Intraperitoneal Chemohyperthermia Using a Closed Abdominal Procedure and Cytoreductive Surgery for the Treatment of Peritoneal Carcinomatosis: Morbidity and Mortality Analysis of 216 Consecutive Procedures

Abstract

The frequency of complications after IPCH and cytoreductive surgery was mainly associated with the carcinomatosis stage and the extent of the surgical procedure. The IPCH closed abdominal procedure has shown an acceptable frequency of adverse events.

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

“…The combination of hyperthermia and high concentration chemotherapy used in HIPEC can also alter physiological healing, which may increase the incidence of anastomotic leaks and GI complication rates [13]. Among the larger series [13][14][15][16][17][18], the reported grade III/IV GI complication rate ranges between 4.5 to 19 %. Small bowel perforations and anastomotic leaks are the most common and clinically significant GI complications after CRS and HIPEC.…”

“…Patients undergoing peritonectomy procedures have a significant risk of post-operative infectious complications and pneumonia is approximately reported in 3.2-10 % of patients [14,15,[24][25][26][27][28][29]. Several studies showed that pulmonary complications can be reduced by local experience, better peri-operative fluid and glycemic control and multi-disciplinary management of patients undergoing CRS and HIPEC [9,[30][31][32].…”

“…Several factors have been analyzed as predictive factors of moderate to severe morbidity following CRS and HIPEC such as sex [35], age, primary colonic anastomosis, number of peritonectomy procedures [10,14,15,28,42], number of visceral resections [10,14,28], number of anastomosis [10], incomplete cytoreduction, disruption of the umbilical fissure [43], dose of chemotherapeutic agent [15], intra-abdominal HIPEC temperature and histopathologic grade [42].…”

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Methodology, Drugs and Bidirectional Chemotherapy

“…There has been no increased risk of anastomotic recurrence or gastrointestinal fistula reported by centres that perform the closure prior to HIPEC [46]. The major advantage of the closed technique is the ability to rapidly achieve and maintain hyperthermia, as there is minimal heat loss from a closed abdomen.…”

Cytoreductive Surgery and Peritonectomy Procedures

“…Similarly, non-anatomic liver resection may be required in patients with extensive deposits on the liver surface. In patients with ovarian cancer, synchronous resection of intraparenchymal liver metastases can be performed with CRS, especially in patients with solitary liver metastases [76,77].…”