Chemohyperthermia for advanced abdominal malignancies: a new procedure with closed abdomen and previously performed anastomosis

Abstract

ChemoHyperthermic Peritoneal Perfusion (CHPP) after cytoreductive surgery is a relatively new procedure in the treatment of abdominal carcinomatosis or sarcomatosis. An assessment of the CHPP technique performed on 20 patients suffering from abdominal malignancies was carried out. After surgical debulking and gastrointestinal anastomosis, two Tenckhoff catheters were positioned for the immediate performance of CHPP, which was carried out at 42-43 degrees C for 1 h, after closing the abdomen. In 19 assessable patients, 47.3% and 36.8% complete responses (CR) were recorded at 1 and 6 months, respectively, with responses of 37.5% in patients affected with gastrointestinal cancer and 50% in patients affected with ovarian cancer. CR were obtained only in patients who had undergone accurate peritoneal debulking. Survival rate for gastrointestinal and ovarian cancer was 68% at 12 months. Patients who underwent radical cytoreductive surgery are all alive at a follow-up median time of 17 months. Two anastomotic leakages with spontaneous recovery were observed, along with one hydrothorax, which was immediately drained during the procedure, three cases of chemotherapic gastrointestinal toxicity, one sepsis, one renal failure that required a transient dialysis, and one cholecystitis that required cholecystectomy. One patient died 30 days after CHPP of a cardiac ischaemia not strictly related to the surgical procedure. In the authors' experience, CHPP with closed abdomen after reconstructive gastrointestinal surgery is a safe and feasible treatment with acceptable side effects.

Cytoreductive Surgery and Intraperitoneal Chemohyperthermia for Recurrent Peritoneal Carcinomatosis from Ovarian Cancer

“…In addition, mild hyperthermia has been shown to enhance cytotoxicity of cisplatin in animals models [10]. In the surgical setting, adding intraperitoneal chemohyperthermia (IPCH) has been shown to be safe and feasible [11, 12, 13].…”

Cytoreductive Surgery Combined with Intraperitoneal Chemohyperthermia for the Treatment of Advanced Colon Cancer

“…27 Morbidity is higher than that described in CHPP for ovarian cancer, but peritonectomy procedures in ovarian carcinomatosis are generally less complicated due to the fact that peritoneal implants from ovarian cancer do not tend to penetrate as in the gastrointestinal neoplasms. 22 In our opinion, the CHPP results are promising. In selected patients, affected by naive or pretreated recurrences of colonic PC, the combination of aggressive cytoreductive surgery and CHPP seems to give an advantage in terms of overall survival compared with the historical data extrapolated from the EVOCAP 1 multicenter study.…”

“…mitomycin C (15 mg/m 2 ) delivered seemed equally efficacious, but less toxic than higher dosages used in other institutions. 22 This combination has been used repeatedly as a treatment for disseminated colorectal cancer and pseudomyxoma peritonei by many teams all around the world using a variety of different devices and techniques. 23 The best results were achieved in cases of small volume peritoneal carcinomatosis in which aggressive surgical procedures effectively reduced tumor volume.…”

“…During our preliminary experience the dosage of i.p. mitomycin C (15 mg/m 2 ) delivered seemed equally efficacious, but less toxic than higher dosages used in other institutions 22. This combination has been used repeatedly as a treatment for disseminated colorectal cancer and pseudomyxoma peritonei by many teams all around the world using a variety of different devices and techniques 23.…”

“…schedule prescribed via the systemic route 27. Morbidity is higher than that described in CHPP for ovarian cancer, but peritonectomy procedures in ovarian carcinomatosis are generally less complicated due to the fact that peritoneal implants from ovarian cancer do not tend to penetrate as in the gastrointestinal neoplasms 22…”