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The role of intraperitoneal chemotherapy in the surgical management of pancreatic ductal adenocarcinoma: a systematic review

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Abstract

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis, particularly for patients with metastatic disease. Treatment for oligometastatic presentation has been reported in recent literature, but the role of intraperitoneal chemotherapy for patients with peritoneal metastases (PM) remains unclear. We performed a systematic literature search of the PubMed, Cochrane and Embase databases in order to identify clinical trials and case-series reporting on the safety and efficacy of intraperitoneal chemotherapy in patients with PDAC-derived PM. Eight publications reporting on 85 patients were identified, using three different therapeutic strategies. First, 37 patients received cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for PDAC with PM. Grade 3 and 4 complications occurred in 37.8% of patients, without perioperative mortality. Median disease-free survival and overall survival (OS) rates varied from 4 to 36 months and 4 to 62 months, respectively. Secondly, 40 patients with resectable PDAC without PM received prophylactic HIPEC following pancreatic resection, with postoperative morbidity and mortality rates of 30% and 5%, and 5-year OS rates of 23–24%. Finally, eight patients with PDAC-derived peritoneal disease were converted to resectable disease after receiving neoadjuvant intraperitoneal chemotherapy and operated on with curative intent, achieving a median OS of 27.8 months. In conclusion, CRS with HIPEC for PDAC-derived PM appears to be safe, conferring the same postoperative morbidity and mortality as reported on non-pancreatic malignancies. In highly selected patients, it could be considered for short-term disease control. However, long-term survival remains poor. The addition of prophylactic HIPEC for resectable PDAC cannot be recommended.

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Authors and Affiliations

  1. Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Alexandre Brind’Amour, Mitchell Webb, Marina Parapini, Maja Segedi, Stephen W. Chung, Stéphanie Chartier-Plante, Charles H. Scudamore & Peter T. W. Kim

  2. Department of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada

    Alexandre Brind’Amour, Lucas Sidéris & Pierre Dubé

  3. Department of Surgery, University of Montreal, Montreal, QC, Canada

    Lucas Sidéris & Pierre Dubé

  4. Gordon & Leslie Diamond Health Care Centre, 2775 Laurel Street, 5th Floor, Vancouver, BC, V5Z 1M9, Canada

    Alexandre Brind’Amour

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AB and PK had the idea for the article; AB and MW performed the literature search and data analysis; AB, MW and MP drafted the manuscript and all authors critically revised the work. PK is guarantor for the project.

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Correspondence to Alexandre Brind’Amour.

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Brind’Amour, A., Webb, M., Parapini, M. et al. The role of intraperitoneal chemotherapy in the surgical management of pancreatic ductal adenocarcinoma: a systematic review. Clin Exp Metastasis 38, 187–196 (2021). https://doi.org/10.1007/s10585-021-10074-2

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