Intraperitoneal chemotherapy for peritoneal surface malignancy: Experience with 1,000 patients

Edward A. Levine, John H. Stewart IV, Perry Shen, Gregory B. Russell, Brian W. Loggie, Konstantinos I. Votanopoulos

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Abstract

Background Peritoneal dissemination of abdominal malignancy (carcinomatosis) has a clinical course marked by bowel obstruction and death; it traditionally does not respond well to systemic therapy and has been approached with nihilism. To treat carcinomatosis, we use cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods A prospective database of patients has been maintained since 1992. Patients with biopsy-proven peritoneal surface disease were uniformly evaluated for, and treated with, CS and HIPEC. Patient demographics, performance status (Eastern Cooperative Oncology Group), resection status, and peritoneal surface disease were classified according to primary site. Univariate and multivariate analyses were performed. The experience was divided into quintiles and outcomes compared. Results Between 1991 and 2013, a total of 1,000 patients underwent 1,097 HIPEC procedures. Mean age was 52.9 years and 53.1% were female. Primary tumor site was appendix in 472 (47.2%), colorectal in 248 (24.8%), mesothelioma in 72 (7.2%), ovary in 69 (6.9%), gastric in 46 (4.6%), and other in 97 (9.7%). Thirty-day mortality rate was 3.8% and median hospital stay was 8 days. Median overall survival was 29.4 months, with a 5-year survival rate of 32.5%. Factors correlating with improved survival on univariate and multivariate analysis (p ≤ 0.0001 for each) were preoperative performance status, primary tumor type, resection status, and experience quintile (p = 0.04). For the 5 quintiles, the 1- and 5-year survival rates, as well as the complete cytoreduction score (R0, R1, R2a) have increased, and transfusions, stoma creations, and complications have all decreased significantly (p

Original languageEnglish
Pages (from-to)573-585
Number of pages13
JournalJournal of the American College of Surgeons
Volume218
Issue number4
DOIs
StatePublished - 2014

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Peritoneal Diseases
Drug Therapy
Neoplasms
Multivariate Analysis
Survival Rate
Carcinoma
Survival
Mesothelioma
Ovary
Length of Stay
Stomach
Demography
Databases
Biopsy
Mortality
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery

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Intraperitoneal chemotherapy for peritoneal surface malignancy : Experience with 1,000 patients. / Levine, Edward A.; Stewart IV, John H.; Shen, Perry; Russell, Gregory B.; Loggie, Brian W.; Votanopoulos, Konstantinos I.

In: Journal of the American College of Surgeons, Vol. 218, No. 4, 2014, p. 573-585.

Research output: Contribution to journalArticle

Levine, Edward A. ; Stewart IV, John H. ; Shen, Perry ; Russell, Gregory B. ; Loggie, Brian W. ; Votanopoulos, Konstantinos I. / Intraperitoneal chemotherapy for peritoneal surface malignancy : Experience with 1,000 patients. In: Journal of the American College of Surgeons. 2014 ; Vol. 218, No. 4. pp. 573-585.
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abstract = "Background Peritoneal dissemination of abdominal malignancy (carcinomatosis) has a clinical course marked by bowel obstruction and death; it traditionally does not respond well to systemic therapy and has been approached with nihilism. To treat carcinomatosis, we use cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods A prospective database of patients has been maintained since 1992. Patients with biopsy-proven peritoneal surface disease were uniformly evaluated for, and treated with, CS and HIPEC. Patient demographics, performance status (Eastern Cooperative Oncology Group), resection status, and peritoneal surface disease were classified according to primary site. Univariate and multivariate analyses were performed. The experience was divided into quintiles and outcomes compared. Results Between 1991 and 2013, a total of 1,000 patients underwent 1,097 HIPEC procedures. Mean age was 52.9 years and 53.1{\%} were female. Primary tumor site was appendix in 472 (47.2{\%}), colorectal in 248 (24.8{\%}), mesothelioma in 72 (7.2{\%}), ovary in 69 (6.9{\%}), gastric in 46 (4.6{\%}), and other in 97 (9.7{\%}). Thirty-day mortality rate was 3.8{\%} and median hospital stay was 8 days. Median overall survival was 29.4 months, with a 5-year survival rate of 32.5{\%}. Factors correlating with improved survival on univariate and multivariate analysis (p ≤ 0.0001 for each) were preoperative performance status, primary tumor type, resection status, and experience quintile (p = 0.04). For the 5 quintiles, the 1- and 5-year survival rates, as well as the complete cytoreduction score (R0, R1, R2a) have increased, and transfusions, stoma creations, and complications have all decreased significantly (p",
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AB - Background Peritoneal dissemination of abdominal malignancy (carcinomatosis) has a clinical course marked by bowel obstruction and death; it traditionally does not respond well to systemic therapy and has been approached with nihilism. To treat carcinomatosis, we use cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods A prospective database of patients has been maintained since 1992. Patients with biopsy-proven peritoneal surface disease were uniformly evaluated for, and treated with, CS and HIPEC. Patient demographics, performance status (Eastern Cooperative Oncology Group), resection status, and peritoneal surface disease were classified according to primary site. Univariate and multivariate analyses were performed. The experience was divided into quintiles and outcomes compared. Results Between 1991 and 2013, a total of 1,000 patients underwent 1,097 HIPEC procedures. Mean age was 52.9 years and 53.1% were female. Primary tumor site was appendix in 472 (47.2%), colorectal in 248 (24.8%), mesothelioma in 72 (7.2%), ovary in 69 (6.9%), gastric in 46 (4.6%), and other in 97 (9.7%). Thirty-day mortality rate was 3.8% and median hospital stay was 8 days. Median overall survival was 29.4 months, with a 5-year survival rate of 32.5%. Factors correlating with improved survival on univariate and multivariate analysis (p ≤ 0.0001 for each) were preoperative performance status, primary tumor type, resection status, and experience quintile (p = 0.04). For the 5 quintiles, the 1- and 5-year survival rates, as well as the complete cytoreduction score (R0, R1, R2a) have increased, and transfusions, stoma creations, and complications have all decreased significantly (p

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