Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for small bowel neuroendocrine tumors with peritoneal metastasis. Issue 7 (July 2022)

• Record Type: Journal Article
• Authors: Hajjar, Roy; Mercier, Frederic; Passot, Guillaume; Pasquer, Arnaud; Gelli, Maximiliano; Levine, Edward A.; Villeneuve, Laurent; Poncet, Gilles; Walter, Thomas; Glehen, Olivier
• Is Part Of: European journal of surgical oncology. Volume 48:Issue 7(2022)
• Page Start: 1626
• Page End: 1630
• Publication Date: 2022-07
• Subjects: Neuroendocrine tumor -- Cytoreductive surgery -- HIPEC -- Peritoneal metastasis; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2022.03.019
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: Up to 20% of patients with small-bowel neuroendocrine tumors (SB-NETs) may present with peritoneal carcinomatosis (PM). Surgical cytoreduction (CRS) has been proposed as an adequate management as it confers a survival benefit in selected patients. The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to CRS in this context may be an option but data on its added benefits is lacking. Methods: A search was performed in the prospective multicenter international collaborative database of the Peritoneal Surface Oncology Group International (PSOGI) and BIG-RENAPE working groups, and patients who underwent a surgical treatment (CRS or CRS with HIPEC) for a SB-NET with PM were identified and compared. Results: Between 2002 and 2016, a total of 67 patients were identified as having a CRS for SB-NET, with 36 receiving HIPEC during surgery. Median postoperative follow-up was 34 months. The peritoneal cancer index (PCI) and the completeness of cytoreduction score (CCR-score) were higher in the CRS-HIPEC group. More grade III-IV complications occurred in this group as assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0. Despite a tendency toward a better progression/recurrence-free survival in patients receiving HIPEC, no significant differences were noted between the CRS and CRS-HIPEC groups in terms of postoperative recurrence. Conclusions: HIPEC does not seem to provide additional benefits in terms of postoperative evolution and survival in patients with SB-NET undergoing CRS. It is associated with higher morbidity. It may possibly lead to an improved recurrence-free survival, but further reports are required to confirm this assumption. Highlights: Surgical cytoreduction without hyperthermic intraperitoneal chemotherapy (HIPEC) may be considered as an appropriate treatment for metastatic small-bowel neuroendocrine tumors (SB-NETs). The addition of HIPEC to surgical cytoreduction may be considered to improve progression/recurrence-free survival and possibly symptoms, but is associated with increased postoperative morbidity. Further data is required to determine if HIPEC provides an added benefit to surgical cytoreduction in patients with SB-NETs.