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The 2022 PSOGI International Consensus on HIPEC Regimens for Peritoneal Malignancies: Pseudomyxoma Peritonei

  • Peritoneal Surface Malignancy
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Abstract

Background

The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) constitutes the established standard of care for pseudomyxoma peritonei patients. However, the role of HIPEC lacks validation through randomized trials, leading to diverse proposed treatment protocols. This consensus seeks to standardize HIPEC regimens and identify research priorities for enhanced clarity.

Methods

The steering committee applied the patient, intervention, comparator, and outcome method to formulate crucial clinical questions. Evaluation of evidence followed the Grading of Recommendations, Assessment, Development, and Evaluation system. Consensus on HIPEC regimens and research priorities was sought through a two-round Delphi process involving international experts.

Results

Out of 90 eligible panelists, 71 (79%) participated in both Delphi rounds, resulting in a consensus on six out of seven questions related to HIPEC regimens. An overwhelming 84% positive consensus favored combining HIPEC with CRS, while a 70% weak positive consensus supported HIPEC after incomplete CRS. Specific HIPEC regimens also gained consensus, with 53% supporting Oxaliplatin 200 mg/m2 and 51% favoring the combination of cisplatin (CDDP) associated with mitomycin-C (MMC). High-dose MMC regimens received an 89% positive recommendation. In terms of research priorities, 61% of panelists highlighted the importance of studies comparing HIPEC regimens post CRS. The preferred regimens for such studies were the combination of CDDP/MMC and high-dose MMC.

Conclusions

The consensus recommends the application of HIPEC following CRS based on the available evidence. The combination of CDDP/MMC and high-dose MMC regimens are endorsed for both current clinical practice and future research efforts.

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Author notes

  1. Olivier Glehen and Brendan Moran have contributed equally to this article.

Authors and Affiliations

  1. Department of Surgical Oncology, PSM Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Shigeki Kusamura MD, PhD & Marcello Deraco MD

  2. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France

    Jean-Baptiste Delhorme MD

  3. Department of Digestive Surgery, Dupuytren University Hospital, CNRS, XLIM, UMR 7252, Limoges, France

    Abdelkader Taibi MD PhD

  4. Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Recherche et d’Epidémiologie Cliniques, Pierre-Bénite, France

    Laurent Villeneuve MBE, PhD

  5. CICLY, Université Claude Bernard Lyon 1, Lyon, France

    Laurent Villeneuve MBE, PhD & Olivier Glehen MD, PhD

  6. Department of General Surgery, Emergency, and New Technologies, San Camillo Forlanini Hospital, Rome, Italy

    Rea Lo Dico MD, PhD

  7. Department of Surgical Oncology, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France

    Olivier Glehen MD, PhD

  8. Peritoneal Malignancy Unit, Basingstoke Hospital, Basingstoke, UK

    Brendan Moran MD

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Olivier Glehen is a consultant for Gamida and no other authors have any disclosures. The authors report no conflict of interest.

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Kusamura, S., Delhorme, JB., Taibi, A. et al. The 2022 PSOGI International Consensus on HIPEC Regimens for Peritoneal Malignancies: Pseudomyxoma Peritonei. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15646-6

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