Cytoreduction and HIPEC in the Netherlands: nationwide long-term outcome following the Dutch protocol

Anke M J Kuijpers, Boj Mirck, Arend G J Aalbers, Simon W Nienhuijs, Ignace H J T de Hingh, Martinus J Wiezer, Bert van Ramshorst, Robert J van Ginkel, Klaas Havenga, Andreas J Bremers, Johannes H W de Wilt, Elisabeth A Te Velde, Vic J Verwaal, Anke M J Kuijpers, Boj Mirck, Arend G J Aalbers, Simon W Nienhuijs, Ignace H J T de Hingh, Martinus J Wiezer, Bert van Ramshorst, Robert J van Ginkel, Klaas Havenga, Andreas J Bremers, Johannes H W de Wilt, Elisabeth A Te Velde, Vic J Verwaal

Abstract

Purpose: This nationwide study evaluated results of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis of colorectal origin in the Netherlands following a national protocol.

Methods: In a multi-institutional study prospective databases of patients with peritoneal carcinomatosis (PC) from colorectal cancer and pseudomyxoma peritonei (PMP) treated according to the Dutch HIPEC protocol, a uniform approach for the CRS and HIPEC treatment, were reviewed. Primary end point was overall survival and secondary end points were surgical outcome and progression-free survival.

Results: Nine-hundred sixty patients were included; 660 patients (69 %) were affected by PC of colorectal carcinoma and the remaining suffered from PMP (31 %). In 767 procedures (80 %), macroscopic complete cytoreduction was achieved. Three-hundred and thirty one patients had grade III-V complications (34 %). Thirty-two patients died perioperatively (3 %). Median length of hospital stay was 16 days (range 0-166 days). Median follow-up period was 41 months (95 % confidence interval (CI), 36-46 months). Median progression-free survival was 15 months (95 % CI 13-17 months) for CRC patients and 53 months (95 % CI 40-66 months) for PMP patients. Overall median survival was 33 (95 % CI 28-38 months) months for CRC patients and 130 months (95 % CI 98-162 months) for PMP patients. Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients.

Conclusions: The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP. It is assumed the uniform Dutch HIPEC protocol was beneficial.

Figures

Fig. 1
Fig. 1
Cumulative number of patients who underwent CRS-HIPEC in the Netherlands over the years
Fig. 2
Fig. 2
a Survival of patients with PC of colorectal cancer (n = 660) in Kaplan–Meier survival curve. b Survival of patients with PMP (n = 300) in Kaplan–Meier survival curve. OS overall survival, PFS progression-free survival

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