Treatment of Peritoneal Carcinomatosis by Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemoperfusion (IHCP): Postoperative Outcome and Risk Factors for Morbidity

Roviello, Franco; Marrelli, Daniele; Neri, Alessandro; Cerretani, Daniela; Manzoni, Giovanni De; Pedrazzani, Corrado; Cioppa, Tommaso; Nastri, G; Giorgi, Gianluca; Pinto, Enrico

doi:10.1007/s00268-006-0038-0

Cited by 74 publications

(55 citation statements)

References 47 publications

(129 reference statements)

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“…In GLP, the occurrence of the relapse is usually confined to the peritoneal cavity and the low incidence of systemic metastasis seems to indicate that the control of peritoneal seeding may provide a potential benefit. As has already been demonstrated for GC with positive peritoneal cytology or limited peritoneal carcinomatosis, hyperthermic intra-peritoneal chemotherapy (HIPEC) could represent an option in GLP and should be tested in specifically designed controlled studies [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Gastric linitis plastica: which role for surgical resection?

et al. 2011

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Background The role of surgery for gastric linitis plastica (GLP) is questioned. This study aimed to analyze our experience in the surgical treatment of GLP with specific reference to the resectability rate, prognosis, and mode of recurrence. Methods Results of surgery were analyzed in 102 patients with GLP. Results Of the 102 patients, 92 underwent surgical exploration, with resection performed in 60 cases. R2 resection was carried out in 20 patients and R1 in 12 patients, while the resection was considered potentially curative (R0) in 28 (27.5%). Overall, the median (95% confidence interval [CI]) survival time was 5.7 (3.7-7.5) months, with none of the patients alive at the end date of the study. For R0 patients the median (95% CI) survival time was 15.8 (11-20.7) months. The great majority of recurrences were intra-abdominal (peritoneal and/or locoregional), with a systemic component of the relapse that was rarely observed (5 cases). Conclusions After primary surgery, GLP showed a poor prognosis without regard to the extent or type of resection. The failure of surgical treatment related mainly to the peritoneal spread of the disease. Specifically designed multimodality treatment protocols should be tested in this setting.

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Section: Discussionmentioning

confidence: 99%

Gastric linitis plastica: which role for surgical resection?

et al. 2011

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“…The overall morbidity after CRS and HIPEC is reported as 12-56% and perioperative mortality between 0-12 %, in the literature, (25)(26)(27)(28). The morbidity rate is associated with disease dissemination, cytoreduction extension, number of removed organs, age, perioperative blood loss and operative time (29,30).…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive surgery (SRC) for treatment of peritoneal carcinomatosis and hyperthermic ıntraperitoneal chemotherapy (HIPEC): Our initial experience and technical details

Topgül

Çetinkaya

Arslan

et al. 2015

UCD

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Objective: The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature. Material and Methods:Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed. Results:The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence. Conclusion:Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.

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“…Compared with children, adults who have CHPP have a higher incidence of small-bowel fistula and obstruction, 11 ileus, 13 and pancreatitis postoperatively. 11 Our patient did not have these complications.…”

Section: Nutrition/gastrointestinal Carementioning

confidence: 99%

“…Ileus is also a potential complication of abdominal cytoreductive surgery and CHPP. 13 If ileus is present, plasma may seep into the intestinal lumen and the peritoneal cavity, causing fluid and electrolyte imbalance. Intravenous infusion of lactated Ringer's solution is normally started at 1.5 times maintenance volume during the first 48 hours after surgery to help maintain adequate circulating blood volume.…”

Section: Fluid and Electrolytesmentioning

confidence: 99%