title: Cytoreduction and HIPEC in the Netherlands: nationwide long-term outcome following the Dutch protocol.
abstract: OBJECTIVE
  This nationwide study evaluated results of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis of colorectal origin in the Netherlands following a national protocol.
  
  
  METHODS
  In a multi-institutional study prospective databases of patients with peritoneal carcinomatosis (PC) from colorectal cancer and pseudomyxoma peritonei (PMP) treated according to the Dutch HIPEC protocol, a uniform approach for the CRS and HIPEC treatment, were reviewed. Primary end point was overall survival and secondary end points were surgical outcome and progression-free survival.
  
  
  RESULTS
  Nine-hundred sixty patients were included; 660 patients (69 %) were affected by PC of colorectal carcinoma and the remaining suffered from PMP (31 %). In 767 procedures (80 %), macroscopic complete cytoreduction was achieved. Three-hundred and thirty one patients had grade III-V complications (34 %). Thirty-two patients died perioperatively (3 %). Median length of hospital stay was 16 days (range 0-166 days). Median follow-up period was 41 months (95 % confidence interval (CI), 36-46 months). Median progression-free survival was 15 months (95 % CI 13-17 months) for CRC patients and 53 months (95 % CI 40-66 months) for PMP patients. Overall median survival was 33 (95 % CI 28-38 months) months for CRC patients and 130 months (95 % CI 98-162 months) for PMP patients. Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients.
  
  
  CONCLUSIONS
  The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP. It is assumed the uniform Dutch HIPEC protocol was beneficial.
authors.affiliation: Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, a.kuijpers@nki.nl.
authors.forename: Anke M J
authors.initials: AM
authors.lastname: Kuijpers
authors.forename: Boj
authors.initials: B
authors.lastname: Mirck
authors.forename: Arend G J
authors.initials: AG
authors.lastname: Aalbers
authors.forename: Simon W
authors.initials: SW
authors.lastname: Nienhuijs
authors.forename: Ignace H J T
authors.initials: IH
authors.lastname: de Hingh
authors.forename: Martinus J
authors.initials: MJ
authors.lastname: Wiezer
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Ginkel
authors.forename: Klaas
authors.initials: K
authors.lastname: Havenga
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Bremers
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Te Velde
authors.forename: Vic J
authors.initials: VJ
authors.lastname: Verwaal
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy; D010478:Chemotherapy, Cancer, Regional Perfusion; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D055815:Young Adult
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