Mentored experience of establishing a national peritoneal malignancy programme – experience of first 50 operative cases

• Published in: European journal of surgical oncology Vol. 43; no. 2; pp. 395 - 400
• Main Authors: Chang, K.H, Kazanowski, M, Staunton, O, Cahil, R.A, Moran, B.J, Shields, C, Mulsow, J., MD FRCSI
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2017
• Subjects: Biomarkers, Tumor - blood; Cytoreduction Surgical Procedures; Cytoreductive surgery; Diagnostic Imaging; Female; Hematology, Oncology and Palliative Medicine; Humans; Hyperthermic intraperitoneal chemotherapy; Ireland - epidemiology; Male; Mesothelioma - mortality; Mesothelioma - pathology; Mesothelioma - surgery; Middle Aged; Neoplasm Metastasis; Outcomes; Peritoneal malignancy; Peritoneal metastasis; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - surgery; Postoperative Complications - mortality; Pseudomyxoma peritonei; Pseudomyxoma Peritonei - mortality; Pseudomyxoma Peritonei - pathology; Pseudomyxoma Peritonei - surgery; Retrospective Studies; Surgery; Treatment Outcome; hyperthermic; intraperitoneal; malignancy; metastasis; outcomes; cytoreductive; pseudomyxoma; peritonei; chemotherapy; peritoneal; surgery; Peritoneal metastasis; Hyperthermic intraperitoneal chemotherapy; Peritoneal malignancy; Cytoreductive surgery; Pseudomyxoma peritonei; Outcomes
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2016.10.007

Abstract Background Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are considered standard of care for pseudomyxoma peritonei (PMP) and selected patients with colorectal peritoneal metastases (CPM) or peritoneal mesothelioma. A National Peritoneal Malignancy programme was established in Ireland (population of 4.5 million) in May 2013 with mentoring and support from the Peritoneal Malignancy Institute, Basingstoke UK. This study reviews the operative and oncological outcomes for the first 50 patients who underwent CRS and HIPEC in Ireland. Methods This is a retrospective review of all patients referred, and of the subset who underwent CRS and HIPEC, for peritoneal malignancy in Ireland between May 2013 and November 2015. Results During the study period, 130 patients were referred and 50 patients were selected for CRS and HIPEC. Three patients were found to have unresectable disease at laparotomy. Of the remaining 47 patients, eight had major tumour debulking. In total, 39 underwent complete cytoreduction and 45 received HIPEC. After a median follow up of 12.7 months, 12 patients had developed further metastatic disease. The rates of complete cytoreduction, complication and operative mortality were 83%, 0% and 0% respectively. There were no major Clavien-Dindo grade III/IV morbidity. Conclusions We report the successful establishment of a national peritoneal malignancy programme. Mentoring from an experienced centre may have shortened the known learning curve evident by our encouraging outcomes. The follow-up period is short, however our early results are comparable with internationally reported figures.