Long-term outcomes with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis: 10-year experience in a developing country

Abstract

Objectives To report oncological outcomes after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) from a center specialized in peritoneal malignancies. Methods A review of 119 CRS/HIPEC patients treated between 2007-2017 at a tertiary referral center in Bogota, Colombia was performed. Patient characteristics, surgical variables, and postoperative outcomes were prospectively collected and analyzed. Results Median age at diagnosis was 51-yo (r, 22-78) and 73% (n = 87) were female. The primary origin of the peritoneal carcinomatosis was the appendix in 64%, advanced ovarian and primary peritoneal serous carcinomas (PC) in 17%, colorectal cancer (CRC) in 10.1%, peritoneal mesothelioma (PM) in 9%, and others in 1.6%. Prior surgical Peritoneal Cancer Index (PCI) was 19 (r, 2-39) and 25.2% were exposed to preoperative chemotherapy. Median time from diagnosis to CRS/HIPEC was 11.4 months (r, 1.0-134.1). Mean operative time was 881 min (SD +/- 223 min) and complete cytoreduction rate (CCR) was 81.5% (75% appendiceal tumors, 94% PC, 83% CRC, and 100% PM [p = 0.81]). Grade IV, and V complications according to the Clavien-Dindo classification were reported in 12%, and 4% of patients, respectively. Progression-Free Survival (PFS) was 38.4 months (95%CI 12.6-64.3) and 5-year PFS was 64%. PFS was positively influenced by appendiceal and multicystic mesothelioma histology (p = 0.035) as well as complete cytoreduction (p = 0.0001). At 42-month median follow-up 26 patients have died and the median overall survival (OS) was 108.5 months (95%CI 77.5-139.5). OS of patients with and without relapse was 78.6 months (95% CI 36.1-121.1) and NR (p = 0.002), respectively, and only this variable adversely affected the multivariate analysis (RR 3.7, 95% CI 1.4-9.5; p = 0.007). Conclusion CRS/HIPEC is an effective treatment for patients with peritoneal neoplasms providing meaningful long-term survival in low and high-grade tumors and should be considered the standard of care. Our results, from a specialized center in a developing Latin-American country, are comparable to those from first-world centers, implying the importance of group experience in providing high-quality outcomes. Results showed that patients without relapse at the 5th year follow-up marker could be considered cured, but should remain under clinical observation.