Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a prospective clinical trial and comparative analysis

Chae Yun Cho; Jula Veerapong; Joel M Baumgartner; James D Murphy; Andrew M Lowy; Kaitlyn J Kelly

doi:10.1007/s00464-022-09589-w

Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a prospective clinical trial and comparative analysis

Surg Endosc. 2023 Jul;37(7):5644-5651. doi: 10.1007/s00464-022-09589-w. Epub 2022 Dec 7.

Authors

Chae Yun Cho¹, Jula Veerapong¹, Joel M Baumgartner¹, James D Murphy², Andrew M Lowy¹, Kaitlyn J Kelly³

Affiliations

¹ Department of Surgery, University of California, San Diego, 3855 Health Sciences Drive, Mail Code 0987, San Diego, La Jolla, CA, 92093, USA.
² Department of Radiation Medicine, University of California, San Diego, La Jolla, USA.
³ Department of Surgery, University of California, San Diego, 3855 Health Sciences Drive, Mail Code 0987, San Diego, La Jolla, CA, 92093, USA. kjkelly3@wisc.edu.

Abstract

Background: Open cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with high morbidity, which limits the degree to which patients may benefit from this therapy. This study aimed to determine the feasibility of laparoscopic CRS/HIPEC.

Methods: This was a single institution prospective clinical trial and comparative study using historical controls. Patients with histologically confirmed peritoneal surface malignancy (PSM) of appendiceal, colorectal, ovarian, or primary peritoneal origin, peritoneal carcinomatosis index (PCI) [Formula: see text] 10 were eligible.

Results: Clinical trial: 18 patients (median age 57 years, 39% female) with appendiceal (15) or colorectal (3) primary PSM underwent laparoscopic CRS/HIPEC. Median and range outcomes were: operative time 219 min (134-378), EBL 10 mL (0-100), time to return to bowel function 3 days (1-7), duration IV narcotic use 3 days (1-8), length of stay 6 days (3-11). All patients had a complete cytoreduction (CC-score 0). Three (17%) experienced minor morbidity, with no major morbidity or mortality. Median DFS and OS were not reached with median follow-up of 48 months. Comparative analysis: Laparoscopic approach associated with reduced time to return of bowel function (3 versus 4 days, p = 0.001), length of stay (8 versus 5 days, p < 0.001), and morbidity (16% versus 42%, p = 0.008). Independent predictors of DFS included prior chemotherapy (HR 5.07, 95% CI 1.85, 13.89; p = 0.002), and CC-score > 0 (HR 3.31, 95% CI 1.19, 9.41; p = 0.025), but not surgical approach. CC-score > 0 was the only independent predictor of OS (HR 10.12, 95% CI 2.16, 47.30, p = 0.003).

Conclusions and relevance: Laparoscopic CRS/HIPEC should be considered for patients with PSM with low-volume disease, including those with adenocarcinoma histology.

Trial registration: Clinicaltrials.gov; NCT02463877.

Keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Minimally-invasive surgery; Peritoneal surface malignancy.

Publication types

Clinical Trial
Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Chemotherapy, Adjuvant
Colorectal Neoplasms* / surgery
Combined Modality Therapy
Cytoreduction Surgical Procedures / adverse effects
Female
Humans
Hyperthermia, Induced*
Laparoscopy*
Male
Middle Aged
Peritoneal Neoplasms* / drug therapy
Prospective Studies
Retrospective Studies
Survival Rate

Associated data

ClinicalTrials.gov/NCT02463877