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Published on: July 31, 2016
Implementation of a standardized HIPEC protocol improves outcome for peritoneal malignancy.
Anke M J Kuijpers1, Arend G J Aalbers, Simon W Nienhuijs
1Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands, a.kuijpers@nki.nl.
The Dutch HIPEC protocol improved outcomes for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Post-protocol implementation saw reduced morbidity and increased complete cytoreductions for peritoneal carcinomatosis and pseudomyxoma peritonei.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have evolved significantly.
- A pioneer hospital's experience led to the development of the standard Dutch HIPEC protocol.
- This study compares outcomes before and after the clinical implementation of the Dutch HIPEC protocol.
Purpose of the Study:
- To evaluate the impact of the Dutch HIPEC protocol implementation on patient outcomes.
- To compare the characteristics and results of CRS and HIPEC during the pioneer phase versus the implementation phase.
Main Methods:
- Retrospective analysis of 472 CRS and HIPEC procedures in the Netherlands.
- Pioneer cohort (1995-1999): 100 procedures.
- Implementation cohort (2005-2012): 272 procedures.
- Control group (2009-2011): 100 recent procedures from the pioneer center.
- Indications included peritoneal carcinomatosis (PC) from colorectal carcinoma and pseudomyxoma peritonei (PMP).
Main Results:
- Of 472 procedures, 69% were for PC and 31% for PMP.
- The pioneer phase showed more affected abdominal regions and resections, but less complete cytoreduction and higher major morbidity (64% vs. 32%).
- Implementation phase outcomes were comparable to the control group, indicating sustained improvement.
Conclusions:
- Implementation of the Dutch HIPEC protocol has led to improved patient outcomes.
- Key improvements include increased completeness of cytoreduction and decreased patient morbidity.
- The protocol has standardized and enhanced the effectiveness of CRS and HIPEC in the Netherlands.
