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Utilization and Treatment Patterns of Cytoreduction Surgery and Intraperitoneal Chemotherapy in the United States

  • Ryan J. Ellis
  • Cary Jo R. Schlick
  • Anthony D. Yang
  • Emma L. Barber
  • Karl Y. Bilimoria
  • Ryan P. MerkowEmail author
Peritoneal Surface Malignancy
  • 25 Downloads

Abstract

Introduction

Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) is an effective treatment option for selected patients with peritoneal metastases (PM), but national utilization patterns are poorly understood. The objectives of this study were to (1) describe population-based trends in national utilization of CRS/IPC; (2) define the most common indications for the procedure; and (3) characterize the types of hospitals performing the procedure.

Methods

The National Inpatient Sample (NIS) was used to identify patients from 2006 to 2015 who underwent CRS/IPC, and to calculate national estimates of procedural frequency and oncologic indication. Hospitals performing CRS/IPC were classified based on size and teaching status.

Results

The estimated annual number of CRS/IPC cases increased significantly from 189 to 1540 (p < 0.001). Overall, appendiceal cancer was the most common indication (25.7%), followed by ovarian cancer (23.3%), colorectal cancer (22.5%), and unspecified PM (15.0%). Remaining cases (13.5%) were performed for other indications. Most cases were performed in large teaching hospitals (65.9%), compared with smaller teaching hospitals (25.1%), large non-teaching hospitals (5.3%), or small non-teaching hospitals (3.2%). Patients were more likely to undergo CRS/IPC without a diagnosis based on level I evidence (appendiceal, ovarian, or colorectal) at large non-academic hospitals (odds ratio 2.00, 95% confidence interval 1.18–3.38, p = 0.010) compared with large academic hospitals.

Conclusions

Utilization of CRS/IPC is increasing steadily in the US, is performed at many types of facilities, and often for a variety of indications that are not supported by high-level evidence. Given associated morbidity of CRS/IPC, a national registry dedicated to cases of IPC is necessary to further evaluate use and outcomes.

Notes

Funding

RJE (AHRQ 5T32HS000078) is supported by a postdoctoral research fellowship and the American College of Surgeons Clinical Scholars in Residence Program; ELB is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12 HD050121); and RPM is supported by the Agency for Research and Healthcare Quality (K12HS026385) and an Institutional Research Grant from the American Cancer Society (IRG-18-163-24).

Disclosures

Ryan J. Ellis, Cary Jo R. Schlick, Anthony D. Yang, Emma L. Barber, Karl Y. Bilimoria, and Ryan P. Merkow report no conflicts of interest, financial or otherwise, related to this work. As an organization, the American College of Surgeons had no role in the design and conduct of this study; analysis and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. Views expressed in this work represent those of the authors only.

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2018;68(1):7-30.CrossRefGoogle Scholar
  2. 2.
    Spratt JS, Adcock RA, Muskovin M, et al., Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res. 1980;40(2):256-60.Google Scholar
  3. 3.
    Field SB, Bleehen NM. Hyperthermia in the treatment of cancer. Cancer Treat Rev. 1979;6(2):63-94.CrossRefGoogle Scholar
  4. 4.
    Alberts DS, Liu PY, Hannigan EV, et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med. 1996;335(26):1950-5.CrossRefGoogle Scholar
  5. 5.
    Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21(20):3737-43.CrossRefGoogle Scholar
  6. 6.
    Armstrong DK, Bundy B, Wenzel L, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354(1):34-43.CrossRefGoogle Scholar
  7. 7.
    van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378(3):230-240.CrossRefGoogle Scholar
  8. 8.
    National Comprehensive Cancer Network. Colon Cancer (Version 4.2018, October 19, 2018). Available at: https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed 14 Feb 2019.
  9. 9.
    National Comprehensive Cancer Network. Ovarian Cancer (Version 2.2018, March 9, 2018). Available at: https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf. Accessed 14 February 2019.
  10. 10.
    Sugarbaker PH, Zhu BW, Sese GB, et al., Peritoneal carcinomatosis from appendiceal cancer: results in 69 patients treated by cytoreductive surgery and intraperitoneal chemotherapy. Dis Colon Rectum. 1993;36(4):323-9.CrossRefGoogle Scholar
  11. 11.
    Jacquet P, Stephens AD, Averbach AM, et al., Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer. 1996;77(12):2622-9.CrossRefGoogle Scholar
  12. 12.
    Kecmanovic DM, Pavlov MJ, Ceranic MS, et al. Treatment of peritoneal carcinomatosis from colorectal cancer by cytoreductive surgery and hyperthermic perioperative intraperitoneal chemotherapy. Eur J Surg Oncol. 2005;31(2):147-52.CrossRefGoogle Scholar
  13. 13.
    Ceelen WP, Peeters M, Houtmeyers P, et al. Safety and efficacy of hyperthermic intraperitoneal chemoperfusion with high-dose oxaliplatin in patients with peritoneal carcinomatosis. Ann Surg Oncol. 2008;15(2):535-41.CrossRefGoogle Scholar
  14. 14.
    Desantis M, Bernard JL, Casanova V, et al. Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC). Langenbecks Arch Surg. 2015;400(1):37-48.CrossRefGoogle Scholar
  15. 15.
    Foster JM, Sleightholm R, Patel A, et al. Morbidity and mortality rates following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy compared with other high-risk surgical oncology procedures. JAMA Netw Open. 2019;2(1):e186847.CrossRefGoogle Scholar
  16. 16.
    Alzahrani NA, Valle SJ, Fisher OM, et al. Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: a multi-institutional experience. J Surg Oncol. 2019;119(3):336-346.Google Scholar
  17. 17.
    Healthcare Cost and Utilization Project. Overview of the National (Nationwide) Inpatient Sample (NIS). Available at: https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 14 February 2019.
  18. 18.
    Houchens RL, Ross DN, Elixhauser A, et al. Nationwide Inpatient Sample Redisign Final Report. HCUP NIS Related Reports Online. US Agency for Healthcare Research and Quality; 2014.Google Scholar
  19. 19.
    Koga S. Prophylactic and therapeutic continuous hyperthermic peritoneal perfusion for peritoneal metastases of gastric cancer [in Japanese]. Gan No Rinsho. 1985;31(9 Suppl):1103-5.Google Scholar
  20. 20.
    Fujimoto S, Shrestha RD, Kokubun M, et al. Intraperitoneal hyperthermic perfusion combined with surgery effective for gastric cancer patients with peritoneal seeding. Ann Surg. 1988;208(1):36-41.CrossRefGoogle Scholar
  21. 21.
    Beeharry MK, Liu WT, Yao XX, et al. A critical analysis of the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy combo in the clinical management of advanced gastric cancer: an effective multimodality approach with scope for improvement. Transl Gastroenterol Hepatol. 2016;1:77.CrossRefGoogle Scholar
  22. 22.
    Feingold PL, Kwong ML, Sabesan A, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer and other less common disease histologies: is it time? J Gastrointest Oncol. 2016;7(1):87-98.Google Scholar
  23. 23.
    Sardi A, Munoz-Zuluaga CA, Sittig M, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma. Clin Case Rep. 2018;6(6):1142-1152.CrossRefGoogle Scholar
  24. 24.
    Hayes-Jordan AA, Coakley BA, Green HL, et al. Desmoplastic small round cell tumor treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: results of a phase 2 trial. Ann Surg Oncol. 2018;25(4):872-877.CrossRefGoogle Scholar
  25. 25.
    Gani F, Conca-Cheng AM, Nettles B, et al. Trends in outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. J Surg Res. 2019;234:240-248.CrossRefGoogle Scholar
  26. 26.
    Kusamura S, Moran BJ, Sugarbaker PH, et al. Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. Br J Surg. 2014;101(13):1758-65.CrossRefGoogle Scholar
  27. 27.
    Stitzenberg KB, Meropol NJ. Trends in centralization of cancer surgery. Ann Surg Oncol. 2010;17(11):2824-31.CrossRefGoogle Scholar
  28. 28.
    Robinson CN, Chen GJ, Balentine CJ, et al. Minimally invasive surgery is underutilized for colon cancer. Ann Surg Oncol. 2011;18(5):1412-8.CrossRefGoogle Scholar
  29. 29.
    Habermann EB, Thomsen KM, Hieken TJ, et al. Impact of availability of immediate breast reconstruction on bilateral mastectomy rates for breast cancer across the United States: data from the nationwide inpatient sample. Ann Surg Oncol. 2014;21(10):3290-6.CrossRefGoogle Scholar
  30. 30.
    Schlottmann F, Strassle PD, Charles AG, et al. Esophageal cancer surgery: spontaneous centralization in the US contributed to reduce mortality without causing health disparities. Ann Surg Oncol. 2018;25(6):1580-1587.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Ryan J. Ellis
    • 1
    • 2
    • 3
  • Cary Jo R. Schlick
    • 1
    • 2
  • Anthony D. Yang
    • 1
    • 2
  • Emma L. Barber
    • 1
    • 4
  • Karl Y. Bilimoria
    • 1
    • 2
    • 3
  • Ryan P. Merkow
    • 1
    • 2
    • 3
    Email author
  1. 1.Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer CenterNorthwestern University Feinberg School of Medicine and Northwestern Memorial HospitalChicagoUSA
  3. 3.Division of Research and Optimal Patient CareAmerican College of SurgeonsChicagoUSA
  4. 4.Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer CenterNorthwestern University Feinberg School of Medicine and Northwestern Memorial HospitalChicagoUSA

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