Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion

Abstract

BACKGROUNDThe purpose of this prospective Phase II study was to analyze morbidity and mortality of cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP) in the treatment of peritoneal surface malignancies.METHODSA total of 205 patients (50 with peritoneal mesothelioma, 49 with pseudomyxoma peritonei, 41 with ovarian cancer, 32 with abdominal sarcomatosis, 13 with colon cancer, 12 with gastric cancer, and 8 with carcinomatosis from other origins) underwent 209 consecutive procedures. Four patients underwent the intervention twice because of disease relapse. There were 70 men and 135 women. Mean age was 52 years (range, 22–76 yrs). CRS was performed by using peritonectomy procedures. IPHP through the closed abdomen technique was conducted with a preheated (42.5 °C) perfusate containing cisplatin + mitomycin C or cisplatin + doxorubicin.RESULTSMajor morbidity rate was 12%. The most significant complications were 23 anastomotic leaks or bowel perforations, 4 abdominal bleeds, and 4 sepses. Operative mortality rate was 0.9%. On logistic regression model multivariate analysis, extent of cytoreduction (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.29–6.40) and dose of cisplatin for IPHP ≥ 240 mg (OR, 3.13; 95% CI, 1.24–7.90) were independent risk factors for major morbidity. Ten patients presented with Grade 3 to 4 toxicity.CONCLUSIONSCRS + IPHP presented acceptable morbidity, toxicity, and mortality rates, all of which support prospective Phase III clinical trials. Cancer 2006. © 2006 American Cancer Society.

Postoperative Infections in Cytoreductive Surgery With Hyperthermic Intraperitoneal Intraoperative Chemotherapy for Peritoneal Carcinomatosis

“…In our study we found 29 postoperative infections in 30 patients, with a 36% rate of infected patients (11/30), and 2.6 infections per patient. This rate is in the range of those reported in the literature (3.3-62.5%) [11,[24][25][26]. However, most of these studies were designed to assess the overall complications of peritonectomy, and not to address postoperative infections specifically.…”

“…In these trials [11,26], infectious complications, especially sepsis and septic shock, were the cause of half deaths. Kusamura [24]. In a more recent study, Sugarbaker et al [25] found 42 % of infectious complications in grade III (National Cancer Institute's Common Toxicity Criteria) (http:// ctep.cancer.gov), adverse events, including 17% line sepsis, 17% urinary tract infections, 5% wound infections, and 3% abdominal abscesses; moreover, they found a 5% infection rate in procedures complicated by grade IV adverse event.…”

Intensive Care Unit Admission after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Is It Necessary?

“…After the gastrointestinal tract, the respiratory tract is probably the system that is most affected by postoperative complications. Pulmonary morbidity was found in six cases of our series and the majority of these were resolved without reintervention or invasive procedures, with the exception of a case of pulmonary embolism [25]. …”

“…High rates of potential fatal complications associated with HIPEC have been reported in the literature [1, 2]; that is why some patients need to be admitted to intensive care unit for stabilization, detection, and early resolution of complications associated with the extension of the surgical procedure, the toxicity of the drugs administered, or both. Particular emphasis should be placed on the dose of cisplatin administered i.p., because in a multivariate analysis it has been reported that doses >240 mg correlate with the appearance of postoperative complications [3–5]. Post-HIPEC morbidity rates range from 30 to 74% and mortality ranges from 0 to 19% [1, 2, 6, 7].…”

Pseudomyxoma peritonei – diagnostic and therapeutic difficulties. Literature review and

“…Śmiertelność wyniosła 0,9%. W analizie wieloczynnikowej niezależny-mi czynnikami ryzyka zwiększonej częstości występo-wania powikłań była rozległość cytoredukcji oraz dawka cisplatyny [40]. W ostatnim przeglądzie systematycznym dotyczącym bezpieczeństwa zabiegu CRS i HIPEC stwierdzono, że chorobowość i śmiertelność zabiegu jest podobna jak w przypadku dużych zabiegów chirurgicznych, takich jak operacja Whippla.…”