Does early post-operative intraperitoneal chemotherapy (EPIC) for patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) make a difference?

Figures & data

Table 1. Patients by whether they received EPIC.

	n (%)
Total	111 (100)
Received EPIC	42 (38)
Did not receive EPIC	69 (62)
Underwent CRS and HIPEC before Nov 12	20 (18)
Due to
Haemorrhage	3 (3)
Sepsis	4 (4)
Renal impairment	4 (4)
Respiratory i.e. pleural effusion	6 (5)
Wound issues i.e. dehiscence	2 (2)
Patient refusal	1 (1)
Underwent CRS and HIPEC from Nov 12	49 (44)

EPIC, early post-operative intraperitoneal chemotherapy; CRS, cytoreductive surgery; HIPEC, hyperthermic intraperitoneal chemotherapy;

Table 2. Patient and treatment characteristics.

		No EPIC
	EPIC (n = 42) (%)	Total (n = 69) (%)	CRS + HIPEC before Nov 12 (n = 20) (%)	CRS + HIPEC after Nov 12 (n = 49) (%)	P for (A) vs
	(A)	(B)	(C)	(D)	(B)	(C)	(D)
Age at CRS and HIPEC, median (range) years	50.3 (14.1–74.6)	53.8 (25.4–73.7)	50.0 (35.5–65.9)	54.7 (25.4–73.7)	0.107	0.542	0.074
Gender
Female	34 (81)	48 (70)	16 (80)	32 (65)	0.185	1.000	0.096
Male	8 (19)	21 (30)	4 (20)	17 (35)
Primary tumour
Peritoneal	2 (5)	3 (4)	0 (–)	3 (6)	0.191	0.451	0.224
Mesothelioma	6 (14)	3 (4)	1 (5)	2 (4)
Colorectal	12 (29)	24 (35)	4 (20)	20 (41)
Appendix	4 (10)	14 (20)	5 (25)	9 (18)
Ovarian	17 (40)	25 (36)	10 (50)	15 (31)
Other	1 (2)	0 (–)	0 (–)	0 (–)
ECOG performance status
0	36 (86)	60 (87)	20 (100)	40 (82)	0.853	0.164	0.601
≥1	6 (14)	9 (13)	0 (–)	9 (18)
PCI score^a
≤20	30 (83)	48 (74)	13 (76)	35 (73)	0.276	0.709	0.259
>20	6 (17)	17 (26)	4 (24)	13 (27)
Median (range)	13 (2–39)	12 (0–39)	15 (5–39)	9 (0–35)	0.782	0.208	0.340
No. of CRS procedures received^b
0	1 (2)	6 (9)	1 (5)	5 (10)	0.373	0.048	0.290
1	13 (31)	18 (26)	1 (5)	17 (35)
2	11 (26)	20 (29)	5 (25)	15 (31)
3	10 (24)	9 (13)	4 (20)	5 (10)
≥4	7 (17)	16 (23)	9 (45)	7 (14)
Median (range)	2 (0–6)	2 (0–5)	3 (0–5)	2 (0–5)	0.774	0.030	0.124
Duration of CRS and HIPEC, min
Median (range)	447.5 (215–920)	515 (200–1520)	582.5 (250–960)	450 (200–1520)	0.283	0.005	0.933
CC score^a
0	35 (85)	53 (79)	12 (67)	41 (84)	0.829	0.130	1.000
1	5 (12)	12 (18)	5 (28)	7 (14)
2	1 (2)	1 (2)	0 (–)	1 (2)
3	0 (–)	1 (2)	1 (6)	0 (–)

CC, completeness of cytoreduction; CRS, cytoreductive surgery; ECOG, Eastern Cooperative Oncology Group; EPIC, early post-operative intraperitoneal chemotherapy; HIPEC, hyperthermic intraperitoneal chemotherapy; PCI, peritoneal cancer index.

^aPercentages were computed among non-missing values.

^bRefers to subdiaphragmatic stripping, gastrectomy, colectomy, small bowel resection, splenectomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy, cholecystectomy and bladder resection.

Table 3. Treatment complications and morbidities.

		No EPIC
	EPIC (n = 42) (%)	Total (n = 69) (%)	CRS + HIPEC before Nov 12 (n = 20) (%)	CRS + HIPEC after Nov 12 (n = 49) (%)	P for (A) vs
	(A)	(B)	(C)	(D)	(B)	(C)	(D)
Estimated blood loss, median (range) mL	1000 (0–4600)	1000 (100–8000)	1500 (450–5100)	1000 (100–8000)	0.066	0.042	0.184
Intraoperative blood transfusion^a
No	14 (35)	12 (18)	3 (15)	9 (19)	0.046	0.105	0.095
Yes	26 (65)	55 (82)	17 (85)	38 (81)
Post-operative blood transfusion
No	20 (48)	29 (42)	2 (10)	27 (55)	0.565	0.004	0.476
Yes	22 (52)	40 (58)	18 (90)	22 (45)
Post-operative complications
No	23 (55)	32 (46)	4 (20)	28 (57)	0.392	0.010	0.820
Yes	19 (45)	37 (54)	16 (80)	21 (43)
Worst grade post-operative complication
I	0 (–)	8 (22)	2 (13)	6 (29)	0.197	0.285	0.048
II	8 (42)	13 (35)	3 (19)	10 (48)
III	6 (32)	8 (22)	6 (38)	2 (10)
IV	4 (21)	7 (19)	5 (31)	2 (10)
V	1 (5)	1 (3)	0 (–)	1 (5)
SICU stay
No	11 (26)	21 (30)	3 (15)	18 (37)	0.632	0.517	0.282
Yes	31 (74)	48 (70)	17 (85)	31 (63)
SICU stay, median (range) days^b	1 (1–4)	2 (1–36)	4 (1–28)	2 (1–36)
Median (range)	1 (1–4)	2 (1–36)	4 (1–28)	2 (1–36)	0.020	<0.001	0.662
Hospital stay, median (range) days	16 (10–77)	14 (7–76)	27.5 (9–57)	13 (7–76)	0.174	0.320	0.019
Follow-up, median (range) months	36.3 (0–74.5)	13.3 (0.7–61.6)	29.9 (0.9–61.6)	11.3 (0.7–21.5)	<0.001	0.466	<0.001

EPIC, early post-operative intraperitoneal chemotherapy; SICU, intensive care unit.

^aPercentages were computed among non-missing values.

^bAmong patients with SICU stay.

Figure 1. Kaplan–Meier curves of overall survival by patients with and without EPIC.

Figure 2. Kaplan–Meier curves of disease-free survival by patients with and without EPIC.

Figure 3. Kaplan–Meier curves of overall survival by patients with and without EPIC: (a) excluding patients with no EPIC post-CRS and HIPEC before November 2012, (b) reclassifying patients with no EPIC post-CRS and HIPEC before November 2012 as having EPIC, (c) truncating follow-up duration of patients with EPIC to 24 months for patients in (a), (d) truncating follow-up duration of patients with EPIC to 24 months for patients in (b). (e) Matched pair analysis based on patients in (a). (f) Matched pair analysis based on patients in (b).

Figure 4. Kaplan–Meier curves of disease-free survival by patients with and without EPIC: (a) excluding patients with no EPIC post-CRS and HIPEC before November 2012, (b) reclassifying patients with no EPIC post-CRS and HIPEC before November 2012 as having EPIC, (c) truncating follow-up duration of patients with EPIC to 24 months for patients in (a), (d) truncating follow-up duration of patients with EPIC to 24 months for patients in (b). (e) Matched pair analysis based on patients in (a). (f) Matched pair analysis based on patients in (b).