Preliminary Results of Hyperthermic Intraperitoneal Intraoperative Chemotherapy as an Adjuvant in Resectable Pancreatic Cancer

Abstract

Background and Aims. 5-year survival in patients with pancreatic cancer is poor. Surgical resection is the only potentially curative resection. The results of adjuvant treatment either with chemotherapy or with radiotherapy have been contradictory and the incidence of local-regional recurrence remains high. If local-regional recurrence is controlled survival may be expected to increase. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) may be used in order to control local-regional recurrences. The purpose of the study is to identify the effect of HIPEC in patients with pancreatic cancer undergoing potentially resection. Patients and Methods. From 2007–2011, 21 patients, mean age 69.4 ± 9.5 (50–86) years, underwent tumor resection, and HIPEC with gemcitabine. The hospital mortality and morbidity rate was 9.5% and 33.3%, respectively. 5-year and median survival was 23% and 11 months, respectively. The recurrence rate was 50% but no patient developed local-regional recurrence. No patient was recorded with gemcitabine-induced toxicity. Conclusions. This clinical study of 21 patients is the first to combine an R0 pancreas cancer resection with HIPEC. Increased morbidity and mortality from intraoperative gemcitabine was not apparent. Patients with pancreatic cancer undergoing potentially curative resection in combination with HIPEC may be offered a survival benefit. Data suggested that local-regional recurrences may be greatly reduced. Further studies with greater number of patients are required to confirm these findings.

Hemodynamic Monitoring During Heated Intraoperative Intraperitoneal Chemotherapy Using the FloTrac/Vigileo System

“…All patients received crystalloids, colloids, and fresh frozen plasma (mean, 4.8; range, 2-12) during the operation, whereas 27 patients were transfused with red blood cells (mean, 2.8; range, [1][2][3][4][5][6]. No serious intraoperative complications during HIPEC were recorded.…”

“…5 Cytoreductive surgery and HIPEC for high-grade malignancy is still debatable, with most surgeons agreeing that the volume of disease and the completeness of cytoreduction are crucial for the overall prognosis. 6 Although the morbidity rate of cytoreductive surgery is acceptable and similar to that associated with other major oncologic procedures, 5 perioperative management of patients during HIPEC remains a challenge for surgeons, anesthesiologists, and intensive care unit physicians. A major issue is the observed hemodynamic instabilities even in low-ASA score patients.…”

Pharmacological principles of intraperitoneal and bidirectional chemotherapy

“…Doses of 50-500 mg/m 2 have been advocated for postoperative intraperitoneal chemotherapy and were associated with low toxicity [93][94][95]. Preliminary results demonstrated that HIPEC with 1,000 mg/m 2 for 60 min as adjuvant treatment after curative excision of pancreatic carcinoma is well tolerated [96].…”

Indikationen und Resultate der Peritonektomie bei nichtkolorektaler Peritonealkarzinose

“…Im Jahr 2012 berichteten Tentes et al erstmalig von 21 Patienten, die im Rahmen einer R0-Resektion bei Pankreaskarzinom mit limitierter, resektabler (CC-Score = 0) Peritonealkarzinose eine HIPEC mit Gemcitabin erhielten [62,63]. Bei einer Mortalität von 9,5% und einer Morbidität von 33,3% betrug das mittlere Überleben 11 Monate, bei einem 5-Jahres-Überleben von 23% [62,63].…”

“…Bei einer Mortalität von 9,5% und einer Morbidität von 33,3% betrug das mittlere Überleben 11 Monate, bei einem 5-Jahres-Überleben von 23% [62,63]. Wenngleich diese Werte mit einer systemischen Chemotherapie beim Pankreaskarzinom mit Peritonealkarzinose nicht erreichbar sind, ist die vorgelegte Studie aufgrund ihrer Größe und ihres Designs deutlich limitiert.…”