What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures.
OBJECTIVE
To review our 25-year experience with hyperthermic intra-peritoneal chemotherapy (HIPEC).


BACKGROUND
Combining cytoreductive surgery (CRS) and HIPEC as local treatments for peritoneal carcinomatosis (PC) was proposed 25 years ago.


METHODS
A prospective database of all patients undergoing HIPEC for PC since 1989 was searched for clinicopathological data, 90-day morbidity and mortality, and survival.


RESULTS
Among 1,125 HIPEC procedures, PC origin was colorectal (342; 30%), ovarian (271; 24%), pseudomyxoma peritonei (189; 17%), gastric (127; 11%), malignant mesothelioma (84; 8%), or other (112; 10%). Between 2004-2009 (n = 321) and 2010-2015 (n = 560), the median peritoneal cancer index decreased (11 vs. 8; P < 0.001), fewer patients underwent incomplete cytoreduction (CC2-3: 4% vs. 0.5%; P < 0.001), and more were included in randomized trials (5% vs. 16%; P < 0.001). Postoperative morbidity (52% vs. 50%, P = 0.672) was not different, but mortality significantly decreased (5% vs. 2%; P = 0.030). Median overall-survival was 42 months, and improved significantly for each 5-year period except for 2006-2010 vs. 2011-2015 (P = 0.097). The 10-year survival without recurrence was 53%, 14%, 4%, 10%, and 9% for pseudomyxoma, mesothelioma, ovarian, colorectal, and gastric PC, respectively.


CONCLUSIONS
This study demonstrated that CRS and HIPEC provide long-term survival irrespective of PC origin, and survival improves with experience. J. Surg. Oncol. 2016;113:796-803. © 2016 Wiley Periodicals, Inc.
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.|EMR 37-38, Lyon 1 University, Lyon, France.
Guillaume
G
Passot
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.
Delphine
D
Vaudoyer
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.|EMR 37-38, Lyon 1 University, Lyon, France.|Department of Pole IMER, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.
Laurent
L
Villeneuve
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.|EMR 37-38, Lyon 1 University, Lyon, France.
Vahan
V
Kepenekian
Department of Anesthesiology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.
Annie-Claude
AC
Beaujard
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.|EMR 37-38, Lyon 1 University, Lyon, France.
Naoual
N
Bakrin
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.|EMR 37-38, Lyon 1 University, Lyon, France.
Eddy
E
Cotte
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.|EMR 37-38, Lyon 1 University, Lyon, France.
Francois-Noel
FN
Gilly
Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, France.|EMR 37-38, Lyon 1 University, Lyon, France.
Olivier
O
Glehen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006801:Humans; D006979:Hyperthermia, Induced; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000473:pathology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents
HIPEC; cytoreductive surgery; experience; long term survival; peritoneal carcinomatosis