Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal malignancy: preliminary results of a multi-disciplinary teamwork model in Asia

Abstract

Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an emerging surgical procedure for peritoneal carcinomatosis (PC). CRS/HIPEC is a complicated treatment that requires multi-disciplinary teamwork (MDT), which may be lacking when establishing a CRS/HIPEC programme. Herein, we report our preliminary treatment outcomes with the early implementation of an MDT model for CRS/HIPEC.

Methods: From April 2015 to December 2016, 45 patients with a diagnosis of PC who received CRS/HIPEC were reviewed retrospectively in a single institution in Taiwan.

Results: Among the 45 patients, CRS was mainly performed by laparotomy (n = 42), and only three patients with limited PC underwent laparoscopic CRS. The first 13 patients received treatment before the MDT had been established (group 1), and the other 32 patients were treated after the MDT had been established (group 2). The highest peri-HIPEC body temperature in group 2 was significantly lower than that in group 1 (36.8 °C vs. 37.5 °C, p < 0.001). Overall, eight patients experienced major complications. The trend of a lower major complication rate was observed after the MDT model had been implemented (30.7% in group 1 vs. 12.4% in group 2, p = 0.202). Pre-CRS/HIPEC abdominal pain significantly increased the risk of post-operative major complications (p = 0.017).

Conclusions: Our experience suggests that the early implementation of an MDT model when establishing a CRS/HIPEC programme at a single institution may result in a higher complete cytoreduction rate and lower major complication rate, and also shorten the learning curve of this complicated procedure.

Keywords:

• Peritoneal carcinomatosis
• cytoreductive surgery
• hyperthermic intraperitoneal chemotherapy
• multi-disciplinary teamwork
• Asia

Acknowledgements

We are grateful to the Prof. Ying-Huang Tsai, the Superintendent of Chang Gung Memorial Hospital, Chiayi, and the members of the Peritoneal Malignancy program of our Cancer Centre: Wen-Shih Huang (proctologist, chief), Meng-Chiao Hsieh, Chih-Jung Chen (proctologists), Chao-Yu Chen (gynaeco-oncologist, vice chief), Ting-Yao Wang (medical oncologist), Tzu-Hao Huang (general surgeon), Yu-San Liao, Li-Wen Lee (radiologists), Wen-Tzu Liao, Chung-Ming Yu (anaesthesiologists), Ming-Shian Lu (thoracic surgeon), Che-Chia Chang (pulmonary and critical care), Tzu-Ting Liao (case manager), Tzu-Ting Lin (business manager), and Yu-Fen Chen (secretary).

We also thank the follow educational courses: the ESSO Advanced Course on the Management of HIPEC after CRS 10th–12th March 2016 in Hamburg and Perioperative Management in CRS and HIPEC of Peritoneal Malignancy 25th–30th November 2016 in Berlin.

We thank ATS Medical Editing and Review Solutions for language editing.

Disclosure statement

No potential conflict of interest was reported by the authors.