Deemantha G. Fernando, MD
Research Technologist II
Medical College of Wisconsin, Wisconsin, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Peritoneal carcinomatosis from small bowel adenocarcinoma (SBA-PC) often presents symptomatically, necessitating surgery for palliation but the role of curative-intent surgery needs to be better defined. Using a systematic review and meta-analysis, this study aims to define the role of CRS/HIPEC in patients with SBA-PC in comparison to systemic chemotherapy (SC) alone.
Methods:
Medline/PubMed was searched for English language articles on SBA-PC, published between 1990 – 2020 (Figure1).
Results:
Ten studies with 461 patients undergoing CRS/HIPEC and seven studies with 285 patients undergoing SC alone were identified. Among patients who had CRS/HIPEC, 215 (46.6%) were male and the median age ranged between 46.5 - 66 years. Primary was most commonly located in the duodenum (n=169, 36.7%) followed by the ileum (n=108, 23.4%). Grade was unspecified in most patients (n=232, 50.3%). Median Peritoneal Cancer Index ranged between 10 -12, and 93.1% underwent complete cytoreduction (CC 0/1). Majority underwent CRS/HIPEC (n=295, 63.9%), with few early postoperative intraperitoneal chemotherapy (EPIC) (n=12, 2.6%) and HIPEC+EPIC (n=10, 2.1%) procedures. Meta-analysis demonstrated CRS/HIPEC related major morbidity and mortality of 20.8% (95% CI 15.8-25.7) and 1.7% (95% CI 0.1-3.3) respectively. After a median follow-up of 21.4 (95% CI 19.2-23.5) months, CRS/HIPEC group demonstrated median overall survival of 32.3 (95% CI 30-34.6) months vs 14.5 (95% CI 14.1-14.9) months for SC alone. Disease-free survival was 13.7 (95% CI 11.2-16.2) months, and 3-year survival was 37% (95% CI 31.3-42.6) in the CRS/HIPEC group.
Conclusions:
In comparison to SC alone, CRS/HIPEC may result in long-term survival with acceptable perioperative morbidity, in well-selected SBA-PC patients with low-volume disease undergoing complete cytoreduction.