Treading the beaten path with old and new obstacles: a report from the Indian HIPEC registry

Figures & data

Table 1. Surgeons participating in the registry and results of the online survey.

Surgeons participating in the registry (n = 43)		No. of surgeons
Surgeons participating	No. of founding members	5
	Overall registered surgeons	43
	Surgeons who have entered data	10
Chronology of surgeon enrolment	2016	10
	2017	33
Surgical Specialty	General surgical oncology	33
	Gastrointestinal oncology	4
	Gynecology Oncology	6
Training for CRS and HIPEC	None	4
	During surgical residency	3
	Workshop	27
	Fellowship	9
Time of joining the registry (times since the start of a peritoneal surface oncology programme)	Within 1 year	23
	Within 3 years	10
	3–5 years	8
	>5 years	2
Type of hospital	Public hospital	6
	Regional Cancer centre	3
	Private cancer centre	7
	Private multi-specialty hospital	27
Results of the online survey*
No of respondents	Not participated	32
	Participated	11
Type of data entry	Prospective	1
	Retrospective	2
	Both	5
Data entered by	Self	9
	Junior surgeon	0
	Ancillary staff	1
Percentage of prospective cases enrolled	100%	6
	50–100%	0
	<50%	2
Barriers to data entry	Complex system	0
	Lack of time	2
	Lack of manpower	4
	All of the above	5
Institutional permission	Required	4
	Not required	7
Problem with obtaining patient consent	Yes	5
	No	6

* Some surgeons did not respond to all the questions.

Table 2. Patient and disease characteristics and operative findings and perioperative outcomes in 332 patients.

Characteristic		Overall (%) (N = 332)	Centers contributing more than 25 cases each						p-value
			1 N = 75	2 N = 86	3 N = 45	4 N = 55	5 N = 39	6 N = 30
Age	0–49	133 (40.0)	23	40	16	29	24	12	.018
	≥50	173 (60.0)	52	46	29	26	15	18
Sex	Male	79 (23.7)	26	17	13	15	06	0	.08
	Female	257(76.3)	49	69	32	40	33	30
Indication	Colorectal	62 (18.6)	12	22	8	14	5	0	.22
	Appendix	90 (27.1)	32	24	3	27	4	0	<.001
	Ovary	127 (38.2)	14	30	24	11	20	27	<.001
	Stomach	2 (0.60)	0	0	2	0	0	0	–
	Mesothelioma	18 (5.4)	7	5	2	2	2	0	.66
	Others*	33 (9.9)	10	5	6	1	8	3	.07
Time point in ovarian cancer	Primary CRS	24 (18.8)	5	8	1	0	8	0	.03
	Interval CRS	48 (37.7)	4	0	18	0	0	26	<.001
	Salvage CRS	55 (43.3)	5	22	5	11	12	4	<.001
Prior surgery	Yes	158 (47.5)	34	61	13	40	0	8	<.001
	No	135 (40.6)	41	25	32	15	0	22
	NR	39 (11.9)	0	0	0	0	39	0
Prior chemotherapy	Yes	192 (57.8)	46	51	36	28	0	29	<.001
	No	101 (33.0)	29	35	9	27	0	1
	NR	39 (13.3)	0	0	0	0	39	0
HIPEC	Yes	274 (89.5)	54	79	43	54	39	3	<.001
	No	58 (10.4)	21	7	2	1	0	27
EPIC	Yes	29 (0.6)	0	0	2	0	0	27
	No	302 (99.4)	75	86	43	55	39	3
Median PCI		10	23	11	9	17.5	5	3
PCI (peritoneal cancer index)	<20	221 (66.5)	26	62	36	29	39	27	<.001
	>20	101 (30.4)	47	23	5	23	0	3
	NA	10 (3.0)	2	1	4	3	0	0
CC-score	CC-0	240 (72.2)	39	57	38	39	37	30	.12
	CC-1	75 (22.5)	28	25	6	12	2	0
	CC-2/3	13 (3.9)	8	3	0	2	0	0
	NA	4 (1.2)	0	1	1	2	0	0
30-day grade 3–4 morbidity	Yes	76 (22.8)	20	15	10	15	8	7	.69
	no	256 (77.2)	55	71	35	40	31	23
90- day grade 3–4 morbidity	Yes	25 (7.5)	10	3	1	4	2	5	.25
	Overall major morbidity	98 (29.5)	30	18	11	19	10	10
In hospital mortality	Yes	15 (4.5)	3	3	1	6	0	2	.10
	No	317 (95.5)	73	84	44	49	39	28
90-day mortality	Yes	19 (5.7)	4	4	1	6	0	4	.19
	No	313 (94.3)	71	82	44	49	39	26

* Uncommon indications; NR: not reported; HIPEC: hyperthermic intraperitoneal chemotherapy; PCI: peritoneal cancer index; CC: score- completeness of cytoreduction score.

Table 3. Cox-regression analysis showing the impact of various factors on survival outcomes according to the primary tumour site.

Characteristic	Disease free survival		Overall survival
	Univariate analysis	Multivariate analysis	Univariate analysis	Multivariate analysis
Colorectal cancer
Synchronous Versus Metachronous PM	0.815		0.280
Sex	0.001	0.002	0.420
PCI ( <20 versus >20)	0.001	0.001	<0.001	0.002
CC-Score ( CC-0/1 versus CC-2/3)			0.789
Histology (signet ring versus non-signet ring)	0.991		0.667
Right colon versus left colon	0.715		0.775
Colon versus rectum	0.761		0.439
Grade 3–4 morbidity	0.287		0.002	NS
HIPEC versus no HIPEC	0.474		0.829
HIPEC with Mitomycin versus Oxaliplatin	0.024		0.445
Lymph node metastases	0.651		0.929
Ovarian cancer
Age (<50 and >50)	0.768		0.041
Primary versus interval versus salvage CRS	0.117		0.245
PCI (<10 versus >10)	0.828	0.016	0.320
CC-Score (CC-0/1 versus CC-2)	0.004	0.036	<0.001	<0.001
Lymph-node metastases	0.040		0.804
HIPEC (yes versus no)	0.890		0.539
HIPEC drug (cisplatin versus others)	0.934		0.728
Grade 3–5 morbidity	0.243		<0.001	<0.001
90-day morbidity	0.455		0.001	NS
Appendiceal tumours and PMP
Prior surgery	0.600	0.002	0.649
Prior chemotherapy	0.002		0.093
Grade	0.598		0.298
Signet ring cells	0.50		0.570
PCI (<20 versus >20)	0.364		0.398
CC-score (CC-0/1 versus CC-2/3)			0.037	0.004
Grade 3–5 morbidity	0.377		<0.001	<0.001
Lymph node involvement			0.754
HIPEC versus no HIPEC	0.915		0.015
Uncommon Indications
Age (<50 versus >50)	0.206		0.986
Sex (Male versus Female)	0.961		0.460
Prior surgery	0.419		0.234
Prior chemotherapy	0.375		0.261
Grade	0.050		0.074
PCI	0.768	0.027	0.224
CC-score (CC-0/1 versus CC-2/3)	0.059		0.123
HIPEC versus no HIPEC	0.007		0.169
Grade 3–5 morbidity	0.565	0.009	0.428
Lymph node involvement	0.006	0.025	0.025	0.043
90-day morbidity	0.008	0.025	0.455

NS: not significant.

Figure 1. Kaplan Meier survival analysis for disease free survival (A) and overall survival (B) according to the primary tumour site.