20-Year Experience with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Sarcomatosis

Background-Aims: About 80-90% of Soft Tissue Sarcomas (STS) patients develop peritoneal sarcomatosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been used in the treatment of peritoneal sarcomatosis but their role has not been clearly defined. The purpose of the study is the presentation of the experience in peritoneal sarcomatosis with CRS plus HIPEC and review of the literature.

Patients-Methods: All patients with peritoneal sarcomatosis treated from 2004-2024 were retrospectively reviewed. Clinical and histopathologic variables were correlated to survival, recurrence, and morbidity.

Results: Thirty-one patients, mean age 59.3+15 (24-93) years underwent 42 cytoreductive surgical operations. HIPEC was used in 33 cases. CC-0 surgery was possible in 90.6%. The 90 days hospital mortality was zero. The morbidity rate was 24.3% but severe complications were recorded in 7.3%. The 10-year survival and disease free survival rate was 78% and 76% respectively.The mean and median follow-up time was 26+27 (2-128) months, and 15 months respectively. The recurrence rate was 53.5%. The age > 65 years was identified as an independent variable of survival. No independent variable of recurrence and morbidity was identified.

Conclusion: A high proportion of patients with peritoneal sarcomatosis may undergo complete cytoreduction. It appears that some histopathologic subtypes may be offered significant benefit from CRS.The heterogeneity of histopathology, the rarity of the disease, and the high rate of recurrence do not allow us to draw definitive conclusions. Further studies are required to understand and define the proper treatment of peritoneal sarcomatosis.

Keywords: Cytoreductive Surgery, HIPEC, Peritoneal Sarcomatosis, Survival, Recurrence, Morbidity.