Meaningful long-term survival is
possible for selected patients suffering from advanced cancer of the abdomen
when treated with cytoreductive surgery with Hyperthermic IntraPeritoneal
Chemotherapy, or HIPEC, according to a first-of-its-size analysis by physicians
at Wake Forest Baptist Medical Center.
Wake Forest Baptist has the largest
reported, single-center experience with cytoreductive surgery and HIPEC, said
lead author Edward A. Levine, M.D., and analysis
of 20 years’ worth of patient data shows that outcomes have clearly improved
for patients undergoing this treatment technique.
surgery, or debulking, is removal of part of a malignant tumor which can’t be
completely excised and is done to enhance chemotherapy effectiveness. HIPEC is
a perfusion technique in which heated chemotherapy is administered directly
into the abdomen during the surgery to kill remaining cancer cells.
findings are published in the current issue of the Journal of the American
College of Surgeons and were presented by Levine, professor of surgery and
chief of surgical oncology service at Wake Forest Baptist, last year at the
annual meeting of the Southern Surgical Association.
dissemination of abdominal malignancy has a clinical course marked by bowel
obstruction and death,” Levine said. “It traditionally does not respond well to
intravenous chemotherapy. This two-phase approach has clearly extended the
lives of many of our patients.”
the study, Levine and colleagues reviewed data of 1,000 patients who underwent
1,095 HIPEC procedures over the past two decades. The average age of patients
was almost 53 years and slightly more than half were female. Primary tumor
sites were: appendix 472(47.2 percent), colorectal 248(24.8 percent),
mesothelioma 72(7.2 percent), ovary 69(6.9 percent), gastric 46(4.6 percent),
others 97(9.7 percent).
said the median overall survival was 29.9 months, with a five-year survival of
32.5 percent. “The data further shows that patients with advanced abdominal
cancer should no longer be approached with therapeutic nihilism,” he said. “Long-term
survival is clearly possible for selected patients treated with HIPEC.”
John H. Stewart IV, M.D., Perry Shen, M.D., Gregory B. Russell, M.S., Brian L.
Loggie, M.D., and Konstantinos I Votanopoulos, M.D., Ph.D., all of Wake Forest