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

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; PSOGI and BIG RENAPE working groups

doi:10.1016/j.ejso.2018.04.023

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

Eur J Surg Oncol. 2018 Sep;44(9):1378-1383. doi: 10.1016/j.ejso.2018.04.023. Epub 2018 Jun 19.

Authors

I Amblard¹, F Mercier², D L Bartlett³, S A Ahrendt³, K W Lee³, H J Zeh³, E A Levine⁴, D Baratti⁵, M Deraco⁵, P Piso⁶, D L Morris⁷, B Rau⁸, A A K Tentes⁹, J-J Tuech¹⁰, F Quenet¹¹, E Akaishi¹², M Pocard¹³, Y Yonemura¹⁴, G Lorimier¹⁵, D Delroeux¹⁶, L Villeneuve¹⁷, O Glehen¹, G Passot¹⁸; PSOGI and BIG RENAPE working groups

Collaborators

PSOGI and BIG RENAPE working groups:
J Abba¹⁹, K Abboud²⁰, M Alyami²¹, C Arvieux¹⁹, N Bakrin²¹, J-M Bereder²², D Bouzard²³, C Brigand²⁴, S Carrère²⁵, D Delroeux²⁶, F Dumont²⁷, C Eveno²⁸, O Facy²⁹, F Guyon³⁰, R Kianmanesh³¹, R Lo Dico²⁸, G Lorimier³², F Marchal³³, P Mariani³⁴, P Meeus³⁵, S Msika²⁵, P Ortega-Deballon³¹, B Paquette²⁸, P Peyrat³⁵, N Pirro³⁶, M Pocard²⁸, J Porcheron²⁰, F Quenet²⁵, P Rat²⁹, O Sgarbura²⁵, E Thibaudeau²⁷, J-J Tuech¹⁰, F Zinzindohoue³⁷, S A Ahrendt³⁸, E Akaishi³⁹, S H Baik⁴⁰, D Baratti⁴¹, A Bhatt⁴², P Cachin⁴³, W Ceelen⁴⁴, I De Hingh⁴⁵, M De Simone⁴⁶, P Dubé⁴⁷, R P Edwards⁴⁸, J Franko⁴⁹, L Gonzalez-Bayon⁵⁰, V Gushchin⁴⁹, M P Holtzman³⁸, M-C Hsieh⁵¹, D Kecmanovic⁴⁸, K W Lee³⁸, K Lehmann⁵², Y Liu⁵³, S Mehta⁵⁴, D L Morris⁵⁵, S O'Dwyer⁵⁶, E Orsevigo⁴¹, P K Pande⁵⁷, E J Park⁴⁰, J F Pingpank³⁸, P Piso⁵⁸, F Rajan⁵⁹, B Rau⁶⁰, A Sardi⁶¹, L Sideris⁴⁷, A Sommariva⁶², J Spiliotis⁶³, P Sugarbaker⁶⁴, A A K Tentes⁶⁵, M Teo⁶⁶, R Yarema⁶⁷, R Younan⁶⁸, S S Zaveri⁶⁹, H J Zeh⁷⁰

Affiliations

¹ Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon; University of Lyon 1, EMR 37-38, France.
² Department of Surgical Oncology, University of Montreal, Montreal, Canada.
³ Department of Surgery, University of Pittsburgh Medical Center Shaydyside Hospital, Pittsburg, USA.
⁴ Department of Surgical Sciences-Oncology, Wake Forest Baptist Medical Center, Winston Salem, USA.
⁵ Department of Surgery, Peritoneal Malignancy Program, National Cancer Institute, Milan, Italy.
⁶ Department of Surgical Oncology, Barmherzige Brüder Krankenhaus Regensburg, Germany.
⁷ Department of Surgery, University of New South Wales, Sidney, Australia.
⁸ Department of Surgical Oncology, Charite Campus Virchow Klinikum University of Berlin, Germany.
⁹ Department of Surgery, Didimotichon General Hospital, Athens/Didimotichon, Greece.
¹⁰ Department of Surgical Oncology, CHU Charles Nicolle, Rouen, France.
¹¹ Department of Surgical Oncology, Institut du Cancer de Montpellier, France.
¹² Department of Surgical Oncology, Centro de Oncologia Hospital Sirio Libanes, Sao Paulo, Brazil.
¹³ Department or Surgical Oncology, Hopital Lariboisière, Paris, France.
¹⁴ Department of Surgical Oncology, Organization to Support Peritoneal Dissemination Treatment, Osaka, Japan.
¹⁵ Department of Surgical Oncology, ICO-Paul Papin, Angers, France.
¹⁶ Department of Surgical Oncology, CHU de Besançon, France.
¹⁷ University of Lyon 1, EMR 37-38, France; Hospices Civils de Lyon, Unité de Recherche Clinique, Pôle Information Medicale Evaluation Recherche, Lyon, France.
¹⁸ Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon; University of Lyon 1, EMR 37-38, France. Electronic address: [email protected].
¹⁹ Department of Surgical Oncology, CHU Grenoble University, Grenoble, France.
²⁰ Department of Surgical Oncology, CHU St Etienne, St Etienne, France.
²¹ Department of Surgical Oncology, Centre Hospitalier Lyon Sud - EMR 3738, Lyon 1 University, Lyon, France.
²² Department of Surgical Oncology, CHU L'Archet 2, Nice, France.
²³ Department of Surgical Oncology, CHU Louis Mourier, Colombes, France.
²⁴ Department of Surgical Oncology, CHRU Hautepierre, Strasbourg, France.
²⁵ Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France.
²⁶ Department of Surgical Oncology, CHU Jean Minjoz, Besançon, France.
²⁷ Department of Surgical Oncology, ICO - René Gauducheau, St Herblain, France.
²⁸ Department of Surgical Oncology, CHU Lariboisière, Paris, France.
²⁹ Department of Surgical Oncology, CHU Dijon, Dijon, France.
³⁰ Department of Surgical Oncology, Institut Bergonié, Bordeaux, France.
³¹ Department of Surgical Oncology, CHU Robert Debré, Reims, France.
³² Department of Surgical Oncology, CHU Angers, Angers, France.
³³ Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France.
³⁴ Department of Surgical Oncology, Institut Curie, Paris, France.
³⁵ Department of Surgical Oncology, Centre Léon Bérard, Lyon, France.
³⁶ Department of Surgical Oncology, CHU La Timône, Marseille, France.
³⁷ Department of Surgical Oncology, Hôpital Européen Georges Pompidou, Paris, France.
³⁸ Department of Surgery, University of Pittsburgh Medical Center Shaydyside Hospital, Pittsburgh, United States.
³⁹ Department of Surgical Oncology, Centro de Oncologia Hospital Sirio Libanes, Sao Paolo, Brazil.
⁴⁰ Department of Surgery, Gangnam Severance Hospital - Yonsei University College of Medicine, Seoul, South Korea.
⁴¹ Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy.
⁴² Department of Surgical Oncology, Fortis Hospitals Limited, Bangalore, India.
⁴³ Department of Surgery, Akademiska sjukhuset, Uppsala University Hospital, Uppasala, Sweden.
⁴⁴ Department of Gastrointestinal Surgery, Gent University Hospital, Ghent, Belgium.
⁴⁵ Department of Surgery, Catharina Ziekenhuis, Eindhoven, Netherlands.
⁴⁶ Department of Surgical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Turin, Italy.
⁴⁷ Department of Surgery, University of Montreal, Montreal, Canada.
⁴⁸ Department of Surgery, First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia.
⁴⁹ Department of Surgical Oncology, Mercy Medical Center, Baltimore, United States.
⁵⁰ Department of Surgical Oncology, Hospital Gregorio Marañón, Madrid, Spain.
⁵¹ Department of General Surgery, Wan-Fang Hospital, Taipei, Taiwan.
⁵² Department of Surgery and Transplantation, University Hospital of Zurich, Zurich, Switzerland.
⁵³ NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Japan.
⁵⁴ Division of Peritoneal Surface Oncology, Saifee Hospital, Mumbai, India.
⁵⁵ Department of Surgery, University of New South Wales, Sydney, Australia.
⁵⁶ Department of Colorectal Surgery, Christie Cancer Center, Manchester, United Kingdom.
⁵⁷ Department of Surgical Oncology, BLK Superspeciality Hospital, New Delhi, India.
⁵⁸ Department of Surgery, University of Regensburg, Regensburg, Germany.
⁵⁹ Department of Surgical Oncology, Kovai Medical Centre, Coimbatore, India.
⁶⁰ Department of Surgical Oncology, Charite Campus Mitte University of Berlin, Berlin, Germany.
⁶¹ Department of Surgical Oncology, Mercy Medical Center Baltimore, United States.
⁶² Melanoma and Sarcoma Unit, Istituto Oncologico Veneto, Padua, Italy.
⁶³ First Department of Surgical Oncology, Metaxa Cancer Memorial Hospital, Piraeus, Greece.
⁶⁴ Department of Surgical Oncology, Washington Hospital Center, United States.
⁶⁵ Department of Surgery, Metropolitan Hospital, Athens, Greece.
⁶⁶ Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
⁶⁷ Department of Oncology and Medical Radiology Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
⁶⁸ Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
⁶⁹ Department of Surgical Oncology, Manipal Hospital, Bangalore, India.
⁷⁰ Department of Surgery, University of Pittsburgh Medical Center, Shaydyside Hospital, Pittsburgh, United States.

PMID: 30131104
DOI: 10.1016/j.ejso.2018.04.023

Abstract

Background: Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy.

Objective: To evaluate the impact on survival of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC.

Material and methods: A 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.

Results: Between 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.

Conclusion: Treatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.

Keywords: Gallbladder; Hilar cholangiocarcinoma; Intra-hepatic cholangiocarcinoma; Klatskin.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Adult
Aged
Aged, 80 and over
Bile Duct Neoplasms / mortality
Bile Duct Neoplasms / secondary
Bile Duct Neoplasms / therapy*
Cytoreduction Surgical Procedures / methods*
Female
Follow-Up Studies
France / epidemiology
Humans
Hyperthermia, Induced / methods*
Male
Middle Aged
Peritoneal Neoplasms / mortality
Peritoneal Neoplasms / secondary
Peritoneal Neoplasms / therapy*
Prognosis
Prospective Studies
Registries*
Survival Rate / trends