AB105. SOH22ABS086. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in small bowel adenocarcinoma with peritoneal carcinomatosis: a systematic review

Background: Small bowel adenocarcinoma (SBA) with peritoneal carcinomatosis (PC) is rare and despite treatment with systemic chemotherapy, the prognosis is poor. However, there is emerging evidence that cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) may offer a survival benefit over systemic therapy alone. This systematic review will assess the effectiveness of CRS-HIPEC for SBA-PC.

Methods: Three databases were searched from inception to 11/10/2021. Clinical outcomes were extracted and analysed.

Results: A total of 164 cases of SBA-PC patients undergoing CRS-HIPEC were identified in 12 studies. The majority of patients had neoadjuvant chemotherapy (87/164, 53%) and complete cytoreduction (143/164, 87%) prior to HIPEC. The mean overall survival was 9- to 32-month and 5-year survival ranged from 25–40%. Clavien-Dindo grade III/IV morbidity ranged between 19.1–50%, while overall mortality was low with only 3 treatment-related deaths.

Conclusions: CRS-HIPEC has the potential to improve the overall survival in a highly select group of SBA-PC patients, with 5-year survival rates comparable to those reported in colorectal peritoneal metastases. However, the expected survival benefits need to be balanced against the intrinsic risk of morbidity and mortality associated with the procedure. Further multicentre studies are required to assess the safety and feasibility of CRS-HIPEC in SBA-PC to guide best practice management for this rare disease.

Keywords: Cytoreductive surgery (CRS); general surgery; hyperthermic intraperitoneal chemotherapy (HIPEC); small bowel adenocarcinoma (SBA); systematic review