May 02, 2014
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Surgery plus intraperitoneal chemotherapy improved long-term survival in abdominal cancer

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For appropriately selected patients with peritoneal dissemination of an abdominal malignancy, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy may offer significant long-term survival.

In the study, researchers evaluated data on 1,000 patients with biopsy-proven peritoneal surface disease from a prospective database maintained since 1992. The patients were evaluated for and treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

The mean age of the patients was 52.9 years, 53.1% were women and 1,097 HIPEC procedures were performed. The primary tumor site was the appendix in 472 patients, the colorectal area in 248 patients, mesothelioma in 72 patients, ovarian in 69 patients, gastric in 46 patients and other in 97 patients.

The researchers categorized the patients’ demographic information, performance status, resection status and peritoneal surface disease based on primary site. They applied univariate and multivariate analyses and categorized the experiences as quintiles and outcomes compared.

The investigators found that the 30-day mortality rate was 3.8%, with a median hospital stay of 8 days. The median OS was 29.4 months, with a 5-year survival rate of 32.5%. Univariate and multivariate analysis revealed that the factors associated with improved survival (P≤.0001 for each) included preoperative performance status, primary tumor type, resection status and experience quintile (P=.04). The researchers found that there has been an increase in the 1- and 5-year survival rates for the five quintiles, along with the complete cytoreduction score (R0, R1, R2a). They also noted a significant reduction in transfusions, creation of stomas and complications (P<.001 for all).

According to study investigator Edward R. Levine, MD,from Wake Forest Baptist Medical Center,these findings represent an important development in the treatment of this often-deadly disease.

“Peritoneal dissemination of abdominal malignancy has a clinical course marked by bowel obstruction and death,” Levine said in a press release. “It traditionally does not respond well to intravenous chemotherapy. This two-phase approach has clearly extended the lives of many of our patients. The data further shows that patients with advanced abdominal cancer should no longer be approached with therapeutic nihilism.”

Disclosure: The researchers report no relevant financial disclosures.