Skip to main content
SpringerLink
Log in

The Second Procedure Combining Complete Cytoreductive Surgery and Intraperitoneal Chemotherapy for Isolated Peritoneal Recurrence: Postoperative Course and Long-Term Outcome

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Complete cytoreductive surgery (CCRS) with intraperitoneal chemotherapy (IPC) is becoming the gold-standard treatment for resectable peritoneal carcinomatosis, when feasible. However, this approach has not yet been evaluated for isolated peritoneal re-recurrences after previous IPC. The aim of this study was to evaluate the postoperative course and long-term outcome after repeat (re-)CCRS + IPC.

Methods

From 1996 to 2007, 25 re-CCRS + IPC were performed in 20 patients with isolated peritoneal re-recurrences, among 393 CCRS + IPC performed during the same period in the department. Selection was based on the supposedly limited extent of the peritoneal disease and an interval of more than 12 months between the first CCRS + IPC procedure and recurrence. After a re-CCRS, we used re-IPC modalities (method and/or drug) that were systematically different from those of the first IPC. The origins of the tumors were pseudomyxoma (n = 12), colorectal cancer (n = 4), mesothelioma (n = 3), and carcinoid tumor (n = 1).

Results

At laparotomy, mean peritoneal index was 7.6 ± 4.8. Among the 25 procedures, hyperthermic intraperitoneal chemotherapy was used in 15 cases and early postoperative intraperitoneal chemotherapy in 10 cases. The postoperative mortality rate was 4% (n = 1) and six grade 3–4 postoperative complications occurred. The overall 5- and 10-year actuarial survival rates were 72.5% and 58%, respectively. The 5-year disease-free survival rate was 19%. The long-term outcome was not different, whatever the type of primary tumor.

Conclusion

Re-CCRS + IPC is feasible and yields prolonged survival in highly selected patients. Also, the switch to another type of IPC or regimen may have contributed to this prolonged survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88:358–63.

    Article  CAS  PubMed  Google Scholar 

  2. Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89:1545–50.

    Article  CAS  PubMed  Google Scholar 

  3. Elias D, Blot F, El Otmany A, Antoun S, Lasser P, Boige V, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer. 2001;92:71–6.

    Article  CAS  PubMed  Google Scholar 

  4. Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, 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;21:3737–43.

    Article  PubMed  Google Scholar 

  5. Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.

    Article  CAS  PubMed  Google Scholar 

  6. Yan TD, Black D, Savady R, Sugarbaker PH. Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol. 2006;24:4011–19.

    Article  PubMed  Google Scholar 

  7. Elias D, Lefevre JH, Chevalier J, Brouquet A, Marchal F, Classe JM, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27:681–5.

    Article  PubMed  Google Scholar 

  8. Yan TD, Links M, Xu ZY, Kam PC, Glenn D, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei from appendiceal mucinous neoplasms. Br J Surg. 2006;93:1270–6.

    Article  CAS  PubMed  Google Scholar 

  9. Elias D, Honoré C, Ciuchendéa R, Billard V, Raynard B, Lo Dico R, et al. Peritoneal pseudomyxoma: results of a systematic policy of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Br J Surg. 2008;95:1164–71.

    Article  CAS  PubMed  Google Scholar 

  10. Yan TD, Welch L, Black D, Sugarbaker PH. A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. Ann Oncol. 2007;18:827–34.

    Article  CAS  PubMed  Google Scholar 

  11. Elias D, Bedard V, Bouzid T, Duvillard P, Kohneh-Sharhi N, Raynard B, et al. Malignant peritoneal mesothelioma: treatment with maximal cytoreductive surgery plus intraperitoneal chemotherapy. Gastroenterol Clin Biol. 2007;31:784–8.

    Article  PubMed  Google Scholar 

  12. Feldman AL, Libutti SK, Pingpank JF, Bartlett DL, Beresnev TH, Mavroukakis SM, et al. Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. J Clin Oncol. 2003;21:4560–67.

    Article  CAS  PubMed  Google Scholar 

  13. Sugarbaker PH, Graves T, DeBruijn EA, Cunliffe WJ, Mullins RE, Hull WE, et al. Early postoperative intraperitoneal chemotherapy as an adjuvant therapy to surgery for peritoneal carcinomatosis from gastrointestinal cancer: pharmacological studies. Cancer Res. 1990;50:5790–4.

    CAS  PubMed  Google Scholar 

  14. Stephens AD, Alderman R, Chang D, Edwards GD, Esquivel J, Sebbag G, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol. 1999;6:790–6.

    Article  CAS  PubMed  Google Scholar 

  15. Verwaal VJ, Boot H, Aleman BM, van Tinteren H, Zoetmulder FA. Recurrences after peritoneal carcinomatosis of colorectal origin treated by cytoreduction and hyperthermic intraperitoneal chemotherapy: location, treatment, and outcome. Ann Surg Oncol. 2004;11:375–9.

    Article  PubMed  Google Scholar 

  16. Bijelic L, Yan TD, Sugarbaker PH. Treatment failure following complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from colorectal or appendiceal mucinous neoplasms. J Surg Oncol. 2008;98:295–9.

    Article  PubMed  Google Scholar 

  17. Deraco M, Nonaka D, Baratti D, Casali P, Rosai J, Younan R, et al. Prognostic analysis of clinicopathologic factors in 49 patients with diffuse malignant peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Ann Surg Oncol. 2006;13:229–37.

    Article  PubMed  Google Scholar 

  18. Smeenk RM, Verwaal VJ, Antonini N, Zoetmulder FA. Survival analysis of pseudomyxoma peritonei patients treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg. 2007;245:104–9.

    Article  PubMed  Google Scholar 

  19. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. In: Sugarbaker PH, editor. Peritoneal carcinomatosis: principles of management. Boston MA: Kluwer Academic Publishers; 1996. p. 359–74.

    Google Scholar 

  20. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221:29–42.

    CAS  PubMed  Google Scholar 

  21. Sugarbaker PH, Chang D. Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol. 1999;6:727–31.

    Article  CAS  PubMed  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  Google Scholar 

  23. Kianmanesh R, Scaringi S, Sabate JM, Castel B, Pons-Kerjean N, Coffin B, et al. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases. Ann Surg. 2007;245:597–603.

    Article  PubMed  Google Scholar 

  24. Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.

    Article  PubMed  Google Scholar 

  25. Elias D, Lasser P, Hoang JM, Leclere J, Debaene B, Bognel C, et al. Repeat hepatectomy for cancer. Br J Surg. 1993;80:1557–62.

    Article  CAS  PubMed  Google Scholar 

  26. Adam R, Bismuth H, Castaing D, Waechter F, Navarro F, Abascal A, et al. Repeat hepatectomy for colorectal liver metastases. Ann Surg. 1997;225:51–60.

    Article  CAS  PubMed  Google Scholar 

  27. Adam R, Pascal G, Castaing D, Azoulay D, Delvart V, Paule B, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61.

    Article  PubMed  Google Scholar 

  28. Sugarbaker PH, Alderman R, Edwards G, Marquardt CE, Gushchin V, Esquivel J, et al. Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol. 2006;13:635–44.

    Article  PubMed  Google Scholar 

  29. Glehen O, Osinsky D, Cotte E, Kwiatkowski F, Freyer G, Isaac S, et al. Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol. 2003;10:863–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The authors particularly thank Lorna Saint Ange for editing.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Gustave Roussy Cancer Institute, Villejuif Cédex, France

    Antoine Brouquet MD, Diane Goéré MD, Jérémie H. Lefèvre MD, Stéphane Bonnet MD, Frédéric Dumont MD & Dominique Elias MD, PhD

  2. Intensive Care Unit, Gustave Roussy Cancer Institute, Villejuif Cédex, France

    Bruno Raynard MD

Authors
  1. Antoine Brouquet MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diane Goéré MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jérémie H. Lefèvre MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stéphane Bonnet MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frédéric Dumont MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bruno Raynard MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dominique Elias MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Diane Goéré MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brouquet, A., Goéré, D., Lefèvre, J.H. et al. The Second Procedure Combining Complete Cytoreductive Surgery and Intraperitoneal Chemotherapy for Isolated Peritoneal Recurrence: Postoperative Course and Long-Term Outcome. Ann Surg Oncol 16, 2744–2751 (2009). https://doi.org/10.1245/s10434-009-0611-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0611-5

Keywords

Search

Navigation