The current practice of cytoreductive surgery and HIPEC for colorectal peritoneal metastases: Results of a worldwide web-based survey of the Peritoneal Surface Oncology Group International (PSOGI)

M Bushati; K P Rovers; A Sommariva; P H Sugarbaker; D L Morris; Y Yonemura; C A Quadros; S P Somashekhar; W Ceelen; P Dubé; Y Li; V J Verwaal; O Glehen; P Piso; J Spiliotis; M C C Teo; S González-Moreno; P H Cashin; K Lehmann; M Deraco; B Moran; I H J T de Hingh

doi:10.1016/j.ejso.2018.07.003

The current practice of cytoreductive surgery and HIPEC for colorectal peritoneal metastases: Results of a worldwide web-based survey of the Peritoneal Surface Oncology Group International (PSOGI)

Eur J Surg Oncol. 2018 Dec;44(12):1942-1948. doi: 10.1016/j.ejso.2018.07.003. Epub 2018 Jul 20.

Authors

M Bushati¹, K P Rovers², A Sommariva³, P H Sugarbaker⁴, D L Morris⁵, Y Yonemura⁶, C A Quadros⁷, S P Somashekhar⁸, W Ceelen⁹, P Dubé¹⁰, Y Li¹¹, V J Verwaal¹², O Glehen¹³, P Piso¹⁴, J Spiliotis¹⁵, M C C Teo¹⁶, S González-Moreno¹⁷, P H Cashin¹⁸, K Lehmann¹⁹, M Deraco²⁰, B Moran²¹, I H J T de Hingh²²

Affiliations

¹ Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, Netherlands; 1(st) Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
² Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, Netherlands.
³ Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Castelfranco Veneto (TV), Italy.
⁴ Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, 106 Irving Street NW, Suite 3900, Washington, DC, 20010, USA.
⁵ Department of Surgery, St George Hospital, Gray St Kogarah, Sydney, NSW, 2217, Australia.
⁶ Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka, 596-8522, Japan.
⁷ Surgical Oncology Unit, São Rafael Hospital, av. São Rafael, 2152, São Marcos, 41253-190, Salvador, Bahia, Brazil.
⁸ Department of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru, 560017, Karnataka, India.
⁹ Department of Gastrointestinal Surgery, Ghent University Hospital Belgium, Gent, Belgium.
¹⁰ Department of Surgery, Hôspital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada.
¹¹ Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital of the Capital Medical University, Beijing, PR China.
¹² Department of Surgery, Aarhus University Hospital, Norrebrogade 44, DK-8000, Aarhus, Denmark.
¹³ Department of Surgical Oncology, Hospices Civils de Lyon and Lyon Faculty of Medicine, Lyon Sud Hospital, Lyon, France.
¹⁴ Department for General- and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany.
¹⁵ European Interbalkan Medical Center, Thessaloniki, Greece.
¹⁶ National Cancer Centre Singapore, Singapore, Singapore.
¹⁷ Surgical Oncology, MD Anderson Cancer Center, Madrid, Spain.
¹⁸ Department of Surgical Sciences, Section of Surgery, Uppsala University, Akademiska Sjukhuset, 75185, Uppsala, Sweden.
¹⁹ Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
²⁰ Peritoneal Surface Malignancies Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²¹ Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals Foundation Trust, Adelmaston Road, Basingstoke, RG24 9NA, UK.
²² Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, Netherlands. Electronic address: ignace.d.hingh@catharinaziekenhuis.nl.

PMID: 30075978
DOI: 10.1016/j.ejso.2018.07.003

Abstract

Background: At present, selected patients with resectable colorectal peritoneal metastases (CRC-PM) are increasingly treated with a combination therapy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study was to investigate the current worldwide practice.

Methods: HIPEC experts from 19 countries were invited through the Peritoneal Surface Oncology Group International (PSOGI) to complete an online survey concerning their personal expertise and current hospital and countrywide practice.

Results: It is estimated that currently more than 3800 patients with CRC-PM (synchronous and metachronous) are annually treated with CRS and HIPEC in 430 centers. Integration of CRS and HIPEC in national guidelines varies, resulting in large treatment disparities between countries. Amongst the experts, there was general agreement on issues related to indication, surgical technique and follow up but less on systemic chemotherapy or proactive strategies.

Conclusion: This international survey demonstrates that CRS and HIPEC is now performed on a large scale for CRC-PM patients. Variation in treatment may result in heterogeneity in surgical and oncological outcomes, emphasising the necessity to reach consensus on several issues of this comprehensive procedure. Future initiatives directed at achieving an international consensus statement are needed.

Keywords: Colorectal peritoneal metastases; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy.

MeSH terms

Colorectal Neoplasms / pathology*
Combined Modality Therapy
Cytoreduction Surgical Procedures / methods*
Humans
Hyperthermia, Induced / methods*
Internet
Peritoneal Neoplasms / secondary*
Peritoneal Neoplasms / therapy*
Practice Patterns, Physicians' / statistics & numerical data*
Surveys and Questionnaires
Treatment Outcome