TY - JOUR
T1 - Cytoreduction with Hyperthermic Intraperitoneal Chemoperfusion for Pancreatic Cancer with Low-Volume Peritoneal Metastasis
T2 - Results from a Prospective Pilot Study
AU - Grotz, Travis E.
AU - Yonkus, Jennifer A.
AU - Thiels, Cornelius A.
AU - Warner, Susanne G.
AU - McWilliams, Robert R.
AU - Mahipal, Amit
AU - Bekaii-Saab, Tanios S.
AU - Cleary, Sean P.
AU - Kendrick, Michael L.
AU - Truty, Mark J.
N1 - Publisher Copyright:
© 2022, Society of Surgical Oncology.
PY - 2023/1
Y1 - 2023/1
N2 - Introduction: Resection of oligometastatic pancreatic ductal adenocarcinoma (PDAC) has historically been ineffective, however modern systemic chemotherapy has improved survival. Thus, re-evaluating safety and outcomes of surgical resection in selected patients with limited peritoneal metastasis (PM) warrants consideration. Methods: From 2018 to 2021, patients with PDAC and positive cytology or limited PM without extraperitoneal metastasis and who had an objective response to ≥ 6 months of systemic chemotherapy were enrolled. Patients underwent laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin/mitomycin C. If amenable to a complete cytoreduction, patients went on to cytoreduction and HIPEC. Results: Overall, 18 patients were enrolled and received a median of 14 (interquartile range [IQR] 12–17) cycles of chemotherapy; 16 (89%) patients received chemoradiation. Laparoscopic HIPEC was completed in 17 patients, with a median length of stay of 1 day, and no grade III complications or hematological toxicities were observed. All 18 patients subsequently underwent a complete cytoreduction (CC-0) along with definitive treatment of the primary tumor, with formal resection (7/18), irreversible electroporation (IRE; 10/18), or intraoperative radiation therapy (IORT; 1/18). Median PCI was 2 (IQR 0–4), median LOS was 7 days (IQR 6–8), and 7 (39%) patients were readmitted. Eight (44%) patients experienced grade 3 or higher complications, including one 30-day mortality. At a median follow-up of 16 months, the median progression-free survival was 20 months and the median overall survival was 26 months. Conclusion: Cytoreduction and HIPEC for selected patients with low-volume PM from PDAC is safe and feasible with favorable short-term outcomes. A phase II trial (NCT04858009) is now enrolling to further assess this multimodality approach in select patients.
AB - Introduction: Resection of oligometastatic pancreatic ductal adenocarcinoma (PDAC) has historically been ineffective, however modern systemic chemotherapy has improved survival. Thus, re-evaluating safety and outcomes of surgical resection in selected patients with limited peritoneal metastasis (PM) warrants consideration. Methods: From 2018 to 2021, patients with PDAC and positive cytology or limited PM without extraperitoneal metastasis and who had an objective response to ≥ 6 months of systemic chemotherapy were enrolled. Patients underwent laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin/mitomycin C. If amenable to a complete cytoreduction, patients went on to cytoreduction and HIPEC. Results: Overall, 18 patients were enrolled and received a median of 14 (interquartile range [IQR] 12–17) cycles of chemotherapy; 16 (89%) patients received chemoradiation. Laparoscopic HIPEC was completed in 17 patients, with a median length of stay of 1 day, and no grade III complications or hematological toxicities were observed. All 18 patients subsequently underwent a complete cytoreduction (CC-0) along with definitive treatment of the primary tumor, with formal resection (7/18), irreversible electroporation (IRE; 10/18), or intraoperative radiation therapy (IORT; 1/18). Median PCI was 2 (IQR 0–4), median LOS was 7 days (IQR 6–8), and 7 (39%) patients were readmitted. Eight (44%) patients experienced grade 3 or higher complications, including one 30-day mortality. At a median follow-up of 16 months, the median progression-free survival was 20 months and the median overall survival was 26 months. Conclusion: Cytoreduction and HIPEC for selected patients with low-volume PM from PDAC is safe and feasible with favorable short-term outcomes. A phase II trial (NCT04858009) is now enrolling to further assess this multimodality approach in select patients.
UR - http://www.scopus.com/inward/record.url?scp=85136133699&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85136133699&partnerID=8YFLogxK
U2 - 10.1245/s10434-022-12328-z
DO - 10.1245/s10434-022-12328-z
M3 - Article
C2 - 35972667
AN - SCOPUS:85136133699
SN - 1068-9265
VL - 30
SP - 395
EP - 403
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 1
ER -