The St Constantin Hospital's initial experience with CRS-HIPEC

Abstract

Introduction: Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is a spreading technique for the treatment of peritoneal carcinomatosis, a technique that is associated with high morbidity and mortality rates. We report retrospectively the experience of St Constantin Hospital Brasov, underlining the good results obtained in terms of both reduction of complications and oncologic outcome. Methods: Between Juin 2013 and October 2015, 32 patients with a median age of 55.6 years, underwent 34 CRS-HIPEC combined procedures. Results: CCR-0 resection was achieved in 19/34 of patients, CCR-1 in 8/34 of patients and CCR-2 in 7/34 of patients, with a median operative time of 560 minutes (range 400-620 minutes). Median hospital stay was 9 days(4 days in laparoscopic HIPEC-20 days). Total morbidity rate was 40%, with WHO grade 3 and 4 morbidity rate 0 and the 30 days mortality was 0. With a median follow up of 11.8 months, the overall survival (OS) rate was 62%. Gastrointestinal (GI) origin in contrast with ovarian origin and peritoneal cancer index (PCI) higher than 19 showed a worst prognosis in terms of both OS and Progression Free Survival (PFS). Conclusions. In a referral surgical oncology centre, CRS-HIPEC related perioperative mortality and morbidity can be reduced with a multidisciplinary patient management and a correct patient selection for this procedure. Our single centre retrospective series confirm the advantage in PFS and OS of the combined treatment CRS-HIPEC in the management of peritoneal carcinomatosis.

Successful Implementation of HITOC and HIPEC in the Management of Advanced Ovarian Carcinoma with Pleural and Peritoneal Carcinomatosis

“…The absence of complications contributed to the overall positive trajectory of the patient’s recovery, allowing the second surgical intervention to be performed, which consisted of peritoneal CRS and HIPEC one month later. It consisted of an en bloc posterior pelvic exenteration with a pelvic peritonectomy [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ], lymphadenectomy, and en bloc enlarged enterectomy with a total colectomy and terminal ileostomy ( Figure 7 and Figure 8 ). It is worth noting that lymphadenectomy plays a crucial role in peritoneal carcinomatosis cases by providing essential insights into regional lymph node involvement in advanced disease forms, aiding in accurate staging, guiding therapeutic decisions, and enhancing prognostic assessments.…”

“…It is worth noting that lymphadenectomy plays a crucial role in peritoneal carcinomatosis cases by providing essential insights into regional lymph node involvement in advanced disease forms, aiding in accurate staging, guiding therapeutic decisions, and enhancing prognostic assessments. The HIPEC lavage was performed using cisplatin 100 mg/m 2 and doxorubicin 50 mg/m 2 at 42 degrees Celsius for 90 min [ 6 , 7 , 8 , 9 , 10 , 11 ]. The patient’s postoperative evolution after HIPEC was marked by a combination of physiological stability, effective pain management, restored organ functions, and an overall improvement in wellbeing.…”