A contemporary analysis of morbidity and outcomes in cytoreduction/hyperthermic intraperitoneal chemoperfusion

Abstract

The risks and benefits of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CS/HIPEC) continue to be debated by the oncology community. A retrospective analysis of contemporary data (2003–2011) was performed to provide objective information regarding surgical morbidity, mortality, and survival for patients undergoing CS/HIPEC at a comprehensive cancer center. While procedure-associated morbidity was comparable to other major surgical oncology procedures, there was no operative or 30-day mortality and 60-day mortality was 2.7%. Increasing numbers of bowel resections were found to correlate to an increased incidence of deep surgical site infections (including abscess and enterocutaneous fistula) and need for reoperation which was in turn associated with a decreased overall survival (OS) and progression-free survival (PFS). Five-year OS rates varied by site of tumor origin and histology (disseminated peritoneal adenomucinosis [91.3%], Mesothelioma [80.8%], Appendiceal Adenocarcinoma [38.7%], and Colorectal Adenocarcinoma [38.2%]). With an acceptable morbidity and mortality rate, CS/HIPEC should be included as an effective treatment modality in the multidisciplinary care of select patients with peritoneal metastases.

Hemodynamic Monitoring During Heated Intraoperative Intraperitoneal Chemotherapy Using the FloTrac/Vigileo System

“…All patients received crystalloids, colloids, and fresh frozen plasma (mean, 4.8; range, 2-12) during the operation, whereas 27 patients were transfused with red blood cells (mean, 2.8; range, [1][2][3][4][5][6]. No serious intraoperative complications during HIPEC were recorded.…”

“…4 The indications of the method continue to expand because favorable 5-year survival rates were observed in low-grade malignancies, such as peritoneal adenomucinosis. 5 Cytoreductive surgery and HIPEC for high-grade malignancy is still debatable, with most surgeons agreeing that the volume of disease and the completeness of cytoreduction are crucial for the overall prognosis. 6 Although the morbidity rate of cytoreductive surgery is acceptable and similar to that associated with other major oncologic procedures, 5 perioperative management of patients during HIPEC remains a challenge for surgeons, anesthesiologists, and intensive care unit physicians.…”

Guidelines on the Use of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Surface Malignancy Arising from Colorectal or Appendiceal Neoplasms

“…Overall survival varies from 20% to 90% at 5 years 70,72,[75][76][77][78][79] . It is influenced 26,29,31,32,55,78 by origin of the psm, histology, pci score, patient comorbidities (performance status, body mass index, health problems), cancer-related symptoms, and surgical morbidity and mortality 79,80 .…”

Hyperthermic intraperitoneal chemotherapy combined with cytoreductive procedure in patients with peritoneal pseudomyxoma

“…Среди осложнений наиболее часто развиваются несостоятельность анастомоза, кишечные и панкре-атические фистулы, пневмония, тромбоэмболия и внутрибрюшинные абсцессы [16]. При этом многие авторы сходятся во мнении, что частота и тяжесть этих послеоперационных осложнений обусловлены характером и объемом хирургического вмешатель-ства и не зависят от выполнения ГИПХ [12,18]. Со-гласно другой точке зрения, ГИПХ может повышать риск развития несостоятельности анастомоза и/или спонтанной перфорации [2].…”