title: Implementation of a standardized HIPEC protocol improves outcome for peritoneal malignancy.
abstract: BACKGROUND
  Experience with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in a pioneer hospital resulted in a treatment protocol that has become the standard in the Netherlands. Outcome of CRS and HIPEC was reviewed to assure differences between the pioneer phase and the period wherein the Dutch HIPEC protocol was clinically implemented.
  
  
  METHODS
  The first consecutive 100 CRS and HIPEC procedures performed in the Netherlands were included as pioneer cohort (1995-1999). Two-hundred and seventy-two procedures that were performed in three participating HIPEC centres after the implementation of the Dutch HIPEC protocol were included as the implementation cohort (2005-2012). Another 100 recent patients of the first centre were included as a control group (2009-2011). Indications for the CRS and HIPEC treatment were peritoneal carcinomatosis (PC) from colorectal carcinoma and pseudomyxoma peritonei (PMP).
  
  
  RESULTS
  Of the 472 included procedures, 327 (69 %) procedures were performed for PC from colorectal carcinoma and 145 for PMP (31 %). Compared with the implementation phase, the pioneer phase was characterized by more affected abdominal regions (mean 4.3 vs. 3.5, p < 0.001), more resections (mean 3.8 vs. 3.4, p < 0.001), less macroscopic radical cytoreductions (66 vs. 86 %, p < 0.001) and more patients with major morbidity (grade III-V) (64 vs. 32 %, p < 0.001). Other determinants of morbidity were high tumour load and multiple organ resections. Outcome of the implementation phase was similar to the control group.
  
  
  CONCLUSIONS
  This study determined that outcome had improved ever since the Dutch HIPEC protocol has been implemented based on completeness of cytoreduction and decreasing morbidity.
authors.affiliation: Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands, a.kuijpers@nki.nl.
authors.forename: Anke M J
authors.initials: AM
authors.lastname: Kuijpers
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: Marinus 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: Wilma D
authors.initials: WD
authors.lastname: Heemsbergen
authors.forename: Michael
authors.initials: M
authors.lastname: Hauptmann
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Verwaal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D002985:Clinical Protocols; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D010534:Peritoneal Neoplasms / Q000628:therapy*; D011553:Pseudomyxoma Peritonei / Q000628:therapy*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult