Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion: The University of Arizona early experience

Abstract

AIM:To evaluate the safety and effectiveness of our new cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) program. METHODS:Retrospective review of patients with gastrointestinal malignancies who were suitable candidates for CRS and HIPEC between 12/1/2009 and 10/1/2010. All clinicopathologic data were reviewed with a special focus on the surgical outcome and the postoperative morbidity and mortality. RESULTS:Fourteen patients were identified. Median age was 64 years; seven were female. The primary tumors were: colonic (29%), appendiceal (36%), peritoneal mesothelioma (14%), gastric (7%), adenocarcinoma of unknown primary (7%), and gastrointestinal stromal tumor (7%). Eleven patients (79%) received CRS/HIPEC, three for palliation. Three patients that did not undergo CRS/HIPEC had an average peritoneal cancer index (PCI) of 25. The eight patients that underwent curative CRS/HIPEC had an average PCI of 10 and a completeness of cytoreduction score of 0 (87.5%) or 1 (12.5%). Postoperative morbidity was 36%; the worst adverse event was Grade 3 ileus. Mortality rate was 0%. CONCLUSION:CRS with HIPEC is safe and feasible at tertiary institutions with fledgling programs. PCI is an accurate predictor of surgical outcomes.

Early experience with cytoreduction and hyperthermic intraperitoneal chemotherapy at a newly developed center for peritoneal malignancy

“…Increasing patient age and the extent of carcinomatosis (PCI score) were independent predictors of major morbidity and mortality. Our results also compare similarly to other new centers who have been able to achieve low morbidity and low perioperative mortality (20,21). Several independent predictors of morbidity and mortality have been identified including age, operative time, extent of disease, completeness of cytoreduction, number of anastomoses, HIPEC center, tumor location and grade, as well as others (10,23,26,27).…”

“…We were able to achieve optimal cytoreduction (CCR 0/1) in 92% of patients. This compares favorably with other new as well as established centers able to achieve CCR 0/1 rates ranging from 70-87% (9,10,18,20,21).…”

The Treatment of Peritoneal Carcinomatosis in Advanced Gastric Cancer: State of the Art

“…Neoadjuvant chemotherapy, routinely recommended for management of GC without PC, may improve survival also in PC from GC [10, 34–37] and adjuvant chemotherapy could prevent recurrence from GC [10]. Finally, the study of molecular and serum tumour markers could provide valuable prognostic information and would allow for a better selection of subsequent treatment combinations [14, 38].…”

“…CRS and HIPEC are associated with significant morbidity and mortality, also in high volume centers, and reported rates are included between 0.9–5.8% and 12–52%, respectively [ 34 ]. The main postoperative complications after CRS and HIPEC are intra-abdominal abscess, gastric or small intestinal perforation, postoperative ileus, anastomotic leakage, postoperative bleeding, fistula, sepsis, respiratory distress, hematologic toxicity, and urinary disturbance [ 6 , 19 ].…”

Initial experience with hyperthermic intra peritoneal chemotherapy and cytoreductivesurgery

“…The procedure of CRS and HIPEC in treating PC arising from different organs is gaining momentum with more institutions acquiring technical support and expertise in various parts of world. Reports from single institutions are published for example in 11 patients from Arizona; [5] 12 patients with irinotecan and mitomycin -Phase I study from France; [6] 20 patients from 2001 to 2008 with follow-up of 8-28 months from Spain; [7] 21 patients followed for 43 months from China; [8] 22 patients from 2007 to 2010 followed for 35 months from Croatia; [9] 26 patients from 2007 to 2011 from Mexico. [10] Peritoneal carcinomatosis is often fatal.…”