Skip to main content
SpringerLink
Log in

Repeat Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Is Not Associated with Prohibitive Complications: Results of a Multiinstitutional Retrospective Study

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is offered to select patients with peritoneal metastases. In instances of recurrence/progression, a repeat CRS/HIPEC may be considered. The perioperative morbidity and the potential oncologic benefits are not well described.

Patients and Methods

We performed a retrospective analysis of a multiinstitutional database to assess the perioperative outcomes following repeat CRS/HIPEC (repeat). Kaplan–Meier and Cox estimates were used to assess survival.

Results

In the entire cohort, 2157 patients were analyzed, with 158 (7.3%) in the repeat cohort. The rate of complete cytoreduction was 89.8% versus 83.0% in initial versus repeat groups. The overall incidence of major complications was similar (26.3% vs. 30.7%); however, reoperation was more common in the repeat group. Perioperative outcomes such as length of stay and nonhome discharge were not significantly different. For the entire cohort, 5-year overall survival (OS) was 56.0% in the initial group and 59.5% in the repeat group. In patients with only appendiceal cancer, we observed a 5-year OS of 64.0% in the initial group compared with 67.3% in the repeat cohort. For patients with appendiceal cancer who developed a recurrence/progression, median OS was 36 months in the no repeat operation group compared with 73 months for those that did. Multivariable regression demonstrated that completeness of cytoreduction and tumor grade were associated with OS, but repeat operation was not.

Conclusions

Repeat CRS/HIPEC is not associated with prohibitive risk. Survival is possibly improved, and therefore, repeat operation should be considered in selected patients with recurrent or progressive disease.

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.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Glehen O, Mohamed F, Gilly FN. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol. 2004;5(4):219–28.

    Article  Google Scholar 

  2. Chua TC, Moran BJ, Sugarbaker PH, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–56.

    Article  Google Scholar 

  3. Levine EA, Stewart JH, Shen P, Russell GB, Loggie BL, Votanopoulos KI. Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1000 patients. J Am Coll Surg. 2014;218(4):573–85.

    Article  Google Scholar 

  4. Dodson RM, McQuellon RP, Mogal HD, et al. Quality-of-life evaluation after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23(Suppl 5):772–83.

    Article  Google Scholar 

  5. Stearns AT, Malcomson L, Punnett G, et al. Long-term quality of life after cytoreductive surgery and heated intraperitoneal chemotherapy for pseudomyxoma peritonei: a prospective longitudinal study. Ann Surg Oncol. 2018;25(4):965–73.

    Article  Google Scholar 

  6. van Oudheusden TR, Nienhuijs SW, Luyer MD, et al. Incidence and treatment of recurrent disease after cytoreductive surgery and intraperitoneal chemotherapy for peritoneally metastasized colorectal cancer: a systematic review. Eur J Surg Oncol. 2015;41(10):1269–77.

    Article  Google Scholar 

  7. 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(4):375–9.

    Article  Google Scholar 

  8. Mogal H, Chouliaras K, Levine EA, Shen P, Votanopoulos KI. Repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: review of indications and outcomes. J Gastrointest Oncol. 2016;7(1):129–42.

    PubMed  PubMed Central  Google Scholar 

  9. Chua TC, Quinn LE, Zhao J, Morris DL. Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases. J Surg Oncol. 2013;108(2):81–8.

    Article  Google Scholar 

  10. Konstantinidis IT, Levine EA, Chouliaras K, Russell G, Shen P, Votanopoulos KI. Interval between cytoreductions as a marker of tumor biology in selecting patients for repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. J Surg Oncol. 2017;116(6):741–5.

    Article  CAS  Google Scholar 

  11. Lee TC, Wima K, Sussman JJ, et al. Readmissions after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a US HIPEC collaborative study. J Gastrointest Surg. 2020;24(1):165–76.

    Article  Google Scholar 

  12. Kelly KJ, Cajas L, Baumgartner JM, Lowy AM. Factors associated with 60-day readmission following cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2018;25(1):91–7.

    Article  Google Scholar 

  13. Beal EW, Ahmed A, Grotz T, et al. Trends in the indications for and short-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Am J Surg. 2019;219:478–83.

    Article  Google Scholar 

  14. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.

    Article  CAS  Google Scholar 

  15. Levesque LE, Hanley JA, Kezouh A, Suissa S. Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes. BMJ. 2010;340:b5087.

    Article  Google Scholar 

  16. Rothman KJ, Greenland S, Lash TL. Modern epidemiology. 3rd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.

    Google Scholar 

  17. Huang Y, Alzahrani NA, Liauw W, Morris DL. Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma. Eur J Surg Oncol. 2015;41(10):1373–8.

    Article  CAS  Google Scholar 

  18. Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S. Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience. Ann Surg Oncol. 2014;21(5):1480–6.

    Article  Google Scholar 

  19. Sardi A, Jimenez WA, Nieroda C, Sittig M, Macdonald R, Gushchin V. Repeated cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from appendiceal cancer: analysis of survival outcomes. Eur J Surg Oncol. 2013;39(11):1207–13.

    Article  CAS  Google Scholar 

  20. Bayat Z, Taylor EL, Bischof DA, McCart JA, Govindarajan A. Impairments in bowel function, social function and quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2019;27:124–31.

    Article  Google Scholar 

  21. Doud AN, Levine EA, Fino NF, Stewart JH, Shen P, Votanopoulos KI. Stoma creation and reversal after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23(2):503–10.

    Article  Google Scholar 

  22. Choudry HA, Bednar F, Shuai Y, et al. Repeat cytoreductive surgery-hyperthermic intraperitoneal chemoperfusion is feasible and offers survival benefit in select patients with peritoneal metastases. Ann Surg Oncol. 2019;26:1445–53.

    Google Scholar 

  23. 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):336–46.

    CAS  PubMed  Google Scholar 

  24. Vassos N, Fortsch T, Aladashvili A, Hohenberger W, Croner RS. Repeated cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with recurrent peritoneal carcinomatosis. World J Surg Oncol. 2016;14(1):42.

    Article  Google Scholar 

  25. Burguete D, Mokdad AA, Augustine MM, et al. Non-home discharge and prolonged length of stay after cytoreductive surgery and HIPEC. J Surg Res. 2019;233:360–7.

    Article  Google Scholar 

  26. Votanopoulos KI, Swett K, Blackham AU, et al. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from rectal cancer. Ann Surg Oncol. 2013;20(4):1088–92.

    Article  Google Scholar 

  27. Martin AS, Abbott DE, Hanseman D, et al. Factors associated with readmission after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol. 2016;23(6):1941–7.

    Article  Google Scholar 

  28. Paredes AZ, Abdel-Misih S, Schmidt C, Dillhoff ME, Pawlik TM, Cloyd JM. Predictors of readmission after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Res. 2019;234:103–9.

    Article  Google Scholar 

  29. Kitai T, Yamanaka K. Repeat cytoreduction and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal carcinomatosis of appendiceal origin. Int J Clin Oncol. 2018;23(2):298–304.

    Article  Google Scholar 

  30. Yan TD, Bijelic L, Sugarbaker PH. Critical analysis of treatment failure after complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from appendiceal mucinous neoplasms. Ann Surg Oncol. 2007;14(8):2289–99.

    Article  Google Scholar 

  31. Mohamed F, Chang D, Sugarbaker PH. Third look surgery and beyond for appendiceal malignancy with peritoneal dissemination. J Surg Oncol. 2003;83(1):5–12; discussion 12-13.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Benjamin D. Powers MD, MS, Seth Felder MD, Iman Imanirad MD, Sophie Dessureault MD, PhD & Sean P. Dineen MD, FACS

  2. Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA

    Benjamin D. Powers MD, MS, Seth Felder MD, Iman Imanirad MD, Sophie Dessureault MD, PhD & Sean P. Dineen MD, FACS

  3. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, San Diego, CA, USA

    Jula Veerapong MD & Joel M. Baumgartner MD, MAS

  4. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Callisia Clarke MD & Harveshp Mogal MD

  5. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Charles A. Staley MD & Shishir K. Maithel MD

  6. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Sameer Patel MD & Vikrom Dhar MD

  7. Department of Surgery, Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Laura Lambert MD

  8. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Ryan J. Hendrix MD

  9. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA

    Daniel E. Abbott MD & Courtney Pokrzywa MD

  10. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

    Mustafa Raoof MD & Byrne Lee MD

  11. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

    Fabian M. Johnston MD, MHS & Jonathan Greer MD

  12. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jordan M. Cloyd MD & Charles Kimbrough MD

  13. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA

    Travis Grotz MD & Jennifer Leiting MD

  14. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Keith Fournier MD & Andrew J. Lee MD

Authors
  1. Benjamin D. Powers MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seth Felder MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jula Veerapong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joel M. Baumgartner MD, MAS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Callisia Clarke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Harveshp Mogal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Charles A. Staley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shishir K. Maithel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sameer Patel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Vikrom Dhar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Laura Lambert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ryan J. Hendrix MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Daniel E. Abbott MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Courtney Pokrzywa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Mustafa Raoof MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Byrne Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Fabian M. Johnston MD, MHS
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Jonathan Greer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Jordan M. Cloyd MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Charles Kimbrough MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Travis Grotz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Jennifer Leiting MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Keith Fournier MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Andrew J. Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Iman Imanirad MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Sophie Dessureault MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Sean P. Dineen MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean P. Dineen MD, FACS.

Ethics declarations

Disclosures

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 97 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Powers, B.D., Felder, S., Veerapong, J. et al. Repeat Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Is Not Associated with Prohibitive Complications: Results of a Multiinstitutional Retrospective Study. Ann Surg Oncol 27, 4883–4891 (2020). https://doi.org/10.1245/s10434-020-08482-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08482-x

Search

Navigation