title: Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients.
abstract: BACKGROUND
  Peritoneal carcinomatosis (PC) from nonovarian malignancies long has been regarded as a terminal disease. Over the past decade, new locoregional therapeutic approaches combining cytoreductive surgery with perioperative intraperitoneal chemotherapy (PIC) have evolved that have demonstrated improved survival.
  
  
  METHODS
  A retrospective, multicenter cohort study was performed in French-speaking institutions to evaluate toxicity and principal prognostic factors after cytoreductive surgery and PIC (hyperthermic intraperitoneal chemotherapy [HIPEC] and/or early postoperative intraperitoneal chemotherapy [EPIC]) for PC from nongynecologic malignancies.
  
  
  RESULTS
  The study included 1290 patients from 25 institutions who underwent 1344 procedures between February 1989 and December 2007. HIPEC was performed in 1154 procedures. The principal origins of PC were colorectal adenocarcinoma (N = 523), pseudomyxoma peritonei (N = 301), gastric adenocarcinoma (N = 159), peritoneal mesothelioma (N = 88), and appendiceal adenocarcinoma (N = 50). The overall morbidity and mortality rates were 33.6% and 4.1%, respectively. In multivariate analysis, patient age, the extent of PC, and institutional experience had a significant influence on toxicity. The overall median survival was 34 months; and the median survival was 30 months for patients with colorectal PC, not reached for patients with pseudomyxoma peritonei, 9 months for patients with gastric PC, 41 months for patients with peritoneal mesothelioma, and 77 months for patients with PC from appendiceal adenocarcinoma. Independent prognostic indicators in multivariate analysis were institution, origin of PC, completeness of cytoreductive surgery, extent of carcinomatosis, and lymph node involvement.
  
  
  CONCLUSIONS
  A therapeutic approach that combined cytoreductive surgery with PIC was able to achieve long-term survival in a selected group of patients who had PC of nonovarian origin and had acceptable morbidity and mortality. The current results indicated that this treatment should be centralized to institutions with expertise in the management of PC.
authors.affiliation: Surgical Oncology Department, Lyon Civil Hospices, South Lyon University Hospital Center, Lyon, France. olivier.glehen@chu-lyon.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
authors.forename: François N
authors.initials: FN
authors.lastname: Gilly
authors.forename: Florent
authors.initials: F
authors.lastname: Boutitie
authors.forename: Jean M
authors.initials: JM
authors.lastname: Bereder
authors.forename: François
authors.initials: F
authors.lastname: Quenet
authors.forename: Lucas
authors.initials: L
authors.lastname: Sideris
authors.forename: Baudouin
authors.initials: B
authors.lastname: Mansvelt
authors.forename: Gérard
authors.initials: G
authors.lastname: Lorimier
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006801:Humans; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary* / Q000601:surgery*