Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2020; 12(7): 756-767
Published online Jul 15, 2020. doi: 10.4251/wjgo.v12.i7.756
Comparison of open and closed hyperthermic intraperitoneal chemotherapy: Results from the United States hyperthermic intraperitoneal chemotherapy collaborative
Jennifer L Leiting, Jordan M Cloyd, Ahmed Ahmed, Keith Fournier, Andrew J Lee, Sophie Dessureault, Seth Felder, Jula Veerapong, Joel M Baumgartner, Callisia Clarke, Harveshp Mogal, Charles A Staley, Mohammad Y Zaidi, Sameer H Patel, Syed A Ahmad, Ryan J Hendrix, Laura Lambert, Daniel E Abbott, Courtney Pokrzywa, Mustafa Raoof, Christopher J LaRocca, Fabian M Johnston, Jonathan Greer, Travis E Grotz
Jennifer L Leiting, Travis E Grotz, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55901, United States
Jordan M Cloyd, Ahmed Ahmed, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Keith Fournier, Andrew J Lee, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Sophie Dessureault, Seth Felder, Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL 33612, United States
Jula Veerapong, Joel M Baumgartner, Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA 92093, United States
Callisia Clarke, Harveshp Mogal, Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Charles A Staley, Mohammad Y Zaidi, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States
Sameer H Patel, Syed A Ahmad, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, United States
Ryan J Hendrix, Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, United States
Laura Lambert, Peritoneal Surface Malignancy Program Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States
Daniel E Abbott, Courtney Pokrzywa, Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI 53792, United States
Mustafa Raoof, Christopher LaRocca, Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States
Fabian M Johnston, Jonathan Greer, Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, United States
Author contributions: Leiting JL designed and performed the research and wrote the paper; Grotz TE designed the research and wrote the paper; Cloyd JM, Ahmed A, Fournier K, Lee AJ, Dessureault S, Felder S, Veerapong J, Baumgartner JM, Clarke C, Mogal H, Staley CA, Zaidi MY, Patel SH, Ahmad SA, Hendrix RJ, Lambert L, Abbott DE, Pokrzywa C, Raoof M, LaRocca CJ, Johnston FM and Greer J analyzed the data and critically revised the manuscript.
Supported by the National Center for Advancing Translational Sciences, No. UL1TR002377.
Institutional review board statement: This study was reviewed and approved by the Institutional Review board at all participating institutions.
Informed consent statement: The requirement to obtain informed consent was waived by each participating Institutional Review Board.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Travis E Grotz, MD, Assistant Professor, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, 200 First Stteer Southwest, Rochester, MN 55905, United States. grotz.travis@mayo.edu
Received: March 3, 2020
Peer-review started: March 3, 2020
First decision: April 18, 2020
Revised: May 1, 2020
Accepted: June 2, 2020
Article in press: June 2, 2020
Published online: July 15, 2020
ARTICLE HIGHLIGHTS
Research background

Appropriately selected patients with peritoneal carcinomatosis are treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC is administered in either an open or a closed fashion.

Research motivation

The two techniques to administer HIPEC both have advantages and disadvantages. The open technique allows for full visualization of the abdomen during the HIPEC administration, though it is more difficult to maintain hyperthermia as well as increased potential for contamination with cytotoxic agents. The closed technique, on the other hand, allows for greater ability for temperature control and limits exposure though at the cost of visibility.

Research objectives

The objective of this study was to determine if one of these techniques was superior to the other in terms of both short- and long-term outcomes. Previous studies have been limited either preclinical animal models or single-center studies.

Research methods

A multi-institutional database from 12 academic institutions across the country was utilized for this study. Patients who underwent curative-intent CRS and HIPEC were identified and demographic, clinical, post-operative, and survival data was obtained. Kaplan-Meier survival method was used to determine estimates for overall and recurrence-free survival. Cox proportional hazard regression was used for multi-variable analysis was also used for overall and recurrence-free survival.

Research results

There was no difference in severe complications or rates of re-operation between the open and the closed HIPEC groups. Open HIPEC had higher mortality within 90 d while closed HIPEC had higher rates of readmission. The HIPEC technique used was also not an independent factor for overall or recurrence-free survival on multi-variable analysis.

Research conclusions

We found that HIPEC technique was not an independent factor for overall or recurrence-free survival, as well as not contributing significantly to relevant post-operative outcomes. Our goal was to determine if there was an optimal HIPEC regimen in order to provide patients with the best possible outcomes.

Research perspectives

The HIPEC technique used can be left to the discretion of the operating surgeon, though continued effort to standardize HIPEC administration would benefit our ability to study patient outcomes. The optimal HIPEC regimen remains unknown and may vary depending on the clinical situation.