Cytoreductive surgery and HIPEC improve survival compared to palliative chemotherapy for biliary carcinoma with peritoneal metastasis: A multi-institutional cohort from PSOGI and BIG RENAPE groups

Publication date: Available online 19 June 2018
Source:European Journal of Surgical Oncology
Author(s): I. Amblard, F. Mercier, D.L. Bartlett, S.A. Ahrendt, K.W. Lee, H.J. Zeh, E.A. Levine, D. Baratti, M. Deraco, P. Piso, D.L. Morris, B. Rau, A.A.K. Tentes, J.-J. Tuech, F. Quenet, E. Akaishi, M. Pocard, Y. Yonemura, G. Lorimier, D. Delroeux, L. Villeneuve, O. Glehen, G. Passot
BackgroundPeritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy.ObjectiveTo evaluate the impact on survival of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC.Material and methodsA prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test.ResultsBetween 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the systemic chemotherapy group. In the surgical group, median peritoneal cancer index was 9 (range 3-26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the chemotherapy group (35% vs. 18%, p=0.001). Median OS was 21.4 and 9.3 months for surgical and chemotherapy group, respectively (p=0.007). Three-year overall survival was 30% and 10% for surgical and chemotherapy group, respectively.ConclusionTreatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.



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