Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma.

OBJECTIVES: The aim of this study is to evaluate the results of treatment of diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) at a single center. METHODS: We conducted a retrospective single-center observational cohort study of consecutive patients with DMPM treated by CRS-HIPEC at the Department of Surgery I of the University Hospital in Olomouc, Czech Republic. RESULTS: Data on a total of 16 patients were processed. The study group of 16 patients had six (37.5 %) women. The mean age was approximately 62 years. Complete cytoreduction was achieved in all patients (100 %) (CC0: 75 %, CC1: 25 %). All patients underwent a closed form of HIPEC with cisplatin and doxorubicin for 90 min. The mean hospital stay was 13.5 days, including 4.38 days in the ICU (13.5 ± 5.07 and 4.38 ± 1.49, respectively). Major postoperative complications (CD grades 3-4) occurred in four patients (25 %). In-hospital mortality was 6.25 %. In the study group, the median overall survival was 20 months, and the median disease-free survival was 10.3 months. CONCLUSIONS: Also under the conditions at our specialized center, CRS-HIPEC is considered as an effective, affordable, and safe therapy with OS, DFS, morbidity, and mortality rates comparable to those reported in the literature (Tab. 5, Fig. 2, Ref. 28). Text in PDF www.elis.sk Keywords: cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, malignant mesothelioma, cisplatin, doxorubicin.

Cost analysis of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and the risk factors for their increased cost in a public insurance health care system - Single centre study.

INTRODUCTION: This study aimed to evaluate the costs of CRS and HIPEC and treatment of the related postoperative complications in the public healthcare system. We also aimed to identify the risk factors that increase the cost of CRS and HIPEC. MATERIALS AND METHODS: We retrospectively evaluated 80 patients who underwent CRS and HIPEC between February 2016 and November 2018 in the Department of Surgery, University Hospital of Olomouc, Czech Republic. Intraoperative factors and postoperative complications were assessed. The treatment cost included the surgery, hospital stay, intensive care unit (ICU) admission, pharmaceutical charges including medication, hospital supplies, pathology, imaging, and allied healthcare services. RESULTS: The postoperative morbidity rate was 50%, and the mortality rate was 2.5%. The mean length of hospitalisation and ICU admission was 15.44 ± 8.43 and 6.15 ± 4.12 for all 80 patients and 10.73 ± 2.93 and 3.73 ± 1.32, respectively, for 40 patients without complications, and 20.15 ± 13.93 and 8.58 ± 6.92, respectively, for 40 patients with complications. The total treatment cost reached €606,358, but the total reimbursement was €262,931; thus, the CRS and HIPEC profit margin was €-343,427. Multivariate analysis showed that blood loss ≥1.000 ml (p = 0.03) and grade I-V Clavien-Dindo complications (p < 0.001) were independently associated with increased costs. CONCLUSION: The Czech public health insurance system does not fully compensate for the costs of CRS and HIPEC. Hospital losses remain the main limiting factor for further improving these procedures. Furthermore, treatment costs increase with increasing severity of postoperative complications.

Trends in peritoneal surface malignancies: evidence from a Czech nationwide population-based study.

BACKGROUND: The aim of this study is to identify the incidence trends of primary and secondary peritoneal surface malignancies in a representative Czech population. METHODS: Data were obtained from patients registered in the Czech National Cancer Registry between 1979 and 2016. The incidence rates were analyzed between 2012 and 2016. To observe the incidence trends, we analyzed the data from two time periods, 1979-2005 and 2006-2016. The analyzed data included age, sex, and the histological types and primary origins of the malignancies. The Cochrane-Armitage test for linear trends was used for verification of the null hypothesis. The significance level established for hypothesis testing was p = 0.05. RESULTS: Between 2012 and 2016, 230 patients with primary peritoneal tumors were identified and divided into the following groups according to their "International Statistical Classification of Diseases and Related Health Problems, 10th revision" codes: malignant neoplasm of specified parts of the peritoneum (C48.1); malignant neoplasm of the peritoneum, unspecified (C48.2); and malignant neoplasm of overlapping sites of the retroperitoneum and peritoneum (C48.8). Moreover, 549 primary tumors of the appendix (C18.1, encompassing all appendiceal malignancies) and 3137 secondary synchronous peritoneal carcinomatoses of other primary origins were documented. The age-adjusted incidence of primary peritoneal tumors in 2012-2016 was 4.36/year/1,000,000 inhabitants. The age-adjusted incidence of synchronous secondary peritoneal malignancies in 2014-2016 was 99.0/year/1,000,000 inhabitants. The diagnoses of primary peritoneal malignancies followed a stable trend between 1979 and 2016. However, the incidences of primary tumors of the appendix increased by 76.7%. CONCLUSIONS: The data produced in our study ought to clarify the status of peritoneal surface malignancies in the Czech Republic, which can lead to improved planning and development of therapeutic interventions as well as physician training.

Peritoneal Carcinomatosis from Ovarian Cancer - Current Clinical Impact of Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy.

Epithelial ovarian cancer is one of the most common causes of cancer-related death in women. More than half of patients are diagnosed at an advanced stage, usually due to locoregional spread of peritoneal carcinomatosis. A combination of systemic chemotherapy and cytoreductive surgery has been the standard treatment since the mid-1990s. However, conventional chemotherapy is poorly delivered to the peritoneum due to the plasma-peritoneal barrier. Intraperitoneal chemotherapy can improve survival by eliminating residual microscopic disease. A combination of hyperthermic intravenous and intraperitoneal chemotherapy may reduce plasma toxicity and increase therapeutic effectiveness. Several experts are investigating the effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for both primary and recurrent ovarian cancer worldwide. Recent randomized studies indicate that this method prolongs overall patient survival and the disease-free interval. This approach is not yet part of standard guidelines and is the subject of several other clinical trials. However, indications should be considered in women with significant residual disease after neoadjuvant chemotherapy because these patients can benefit from comprehensive surgical resection in combination with hyperthermic intraperitoneal chemotherapy to prevent locoregional relapses.

Current status of cytoreductive surgery (CRS) and intraperitoneal hyperthermic chemotherapy (HIPEC) in the multimodal treatment of peritoneal surface malignancies.

The tumors of the peritoneal surface, both primary and secondary, are associated with a very poor prognosis and rapid progression through conventional oncology treatment including systemic chemotherapy, targeted treatment, radiotherapy, surgery, and symptomatic treatment. Until recently, most of them were considered incurable. In the 1980s, the first cytoreductive surgery ("CRS") combined with intraperitoneal hyperthermic chemotherapy ("HIPEC") became the standard of treatment for selected tumor peritoneal tumor (pseudomyxoma peritonei and primary peritoneal malignant mesothelioma). In some cases of other peritoneal carcinomatosis associated with colorectal cancer, gastric cancer and ovarian cancer in the subgroup of well selected patients, this treatment can lead to a significant prolongation of overall survival and good standard of quality of life. This method is safe in specialized centers with an acceptable rate of morbidity and mortality comparable to foreign workplaces and is also available for patients in the Czech Republic. Key words surgery, oncology, cytoreduction, intraperitoneal chemotherapy, hyperthermia.