Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Peritoneal carcinomatosis, marked by bowel obstruction and death, traditionally has poor response to systemic therapy.
• Cytoreductive surgery (CS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an emerging treatment modality.

Purpose of the Study:

• To evaluate the outcomes and prognostic factors of CS and HIPEC for patients with peritoneal carcinomatosis.
• To assess the impact of institutional experience on treatment outcomes.

Main Methods:

• A prospective database of 1,000 patients treated with CS and HIPEC between 1991 and 2013 was analyzed.
• Patient demographics, performance status, and disease characteristics were recorded.
• Univariate and multivariate analyses were performed, comparing outcomes across experience quintiles.

Main Results:

• The 5-year survival rate was 32.5%, with a median overall survival of 29.4 months.
• Improved survival correlated with preoperative performance status, primary tumor type, resection status, and experience quintile.
• Outcomes, including survival rates and complete cytoreduction, improved over time, while complications decreased.

Conclusions:

• Primary site, performance status, completeness of resection, and institutional experience are key prognostic factors for CS and HIPEC.
• Outcomes have significantly improved due to better patient selection and increased surgical experience.
• CS and HIPEC offer substantial improvement over historical treatments, enabling long-term survival for selected carcinomatosis patients.