and hospital stay were similar between the initial and first repeat CRS/HIPEC procedures. No 90-day postoperative mortality occurred. For CRPM, the median OS was 82.3, 53.9, and 74.5 months from the initial, first, and second repeat CRS/HIPEC procedures, respectively, with a median RFS of 22.0, 36.9, and 13.2 months, respectively. For PMP, after a median follow-up of 70.8 and 39.3 months from the initial and first repeat CRS/HIPEC procedures, respectively, all patients were alive, with a median RFS of 22.4 and 39.4 months, respectively. Multivariate analysis shown that no factor was significantly related to severe complications (Dindo-Clavien 3-4) or OS.
Conclusions: In selected patients with CRPM and PMP, CRS/HIPEC shows comparable results between the initial and repeat procedures in terms of postoperative outcomes, and appears to improve survival, especially for PMP. Repeat CRS/HIPEC is an option to be considered in patients presenting with CRPM or PMP.
Competing Interests: Declarations. Conflicts of interest: Olivier Glehen is a consultant for Gamida. Fatah Tidadini, Catherine Arvieux, Isabelle Sourrouille, Frédéric Marchal, Julio Abba, Brice Malgras, Jean-Louis Quesada, Marc Pocard, and Anne-Cécile Ezanno have no conflicts of interest to declare that may be relevant to the contents of this study. Ethical approval: All procedures performed in this study were in accordance with the Ethical Standards Research Committee and the Helsinki Declaration. The study was registered in the internal register of the Grenoble Alpes University Hospital of studies respecting the reference methodology MR004 of the French National Commission for Informatics and Freedoms (CNIL). Informed consent: Patients were informed that their anonymized data might be the subject of clinical research in the future and that they could oppose this by informing the doctor. Disclaimer: The contents of this study are solely the responsibility of the authors. Data availability: Data are available for bona fide researchers upon written request to the authors.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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