title: Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC).
abstract: OBJECTIVE
  Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a novel curative treatment option for selected patients with peritoneal carcinomatosis (PC). We aimed to report the mortality rate and the most frequent grade III-IV adverse events and to identify associated prognostic markers. We report oncological outcomes and major prognostic factors influencing overall survival (OS) and disease-free survival.
  
  
  METHODS
  A total of 401 CRS plus HIPEC procedures were performed on 356 patients. Mortality, grade III-IV adverse events, OS, disease-free survival, and prognostic factors were studied.
  
  
  RESULTS
  Based on Common Terminology Criteria for Adverse Events (CTCAE of the National Cancer Institute 2006), mortality rate was 1 % and overall rate of morbidity grade III-IV was 12.5 %. In multivariate analysis, only the number of digestive anastomoses (>1) significantly correlated with adverse events with an odds ratio of 2.8 (p = 0.032). OS was related to histological type of PC, with a median survival reaching 47.6 months for PC of ovarian cancer origin, 45.8 months for that of colorectal origin, 64.2 months for peritoneal mesothelioma, and 8.1 months for PC of gastric cancer origin. Over half the patients with pseudomyxoma are still alive. Major prognostic factors influencing survival were histological type, World Health Organization performance status (WHO PS) (hazard ratio (HR) = 3.56), operating time (HR = 0.45), previous chemotherapy (HR = 2.04), number of peritonectomies (HR = 2.03), and completeness of cytoreduction score (HR = 3.12). Disease-free survival across all groups was 16.8 months.
  
  
  CONCLUSIONS
  The low mortality rate and 12.5 % grade III-IV morbidity of CRS and HIPEC are acceptable when weighed against overall oncologic survival. This multimodal treatment appears feasible for selected patients and trained centers.
authors.affiliation: Department of General Surgery and Gastrointestinal Oncology, Archet 2 CHU Nice, 151 route de St. Antoine de la Ginestière, 06200, Nice, France, mariangela.desantis@hotmail.fr.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Desantis
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bernard
authors.forename: Vincent
authors.initials: V
authors.lastname: Casanova
authors.forename: Marianne
authors.initials: M
authors.lastname: Cegarra-Escolano
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Benizri
authors.forename: Amine M
authors.initials: AM
authors.lastname: Rahili
authors.forename: Daniel
authors.initials: D
authors.lastname: Benchimol
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Bereder
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D011553:Pseudomyxoma Peritonei / Q000401:mortality / Q000628:therapy; D013274:Stomach Neoplasms / Q000473:pathology