Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2020; 12(7): 756-767
Published online Jul 15, 2020. doi: 10.4251/wjgo.v12.i7.756
Comparison of open and closed hyperthermic intraperitoneal chemotherapy: Results from the United States hyperthermic intraperitoneal chemotherapy collaborative
Jennifer L Leiting, Jordan M Cloyd, Ahmed Ahmed, Keith Fournier, Andrew J Lee, Sophie Dessureault, Seth Felder, Jula Veerapong, Joel M Baumgartner, Callisia Clarke, Harveshp Mogal, Charles A Staley, Mohammad Y Zaidi, Sameer H Patel, Syed A Ahmad, Ryan J Hendrix, Laura Lambert, Daniel E Abbott, Courtney Pokrzywa, Mustafa Raoof, Christopher J LaRocca, Fabian M Johnston, Jonathan Greer, Travis E Grotz
Jennifer L Leiting, Travis E Grotz, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55901, United States
Jordan M Cloyd, Ahmed Ahmed, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Keith Fournier, Andrew J Lee, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Sophie Dessureault, Seth Felder, Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL 33612, United States
Jula Veerapong, Joel M Baumgartner, Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA 92093, United States
Callisia Clarke, Harveshp Mogal, Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Charles A Staley, Mohammad Y Zaidi, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States
Sameer H Patel, Syed A Ahmad, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, United States
Ryan J Hendrix, Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, United States
Laura Lambert, Peritoneal Surface Malignancy Program Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States
Daniel E Abbott, Courtney Pokrzywa, Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI 53792, United States
Mustafa Raoof, Christopher LaRocca, Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States
Fabian M Johnston, Jonathan Greer, Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, United States
Author contributions: Leiting JL designed and performed the research and wrote the paper; Grotz TE designed the research and wrote the paper; Cloyd JM, Ahmed A, Fournier K, Lee AJ, Dessureault S, Felder S, Veerapong J, Baumgartner JM, Clarke C, Mogal H, Staley CA, Zaidi MY, Patel SH, Ahmad SA, Hendrix RJ, Lambert L, Abbott DE, Pokrzywa C, Raoof M, LaRocca CJ, Johnston FM and Greer J analyzed the data and critically revised the manuscript.
Supported by the National Center for Advancing Translational Sciences, No. UL1TR002377.
Institutional review board statement: This study was reviewed and approved by the Institutional Review board at all participating institutions.
Informed consent statement: The requirement to obtain informed consent was waived by each participating Institutional Review Board.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Travis E Grotz, MD, Assistant Professor, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, 200 First Stteer Southwest, Rochester, MN 55905, United States. grotz.travis@mayo.edu
Received: March 3, 2020
Peer-review started: March 3, 2020
First decision: April 18, 2020
Revised: May 1, 2020
Accepted: June 2, 2020
Article in press: June 2, 2020
Published online: July 15, 2020
Processing time: 133 Days and 16.8 Hours
Abstract
BACKGROUND

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis can be performed in two ways: Open or closed abdominal technique.

AIM

To evaluate the impact of HIPEC method on post-operative and long-term survival outcomes.

METHODS

Patients undergoing CRS with HIPEC from 2000-2017 were identified in the United States HIPEC collaborative database. Post-operative, recurrence, and overall survival outcomes were compared between those who received open vs closed HIPEC.

RESULTS

Of the 1812 patients undergoing curative-intent CRS and HIPEC, 372 (21%) patients underwent open HIPEC and 1440 (79%) underwent closed HIPEC. There was no difference in re-operation or severe complications between the two groups. Closed HIPEC had higher rates of 90-d readmission while open HIPEC had a higher rate of 90-d mortalities. On multi-variable analysis, closed HIPEC technique was not a significant predictor for overall survival (hazards ratio: 0.75, 95% confidence interval: 0.51-1.10, P = 0.14) or recurrence-free survival (hazards ratio: 1.39, 95% confidence interval: 1.00-1.93, P = 0.05) in the entire cohort. These findings remained consistent in the appendiceal and the colorectal subgroups.

CONCLUSION

In this multi-institutional analysis, the HIPEC method was not independently associated with relevant post-operative or long-term outcomes. HIPEC technique may be left to the discretion of the operating surgeon.

Keywords: Mucinous appendiceal carcinoma; Cytoreductive surgery; Multi-institutional

Core tip: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of care for carefully selected patients with peritoneal carcinomatosis. HIPEC can be performed in one of two ways: Open or closed abdominal technique. Our goal was to use a multi-institutional database to determine the impact of HIPEC method on post-operative and long-term survival outcomes. Among 1812 patients undergoing cytoreductive surgery-HIPEC in this multi-institutional analysis, the method of HIPEC delivery was not independently associated with relevant post-operative or long-term survival outcomes. The method of HIPEC may be left to the discretion of the primary surgeon.