Complications of Cytoreductive Surgery and HIPEC in the Treatment of Peritoneal Metastases

Abstract

The combined treatment concept of cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) has shown to be an efficient therapeutic option for selected patients with primary and secondary peritoneal carcinomatosis (PC). This strategy represents the standard of care for diseases like pseudomyxoma peritonei and peritoneal mesothelioma, and offers the best long-term results for PC from colorectal cancer. Despite these results, skepticism exists regarding this therapeutic approach partly because of its perceived high toxicity. In this article, we review the current evidence on complications that can occur after CRS and HIPEC and the risk factors associated with increased incidence of morbidity and mortality.

Body surface area‐based vs concentration‐based perioperative intraperitoneal chemotherapy after optimal cytoreductive surgery in colorectal peritoneal surface malignancy treatment: COBOX trial

“…This was reflected in the high range of Pt concentration in the tumor nodule at the end the 30-minute HIPEC procedure in the HIPEC-CONC group.CRS and HIPEC are associated with a steep learning curve concerning the demanding surgical and comprehensive procedures, meticulous patient selection, and management of treatment-related morbidity [31][32][33][34]. In literature, overall morbidity ranges from 12% to 52% and mortality from 0.9% to 5.8% in established institutions 35,36. In this trial, we report that all patients experienced minor morbidity whendischarged from the hospital.…”

Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies

“…The median DFS for peritoneal mesothelioma ranged from 7.2 to 40 months . Despite this success, the use of HIPEC for peritoneal carcinoma is associated with significant morbidity and mortality, with mortality rates from 0.9% to 5.8% (mostly gastrointestinal, pulmonary, and hematologic), and rates from 12% to 52% being reported even at tertiary centers with significant expertise in these techniques …”

“…111 Despite this success, the use of HIPEC for peritoneal carcinoma is associated with significant morbidity and mortality, with mortality rates from 0.9% to 5.8% (mostly gastrointestinal, pulmonary, and hematologic), and rates from 12% to 52% being reported even at tertiary centers with significant expertise in these techniques. 113 Emerging Therapeutic Drug-Delivery Strategies for LRR This review demonstrates that there is a critical unmet need to improve the prevention and treatment of LRR across several major malignancies. Fortunately, several novel treatment strategies are emerging to improve local drug delivery to the tumor bed ( Fig.…”

Malignant Peritoneal Tumors – Introduction

“…Z chirurgických komplikací jsou to nejčastěji střevní perforace, píštěle a abscesy, pooperační ileus, krvácení, raný infekt či sepse, objevit se mohou ale i píštěle pankreatické a biliární. Z extraabdominálních komplikací se vyskytují nejčastěji respirační infekce, toxicita použitého chemoterapeutika vede cca v 11 % případů k dřeňovému útlumu a leukopenii, v 6-8 % případů působí chemoterapeutikum nefrotoxicky [15,16]. K minimalizaci komplikací přispívá vhodná selekce pa cientů, adekvátní perioperační péče, a především zdokonalování operační technikys narůstajícím počtem výkonů pooperační morbidita i mortalita klesá, learn ing curve se pohybuje okolo 100 výkonů [17].…”