PSM
CME
.jpg "Hallbera Gudmundsdottir, MD photo")
Hallbera Gudmundsdottir, MD
Resident
Department of Surgery, Mayo Clinic, United States
Disclosure(s): No financial relationships to disclose
Hallbera Gudmundsdottir, MD
Resident
Department of Surgery, Mayo Clinic, United States
Disclosure(s): No financial relationships to disclose
Jennifer Yonkus, MD
General Surgery Resident
Mayo Clinic, United States
Disclosure information not submitted.
Cornelius A. Thiels, DO, MBA
Assistant Professor
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, United States
Disclosure information not submitted.
Susanne G. Warner, MD
Assistant Professor of Surgery
Mayo Clinic
Disclosure information not submitted.
Sean Cleary, MD
Professor
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, United States
Disclosure information not submitted.
Michael Kendrick, MD
Professor
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, United States
Disclosure information not submitted.
Mark J. Truty, MD, MSc
Practice Chair
Mayo Clinic Rochester
Rochester, Minnesota, United States
Disclosure information not submitted.
Travis E. Grotz, MD
Assistant Professor
Mayo Clinic
Rochester, Minnesota, United States
Disclosure(s): No financial relationships to disclose
Surgical resection of pancreatic ductal adenocarcinoma (PDAC) with peritoneal metastases has historically been found to be ineffective. However, in the era of modern systemic chemotherapy, a phase I clinical trial of hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) demonstrated acceptable short-term morbidity. The oncologic outcomes of this approach compared to standard systemic therapy (SST) remains unknown.
Methods:
Patients with PDAC and limited peritoneal metastases who underwent CRS and HIPEC from 2018 to 2022 were identified from a prospective trial database. For the comparison group, patients diagnosed with peritoneal metastases on staging laparoscopy from 2017 to 2021 were identified and only patients who met trial inclusion criteria, but were not enrolled in the trial, were identified for comparison. Overall (OS) and progression-free survival (PFS) from diagnosis of peritoneal metastases was estimated using Kaplan-Meier analysis and groups compared using the log-rank test.
Results:
In total, 60 patients met inclusion criteria: 38 underwent SST and 22 HIPEC/CRS. The two groups were balanced in terms of prognostic factors, with no statistically significant difference in age, sex, presence of gross metastases, serum CA 19-9 and CEA, or peritoneal fluid CA 19-9 and CEA (all p >0.05). In the SST arm, median OS was 19 months and none survived past 30 months, with a 1-, 2-, and 3-year survival of 82%, 29%, and 0%, respectively. In contrast, median OS in the CRS/HIPEC arm was 41 months and 1-, 2-, and 3-year survival was 91%, 71%, and 63%, respectively, which compared favorably with the SST group (p=0.003, Figure). At a median follow-up of 18 months, 14 patients (64%) treated with CRS and HIPEC remain off all therapy and without any evidence of disease.
Conclusions:
Systemic chemotherapy followed by HIPEC/CRS was associated with improved survival compared to systemic therapy alone in highly selected patients with PDAC and limited peritoneal metastases. Prospective validation of these results is needed and a phase II trial is underway.