Objectives In 2020, Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) reached stage 2b of the IDEAL framework and a prospective international PIPAC database was launched in June 2020 by the International Society for the Study of the Pleura and Peritoneum (ISSPP). The ISSPP PIPAC database consists of six key elements, which are reported in an annual report. The ISSPP Registry Group decided to investigate data completeness within the ISSPP PIPAC Database. Methods Retrospective analysis of data completeness in the six key elements was performed between October 1st and 14th, 2024. This was complemented by an in-depth analysis of missing data in Response Evaluation, Complications, and Follow-up . Results Thirty centers, 950 patients, and 2777 PIPAC procedures were registered in the ISSPP database by October 2024. Sixteen of the 30 centers had included patients. Incomplete data were observed in four of the six key elements. Most centers (7/16) had incomplete data in Complications , followed by Response evaluation (5/16), and Follow-up (2/16). In depth analysis showed that, e.g., for complications, the date and type of the complication was registered in 88 and 89 %, respectively. Incomplete data in Response evaluation occurred mainly in the small group of patients evaluated by nonperitoneal regression grading score (non-PRGS, n=316), where no scoring was provided in 211 patients (72 %). Follow-up data, such as date of death or reasons for stopping PIPAC, were provided for 86 and 85 % of patients. Conclusions Overall data completeness of the ISSPP PIPAC Database was considered satisfactory at the present state, and the ISSPP Registry Group has launched several initiatives to further improve data completeness and quality, to provide solid data sets for future annual reports and other research.

BACKGROUND:Standard treatment for resectable peritoneal metastasis (PM) includes the combination of cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Postoperative evisceration is a rare but major complication after CRS and HIPEC. This study aimed to identify the risk factors associated with evisceration after HIPEC, comparing outcomes between open and closed abdominal HIPEC. METHODS:We conducted a retrospective multi-center study analyzing data of 233 patients with PM who underwent CRS/HIPEC between 2014 and 2023. Patients were categorized based on the HIPEC technique: Open (OPEN_HIPEC), n = 110; Closed abdominal technique (CLOSED_HIPEC), n = 123). We aimed to identify patient factors associated with evisceration within 30 days of CRS/HIPEC, using multivariate analysis. RESULTS:Among 233 patients included, 129 (55.4 %) were women. The median age was 60 [51; 67] years. The OPEN_HIPEC group was significantly younger than the CLOSED_HIPEC group (median 57 [47; 62] vs 63 [54; 70] years; p ≤ 0.001) with a higher PCI score (median 9.5 [5; 17] vs 6 [2; 11]; p ≤ 0.001). Severe complications were similar between OPEN and CLOSED_HIPEC: 17 (15.5 %) vs 15 (12.2 %); p = 0.471 with no mortality. Eight (3.4 %) patients had postoperative evisceration with significantly more occurrences in the OPEN_HIPEC than in the CLOSED_HIPEC group (7/110 (6.4 %) vs 1/123 (0.8 %); p = 0.028). Univariate analysis identified chronic obstructive pulmonary disease (COPD)/respiratory pathology (HR = 7.02 [1.76-28.1]) and PCI score category of 11-15 (HR = 5.09 [1.03-25.2] as risk factors. Multivariate analysis identified a history of COPD/respiratory pathology (HR = 7.39 [1.85-29.6], p = 0.005) and OPEN_HIPEC (HR = 8.37 [1.03-68.1], p = 0.047) as risk factors of postoperative evisceration. Although suture material was not identified as a significant factor by the analysis, all eviscerations in the OPEN_HIPEC group were observed following musculoaponeurotic closures using Vicryl 1 sutures. CONCLUSIONS:Following CRS/HIPEC treatment, 3.4 % patients had evisceration by day 30. A history of COPD/respiratory pathology and OPEN_HIPEC technique were identified as independent risk factors associated with evisceration, necessitating reintervention. It should also be noted that in the OPEN_HIPEC group there were no eviscerations after the change to PDS sutures.

INTRODUCTION:Pseudomyxoma peritonei (PMP) is a rare malignancy characterized by mucinous ascites and peritoneal implants, primarily arising from ruptured appendiceal neoplasms. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the preferred treatment for resectable and operable cases. METHODS:An international panel from the Peritoneal Surface Oncology Group International (PSOGI), the International Society for the Study of Pleura and Peritoneum (ISSPP), the Society of Surgical Oncology (SSO), the European Society of Surgical Oncology (ESSO), and EURACAN used the GRADE methodology and ADOLOPMENT approach to adapt existing guidelines. Clinical questions were framed using the PICO framework, and systematic reviews were conducted. Evidence certainty and the balance of benefits and harms were evaluated with the Evidence-to-Decision framework. RESULTS:A strong recommendation was made for CRS and HIPEC over debulking surgery for resectable PMP. Observational studies reported 5- and 10-year survival rates of 80% and 55%, respectively, with CRS and HIPEC, compared to lower outcomes with debulking. Despite the very low certainty of evidence, the panel strongly endorses CRS and HIPEC over debulking surgery. This recommendation is driven by PMP's known chemoresistance, the lack of viable alternative treatments, and the survival benefits observed in observational studies coming only from radical surgery. CONCLUSION:This consensus endorses CRS and HIPEC as the standard of care for operable and resectable PMP. This recommendation will increase acceptance and awareness among a broader audience of healthcare professionals about the potential benefits of this treatment in managing this rare peritoneal disease.

Selected diffuse malignant peritoneal mesothelioma (DMPM) patients may be radically treated with complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Two thirds of them recur with the possibility of iterative CRS-HIPEC and/or systemic chemotherapy. The postoperative follow-up management is based on scarce data. The recurrence profile was explored in a large national database to challenge the standard follow-up protocol. Consecutive, pathologically proven, epithelioid DMPM patients from the RENAPE database, treated with complete CRS-HIPEC were included in this analysis. Patients with more than 5 years of follow-up were divided into long-term control group (event-free), early relapse group (event within 2 years), and intermediate relapse group. Survival distributions were estimated by the Kaplan-Meier method. Overall, 288 patients met the inclusion criteria (95

AIM:Alteration of bowel function after delayed coloanal anastomosis (DCAA) might be a limitation to its utilization. Our aim was to assess the long-term bowel function of DCAA in a large multicentric cohort. METHOD:All patients who underwent DCAA interventions at 29 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Low anterior resection syndrome (LARS) score or confection of a stoma due to poor bowel function was assessed in eligible patients. Good bowel function was defined by the preservation of bowel continuity with no LARS or a minor LARS. RESULTS:Among the 385 eligible patients to assess long-term bowel continuity, 63% (n = 243) responded to the questionnaire or had a definitive stoma because of poor bowel function. After a median follow-up of 32 months, good bowel function was reported by 60% (n = 146) of patients (with no LARS 36% and minor LARS 24%), whereas 40% of patients (n = 146) had a poor bowel function including major LARS (36%) and definitive stoma due to poor bowel function (4%). No variables tested were predictive of a poor bowel function after DCAA, including a history of pelvic radiotherapy (P = 0.722), salvage DCAA after failure of a previous anastomosis (P = 0.755), presence of a diverting stoma (P = 0.556), occurrence of an anastomotic leakage (P = 0.416) and time interval from the DCAA to the bowel function assessment (P = 0.350). CONCLUSIONS:No LARS or minor LARS was reached for 60% of patients after DCAA. Less than 5% of patients received a definitive stoma due to a poor bowel function.

[This corrects the article DOI: 10.1371/journal.pone.0287785.].

BACKGROUND:Complete cytoreductive surgery with Hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment for patients with peritoneal metastases. In this retrospective observational two-center study, we assessed the impact of patient's body mass index (BMI) on surgical and oncological outcomes. METHODS:Between 2017 and 2021, 144 patients with peritoneal metastases (all etiologies) were included. Morbi-mortality at day-30, overall survival and free-recurrence-survival were compared according to the patients BMI. The patients were divided into 2 groups (BMI < 25, and BMI ≥ 25). RESULTS:Median overall survival (OS) was 71.3 months [63-71.5], with significant differences observed between BMI groups (p = 0.015). Recurrence-free survival (RFS) averaged 26.8 months [20-35.3] and did not significantly differ between groups (p = 0.267). After stratification by histology, OS and RFS remained consistent. Cox multivariate analysis adjusted for Peritoneal Carcinomatosis Index (PCI) revealed BMI < 25 (HR = 2.53 [1.10-5.80]) and male sex (HR = 2.34 [1.11-4.92]) as predictors of poorer OS. 30-Day complication rates did not significantly differ (p = 0.094). The BMI ≥ 25 group experienced higher rates of digestive fistulas (p = 0.05) and 90-day readmissions (p = 0.007), although reintervention rates were comparable (p = 0.723). CONCLUSIONS:Our study suggests a potential 'obesity paradox' in the context of HIPEC procedures. Morbidity at day-30 was similar for BMI < 25, and BMI ≥ 25 patients. Readmissions at day-90 were more frequent in high-BMI group. BMI < 25 is deleteriously associated with mortality. BMI and sex were related to OS.

Introduction La chirurgie de cytoréduction combinée à une CHIP est réalisée pour des patients sélectionnés atteints de carcinose. En cas d’atteinte diaphragmatique, une résection partielle du diaphragme peut être nécessaire pour être CC0. En cas d’invasion pleurale macroscopique, mais CC0, une CHIP abdominale et intrathoracique (CHIT) à travers le diaphragme peut être envisagée. Objectifs Rapporter la procédure combinée, l’évolution postopératoire, la morbidité et les résultats. Méthodes Une base de données monocentrique a été utilisée. Résultats Sept cas de CHIT synchrones ont été identifiés. PCI médian à 12 (3–39). Quatre patients avaient une anastomose et deux une splénectomie. L’oxaliplatine était utilisé dans 4 CHIT, cisplatine 2 fois, mitomycine 1. Le cathéter d’entrée était derrière la rate – le cathéter de sortie dans le thorax droit. La chirurgie durait 580minutes (300–720), avec une extubation 2–4heures après l’opération, ou le 1er jour. Le drainage thoracique à J1 était de 657mL (300–1600), diminuant à J 3. Le retrait du drain était au 8e jour (7–17), le séjour hospitalier de 12jours (8–16). Un patient a présenté une fistule pancréatique et une pneumopathie, 6 autres sans complications majeures. Un épanchement pleural résiduel unique identifié à un mois. Aucune récidive pleurale n’a été observée pour les PMP, à 88 mois (30–166). Conclusions La combinaison d’une CHIP et d’une CHIT est possible sans risques majeurs. Le drainage thoracique peut produire des volumes importants en postopératoire. Des résultats favorables à long terme sont observés pour les PMP de bas grade.

BACKGROUND:Standard treatment for resectable peritoneal metastases (PM) combines cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC); however, the rate of recurrence remains high and repeat CRS/HIPEC may be considered in well-selected patients. We describe our postoperative and oncological outcomes. METHODS:Between 1994 and 2024, data from 132 repeat CRS/HIPEC procedures were analyzed in this retrospective multicenter study. Morbimortality, overall survival (OS) and recurrence-free survival (RFS) were evaluated for colorectal peritoneal metastases (CRPM) and peritoneal pseudomyxoma (PMP). RESULTS:Overall, 63 patients, including 55 patients with CRPM (87.3%) and 8 patients with PMP (12.7%), underwent CRS/HIPEC. Of these patients, 58 (92%) underwent CRS/HIPEC twice, 4 (6.3%) underwent CRS/HIPEC three times, and 1 (1.6%) underwent CRS/HIPEC four times. Peritoneal Carcinomatosis Index (PCI) score, operating room occupancy, complication and readmission rates at day 90, and length of intensive care unit and hospital stay were similar between the initial and first repeat CRS/HIPEC procedures. No 90-day postoperative mortality occurred. For CRPM, the median OS was 82.3, 53.9, and 74.5 months from the initial, first, and second repeat CRS/HIPEC procedures, respectively, with a median RFS of 22.0, 36.9, and 13.2 months, respectively. For PMP, after a median follow-up of 70.8 and 39.3 months from the initial and first repeat CRS/HIPEC procedures, respectively, all patients were alive, with a median RFS of 22.4 and 39.4 months, respectively. Multivariate analysis shown that no factor was significantly related to severe complications (Dindo-Clavien 3-4) or OS. CONCLUSIONS:In selected patients with CRPM and PMP, CRS/HIPEC shows comparable results between the initial and repeat procedures in terms of postoperative outcomes, and appears to improve survival, especially for PMP. Repeat CRS/HIPEC is an option to be considered in patients presenting with CRPM or PMP.

Background: Despite modern systemic chemotherapy, survival remains poor for patients with advanced isolated peritoneal metastases from the gastrointestinal tract. We aimed to assess the safety and efficacy of pressurized intraperitoneal aerosol chemotherapy (PIPAC) with oxaliplatin. Patients and methods: We conducted a phase 1/2, open label, non -comparative, dose escalation and expansion trial of PIPAC with oxaliplatin in patients with a peritoneal cancer index (PCI) of more than 5, 13 and 15 for respectively a gastric, small bowel and colorectal primary cancer, and who had received at least three months of systemic chemotherapy. PIPAC cycle lengths were 4 -6 weeks with systemic chemotherapy allowed 15 days after each PIPAC. PCI and oxaliplatin tumor concentration were assessed every PIPAC cycle. The main endpoints were tolerability, tumor response, and survival. Results: Between 2017 and 2020, 34 patients were enrolled in three centers, in this phase 1/2 study, of whom 25 were evaluable at the recommended dose determined in the phase I trial (90 mg/m 2 plus systemic 5 -FU). Before inclusion, patients received a median of 2 [1 -4] chemotherapy lines and had a median PCI of 22.5 [7 -29]. At this dose, the safety profile showed acceptable tolerability. Eight patients (32 %) had grade 3/4 treatment -related adverse events. Minor (grade 1/2) adverse events were mainly abdominal pain (n = 19, 76 %) and nausea (n = 16, 64 %). Median PFS was 6.1 months and median OS was 13 months. Conclusion: In patients with advanced and refractory peritoneal metastasis, PFS of 6.1 months is encouraging. A prospective randomized phase II study is required.