Early postoperative intraperitoneal chemotherapy for lower gastrointestinal neoplasms with peritoneal metastasis: a systematic review and critical analysis

BackgroundEarly postoperative intraperitoneal chemotherapy (EPIC) can be used in combination with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) to treat patients with peritoneal carcinomatosis (PC) of multiple origins. The present study is a systematic review to evaluate the role of EPIC after CRS + HIPEC for appendiceal and colorectal cancers with PC.ContentWe conducted a systematic search in PubMed according to the PRISMA guidelines and included all studies published before June 27 of 2019 comparing EPIC to HIPEC or the combination of both. Our search found 79 articles. After excluding non-relevant articles, a total of 13 retrospective clinical studies reporting on the efficacy and safety of EPIC compared to HIPEC or as a combination therapy for lower gastrointestinal neoplasms were analyzed. Initial EPIC reports led to its declined usage because of concerns with increased postoperative morbidity and uncertain added benefit on survival. Recent retrospective studies have been promising, showing significant improvements in OS and fewer issues with complications when adding EPIC to CRS + HIPEC.ConclusionsCurrent evidence is entirely retrospective and is conflicting. It is hoped that ongoing clinical trials and additional studies will clarify EPIC’s role in the treatment of patients with PC.

Neoadjuvant, adjuvant and long-term intravenous/intraperitoneal chemotherapy, hyperthermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy for ovarian cancer

Ovarian cancer is commonly diagnosed after dissemination and is accompanied by a poorer overall prognosis. Treatment incorporates a multimodal approach, utilizing various combinations of surgery and chemotherapy. Ultimately, better screening tests are needed for ovarian cancer to help reduce the burden of advanced-stage disease. For those women with advanced-stage tumors, newer therapeutic strategies may help prolong survival and increase the chance for cure. The aim of this study is to review current trends in the treatment of women diagnosed with advanced-stage epithelial ovarian cancer.