Cytoreductive Surgery Treatment: Advances and Obstacles

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Surgical Oncology".

Deadline for manuscript submissions: closed (31 October 2023) | Viewed by 5949

Special Issue Editors


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Guest Editor
University Hospital of Larissa, Larissa, Greece
Interests: surgery; clinical trials; oncology

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Guest Editor
Department of Surgery, University Hospital of Larissa, Mezourlo, Greece
Interests: surgical oncology; gastrointestinal malignancies; clinical trials

Special Issue Information

Dear Colleagues,

Peritoneal dissemination of intra-abdominal malignancies is generally regarded as an unfavorable prognostic indicator. Historically, therapeutic interventions in cases of peritoneal carcinomatosis (PC) were minimal. However, the introduction of cytoreductive surgery (CRS) allowed the macroscopic removal of the peritoneal metastatic foci, while in parallel, the administration of intraperitoneal hyperthermic chemotherapy (HIPEC) enabled the management of the microscopic residual disease, thus improving the survival and quality of life outcomes. The perioperative safety and oncological efficacy of CRS and HIPEC have been confirmed by multiple trials, in various clinical settings. Despite the wide acceptance of CRS, there is still a considerable discrepancy in terms of operative indications, surgical techniques and treatment protocols.     

We are pleased to invite you to the “Cytoreductive Surgery Treatment: Advances and Obstacles” Special Issue of Current Oncology. This Special Issue aims to highlight the recent innovations in both cytoreductive surgery and intraperitoneal chemotherapy, while also addressing all current application issues and future research directions.

In this Special Issue, original research articles and reviews are welcome. Research areas may include, but are not limited to, the following:

  • Patient selection and preoperative risk stratification;
  • Enhanced recovery after CRS;
  • Acceleration of the learning curve;
  • Adjunctive techniques in CRS;
  • HIPEC and associated alternatives;
  • Novel predictive biomarkers;
  • Improving oncological efficacy;
  • Current and emerging chemotherapeutic agents.

We look forward to receiving your contributions.

Dr. Konstantinos Perivoliotis
Prof. Dr. Konstantinos Tepetes
Guest Editors

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Keywords

  • cytoreductive
  • surgery
  • hyperthermic
  • intraperitoneal
  • chemotherapy
  • peritoneal
  • metastasis
  • cancer

Published Papers (4 papers)

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12 pages, 961 KiB  
Article
Paclitaxel as HIPEC-Drug after Surgical Cytoreduction for Ovarian Peritoneal Metastases: A Randomized Phase III Clinical Trial (HIPECOVA)
by Pedro Villarejo Campos, Susana Sánchez García, Mariano Amo-Salas, Esther García Santos, Carlos López de la Manzanara, Ana Alberca, David Padilla-Valverde, Francisco Javier Redondo Calvo and Jesús Martín
Curr. Oncol. 2024, 31(2), 660-671; https://doi.org/10.3390/curroncol31020048 - 24 Jan 2024
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Abstract
Multidisciplinary strategies have transformed the management of advanced ovarian cancer. We aimed to evaluate the effectiveness of paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) following surgical cytoreduction for ovarian peritoneal metastases in a randomized phase III trial conducted between August 2012 and December 2019. [...] Read more.
Multidisciplinary strategies have transformed the management of advanced ovarian cancer. We aimed to evaluate the effectiveness of paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) following surgical cytoreduction for ovarian peritoneal metastases in a randomized phase III trial conducted between August 2012 and December 2019. Seventy-six patients were randomized to either the HIPEC or no HIPEC group. Although median values for the primary endpoints (recurrence-free survival (RFS) and overall survival (OS)) revealed superior outcomes for the HIPEC (RFS: 23 months, OS: 48 months) over the control group (RFS: 19 months, OS: 46 months), these differences were not statistically significant (p = 0.22 and p = 0.579). Notably, the HIPEC group demonstrated significantly higher 5-year OS and 3-year RFS rates (47.2% and 47.5%) compared to patients without HIPEC (34.5% and 21.3%). Stratification according to Peritoneal Surface Disease Severity Score (PSDSS) showed improved OS and RFS for patients with lower PSDSS (I–II) in the HIPEC-treated group (p = 0.033 and p = 0.042, respectively). The Clavien–Dindo classification of adverse event grades revealed no significant differences between HIPEC and controls (p = 0.482). While overall results were not statistically significant, our long-term follow-up emphasized the potential benefit of HIPEC-associated cytoreduction with paclitaxel, particularly in selected ovarian cancer patients with lower PSDSS indices. Full article
(This article belongs to the Special Issue Cytoreductive Surgery Treatment: Advances and Obstacles)
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11 pages, 269 KiB  
Article
Low-Grade Pseudomyxoma Peritonei Behaving as a High-Grade Disease: A Case Series and Literature Review
by Petros Bangeas, Dimitrios Kyziridis, Apostolos Kalakonas and Apostolis A. Tentes
Curr. Oncol. 2023, 30(11), 9996-10006; https://doi.org/10.3390/curroncol30110726 - 18 Nov 2023
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Abstract
Patients with low-grade appendiceal mucinous carcinomas (LAMNs) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have a favorable prognosis. However, a subgroup of patients presents a clinically aggressive course with disease progression despite receiving treatment. The purpose of this study is [...] Read more.
Patients with low-grade appendiceal mucinous carcinomas (LAMNs) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have a favorable prognosis. However, a subgroup of patients presents a clinically aggressive course with disease progression despite receiving treatment. The purpose of this study is to report the experience of clinically aggressive LAMN patients treated by the same team, and to present a review of the literature. The cases of four patients with clinically aggressive LAMNs were reviewed. Clinical and histopathological characteristics were re-examined. Recurrences and the time of recurrence, as well as the survival time, were recorded. These patients were four men with clinically aggressive LAMNs treated with CRS plus HIPEC. One of them underwent CC-0 surgery, two underwent CC-1 surgery, and one underwent CC-3 surgery. All patients received systemic chemotherapy after surgery. Recurrence was recorded in three of the patients within 4–23 months after the initial treatment. Two of the patients underwent secondary CRS. Three patients died of disease recurrence within 13–23 months, and one is alive with a disease relapse at 49 months after his initial surgery. LAMNs were identified in both the initial specimens and the specimens obtained during reoperation. The prognosis of LAMN patients treated with CRS plus HIPEC is favorable. A small number of patients present a clinically aggressive course that is unresponsive to any treatment. Molecular and genetic studies are required to identify this group of LAMN patients who have an unfavorable prognosis. Full article
(This article belongs to the Special Issue Cytoreductive Surgery Treatment: Advances and Obstacles)
11 pages, 1440 KiB  
Article
The Impact of Computed Tomography Measurements of Sarcopenia on Postoperative and Oncologic Outcomes in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
by Maher Al Khaldi, Massine Fellouah, Pierre Drolet, Julien Côté, Bertrand Trilling, Alexandre Brind’Amour, Alexandre Dugas, Jean-François Tremblay, Suzanne Fortin, Lara De Guerké, Marie-Hélène Auclair, Pierre Dubé, Mikaël Soucisse and Lucas Sideris
Curr. Oncol. 2022, 29(12), 9314-9324; https://doi.org/10.3390/curroncol29120730 - 29 Nov 2022
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Abstract
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a treatment option for peritoneal metastases (PM) but is associated with significant postoperative morbidity. The aim of this study was to determine the prognostic value of computed tomographic (CT)-measured sarcopenia on postoperative outcomes and survival [...] Read more.
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a treatment option for peritoneal metastases (PM) but is associated with significant postoperative morbidity. The aim of this study was to determine the prognostic value of computed tomographic (CT)-measured sarcopenia on postoperative outcomes and survival in patients undergoing CRS-HIPEC for PM from various origins. A retrospective cohort study was conducted between 2012 and 2020. Three-hundred and twelve patients (mean age 57.6 ± 10.3, 34.3% male) were included, of which 88 (28.2%) were sarcopenic. PM from a colorectal origin was the most common in both groups. The proportion of major postoperative complications (Clavien-Dindo ≥ III) was not higher in the sarcopenic group (15.9% in sarcopenic patients vs. 23.2% in nonsarcopenic patients, p = 0.17). The mean Comprehensive Complication Index scores, HIPEC-related toxicities, length of hospital stay, and duration of parenteral nutrition were comparable regardless of sarcopenia status. In the multivariate logistic regression analysis of severe complications, only peritoneal carcinomatosis index reached statistical significance (OR, 1.05; 95% CI, 1.01 to 1.08, p = 0.007). Sarcopenia did not impact origin-specific overall survival on Cox regression analysis. Sarcopenia was not associated with worse rates of postoperative severe complications or worse survival rates. Future prospective studies are required before considering sarcopenia as part of preoperative risk assessment. Full article
(This article belongs to the Special Issue Cytoreductive Surgery Treatment: Advances and Obstacles)
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14 pages, 663 KiB  
Systematic Review
Therapeutic Strategies and Oncological Outcome of Peritoneal Metastases from Lung Cancer: A Systematic Review and Pooled Analysis
by Leandro Siragusa, Sara Di Carlo, Alessia Fassari, Bruno Sensi, Camilla Riccetti, Luciano Izzo, Giuseppe Cavallaro, Enrico Fiori, Paolo Sapienza, Letizia Mallia, Graziano Pernazza and Simone Sibio
Curr. Oncol. 2023, 30(3), 2928-2941; https://doi.org/10.3390/curroncol30030224 - 01 Mar 2023
Cited by 1 | Viewed by 1636
Abstract
The peritoneum is an unusual site of metastases from lung cancer, and optimal management at the moment remains unclear and mostly based on palliative strategies. Therefore, the aim of the study was to investigate demographic characteristics, management and overall survival of patients with [...] Read more.
The peritoneum is an unusual site of metastases from lung cancer, and optimal management at the moment remains unclear and mostly based on palliative strategies. Therefore, the aim of the study was to investigate demographic characteristics, management and overall survival of patients with peritoneal metastases from lung cancer (PCLC). A PRISMA-compliant systematic review and pooled analysis was performed searching all English studies published until December 2022. PROSPERO, CRD42022349362. Inclusion criteria were original articles including patients with peritoneal carcinomatosis from lung cancer, specifying at least one outcome of interest. Exclusion criteria were being unable to retrieve patient data from articles, and the same patient series included in different studies. Among 1746 studies imported for screening, twenty-one were included (2783 patients). Mean overall survival was between 0.5 and 5 months after peritoneal carcinomatosis diagnosis and 9 and 21 months from lung cancer diagnosis. In total, 27% of patients underwent first-line or palliative chemotherapy and 7% of them surgery. Management differs significantly among published studies. The literature on PCLC is scarce. Its incidence is low but appears to be substantially rising and is likely to be an underestimation. Prognosis is very poor and therapeutic strategies have been limited and used in a minority of patients. Subcategories of PCLC patients may have an improved prognosis and may benefit from an aggressive oncological approach, including cytoreductive surgery. Further investigation would be needed in this regard. Full article
(This article belongs to the Special Issue Cytoreductive Surgery Treatment: Advances and Obstacles)
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