Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Surface Malignancy

Experience with 501 Procedures

Edward A. Levine, John H. Stewart IV, Gregory B. Russell, Kim R. Geisinger, Brian W. Loggie, Perry Shen

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Background: Peritoneal dissemination of abdominal malignancy (PSD) has a clinical course marked by bowel obstruction and death. We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (IPHC) to treat PSD. The purpose of this article was to review our experience with IPHC. Study Design: A prospective database of patients undergoing IPHC has been maintained since 1991. Patients were uniformly evaluated and treated. Demographics, performance status, resection status, primary site, and experience quartile were compared with outcomes. Univariate and multivariate analyses were performed. Results: A total of 460 patients underwent 501 IPHC procedures. Average age was 53.0 years, and 50.4% were women. The 30-day mortality rate was 4.8%, the complication rate was 43%, and median hospital stay was 9 days. Median followup was 55.4 months, median survival was 22.2 months, and 5-year survival rate was 27.8%. Factors correlating with improved survival were performance status (p = 0.0001), primary tumor (p = 0.0001), resection status (p = 0.0001), complications (p = 0.002), previous IPHC (p = 0.006), and experience quartile (p = 0.031). On multivariate analysis, primary tumor site, performance status, resection status, and development of complications (p <0.001) predicted outcomes. Conclusions: Our experience demonstrated that preoperative criteria for better outcomes include primary tumor site and performance status. Completeness of resection and development of postoperative complications are also crucial, and outcomes have improved over time. Cytoreductive surgery and IPHC represent substantial improvements in outcomes compared with historic series and best-available systemic therapy. Longterm survival is possible for selected patients who undergo the procedure.

Original languageEnglish
Pages (from-to)943-953
Number of pages11
JournalJournal of the American College of Surgeons
Volume204
Issue number5
DOIs
StatePublished - May 2007

Fingerprint

Drug Therapy
Neoplasms
Survival
Multivariate Analysis
Length of Stay
Survival Rate
Demography
Databases
Mortality
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Surface Malignancy : Experience with 501 Procedures. / Levine, Edward A.; Stewart IV, John H.; Russell, Gregory B.; Geisinger, Kim R.; Loggie, Brian W.; Shen, Perry.

In: Journal of the American College of Surgeons, Vol. 204, No. 5, 05.2007, p. 943-953.

Research output: Contribution to journalArticle

Levine, Edward A. ; Stewart IV, John H. ; Russell, Gregory B. ; Geisinger, Kim R. ; Loggie, Brian W. ; Shen, Perry. / Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Surface Malignancy : Experience with 501 Procedures. In: Journal of the American College of Surgeons. 2007 ; Vol. 204, No. 5. pp. 943-953.
@article{5f272a9aa7514b7fab7001d26ce415bf,
title = "Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Surface Malignancy: Experience with 501 Procedures",
abstract = "Background: Peritoneal dissemination of abdominal malignancy (PSD) has a clinical course marked by bowel obstruction and death. We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (IPHC) to treat PSD. The purpose of this article was to review our experience with IPHC. Study Design: A prospective database of patients undergoing IPHC has been maintained since 1991. Patients were uniformly evaluated and treated. Demographics, performance status, resection status, primary site, and experience quartile were compared with outcomes. Univariate and multivariate analyses were performed. Results: A total of 460 patients underwent 501 IPHC procedures. Average age was 53.0 years, and 50.4{\%} were women. The 30-day mortality rate was 4.8{\%}, the complication rate was 43{\%}, and median hospital stay was 9 days. Median followup was 55.4 months, median survival was 22.2 months, and 5-year survival rate was 27.8{\%}. Factors correlating with improved survival were performance status (p = 0.0001), primary tumor (p = 0.0001), resection status (p = 0.0001), complications (p = 0.002), previous IPHC (p = 0.006), and experience quartile (p = 0.031). On multivariate analysis, primary tumor site, performance status, resection status, and development of complications (p <0.001) predicted outcomes. Conclusions: Our experience demonstrated that preoperative criteria for better outcomes include primary tumor site and performance status. Completeness of resection and development of postoperative complications are also crucial, and outcomes have improved over time. Cytoreductive surgery and IPHC represent substantial improvements in outcomes compared with historic series and best-available systemic therapy. Longterm survival is possible for selected patients who undergo the procedure.",
author = "Levine, {Edward A.} and {Stewart IV}, {John H.} and Russell, {Gregory B.} and Geisinger, {Kim R.} and Loggie, {Brian W.} and Perry Shen",
year = "2007",
month = "5",
doi = "10.1016/j.jamcollsurg.2006.12.048",
language = "English",
volume = "204",
pages = "943--953",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Surface Malignancy

T2 - Experience with 501 Procedures

AU - Levine, Edward A.

AU - Stewart IV, John H.

AU - Russell, Gregory B.

AU - Geisinger, Kim R.

AU - Loggie, Brian W.

AU - Shen, Perry

PY - 2007/5

Y1 - 2007/5

N2 - Background: Peritoneal dissemination of abdominal malignancy (PSD) has a clinical course marked by bowel obstruction and death. We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (IPHC) to treat PSD. The purpose of this article was to review our experience with IPHC. Study Design: A prospective database of patients undergoing IPHC has been maintained since 1991. Patients were uniformly evaluated and treated. Demographics, performance status, resection status, primary site, and experience quartile were compared with outcomes. Univariate and multivariate analyses were performed. Results: A total of 460 patients underwent 501 IPHC procedures. Average age was 53.0 years, and 50.4% were women. The 30-day mortality rate was 4.8%, the complication rate was 43%, and median hospital stay was 9 days. Median followup was 55.4 months, median survival was 22.2 months, and 5-year survival rate was 27.8%. Factors correlating with improved survival were performance status (p = 0.0001), primary tumor (p = 0.0001), resection status (p = 0.0001), complications (p = 0.002), previous IPHC (p = 0.006), and experience quartile (p = 0.031). On multivariate analysis, primary tumor site, performance status, resection status, and development of complications (p <0.001) predicted outcomes. Conclusions: Our experience demonstrated that preoperative criteria for better outcomes include primary tumor site and performance status. Completeness of resection and development of postoperative complications are also crucial, and outcomes have improved over time. Cytoreductive surgery and IPHC represent substantial improvements in outcomes compared with historic series and best-available systemic therapy. Longterm survival is possible for selected patients who undergo the procedure.

AB - Background: Peritoneal dissemination of abdominal malignancy (PSD) has a clinical course marked by bowel obstruction and death. We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (IPHC) to treat PSD. The purpose of this article was to review our experience with IPHC. Study Design: A prospective database of patients undergoing IPHC has been maintained since 1991. Patients were uniformly evaluated and treated. Demographics, performance status, resection status, primary site, and experience quartile were compared with outcomes. Univariate and multivariate analyses were performed. Results: A total of 460 patients underwent 501 IPHC procedures. Average age was 53.0 years, and 50.4% were women. The 30-day mortality rate was 4.8%, the complication rate was 43%, and median hospital stay was 9 days. Median followup was 55.4 months, median survival was 22.2 months, and 5-year survival rate was 27.8%. Factors correlating with improved survival were performance status (p = 0.0001), primary tumor (p = 0.0001), resection status (p = 0.0001), complications (p = 0.002), previous IPHC (p = 0.006), and experience quartile (p = 0.031). On multivariate analysis, primary tumor site, performance status, resection status, and development of complications (p <0.001) predicted outcomes. Conclusions: Our experience demonstrated that preoperative criteria for better outcomes include primary tumor site and performance status. Completeness of resection and development of postoperative complications are also crucial, and outcomes have improved over time. Cytoreductive surgery and IPHC represent substantial improvements in outcomes compared with historic series and best-available systemic therapy. Longterm survival is possible for selected patients who undergo the procedure.

UR - http://www.scopus.com/inward/record.url?scp=34247476058&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247476058&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2006.12.048

DO - 10.1016/j.jamcollsurg.2006.12.048

M3 - Article

VL - 204

SP - 943

EP - 953

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -