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428. Proactive HIPEC treatment of pelvic T4 locally advanced cancer and recurrent pelvic colorectal cancer: Preliminary results
S164 428. Proactive HIPEC treatment of pelvic T4 locally advanced cancer and recurrent pelvic colorectal cancer: Preliminary results C. Sassaroli1, D. Scala2, D. Rega2, U. Pace2, F. Ruffolo2, A. Cassata3, P. Delrio2 1 Istituto Nazionale Tumori Fondazione “G.Pascale”, Napoli, Italy 2 Istituto Nazionale Tumori Fondazione “G.Pascale”, Colorectal Surgical Oncology and Abdominal Oncology Department, Napoli, Italy 3 Istituto Nazionale Tumori Fondazione “G.Pascale”, Abdominal Oncology Department, Napoli, Italy Introduction: Colorectal cancer with localized pelvic disease and no distant metastases is amenable to a curative approach. Both in case of T4 locally advanced pelvic tumor or in presence of a pelvic recurrence, peritoneum is the first actor in spreading cancer cells beneath pelvic organs. It is now known that peritoneal metastases can be cured by early referral HIPEC. The goal of such an aggressive surgical strategy is to provide a complete clearance of the primary cancer and preventing intraabdominal diffusion of the disease. Patients and methods: From 2010 to 2014, among 46 pelvectomies performed both for pelvic recurrence or locally advanced recto-sigmoid tumors, in 10 patients we performed simultaneous HIPEC (proactive treatment). Total pelvectomy was performed in 3 patients: 2 for T4 tumors (1 mucinous) and one for pelvic recurrence (mucinous); posterior pelvectomy was performed in 7 patients: 3 for T4 tumors (2 mucinous) and 4 for pelvic recurrence (all mucinous). All patients received pelvic peritonectomy, intraperitoneal oxaliplatin with systemic 5 e Fluorouracil for a 30 minutes HIPEC treatment. Peritoneal dissection was started at the transverse umbilical line. Results: There were 3 complications of grade III-IV sec. Clavien. No postoperative death occurred. The median postoperative hospital stay was 17 days. After variable follow up all patients are free of disease: 1 after 4 years, 1 after 3 years, 3 after 2 years, 4 after 6 months. One patient is free of disease at one year but she developed a single, centimetric liver metastasis 2 months after surgical procedure and she was treated by radiofrequency ablation and systemic chemotherapy. Conclusions: In high risk patients (evident peritoneal involvement, ovarian metastatic disease, perforated cancers, previous R1-2 resections or intraoperative tumor disruption, positive cytology, adjacent organs involvement, T3 mucinous tumor, T4 cancers, obstructed cancer) ’proactive’ HIPEC is a very interesting and promising treatment option to prevent intra-abdominal diffusion of pelvic disease. Our results, in line with other authors, show the feasibility and the oncological safety of this approach that carries an acceptable morbidity and no mortality. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.418
429. Cytoreductive surgery with intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin D. Park1, H. Namgong1, M.J. Baek2, J.Y. Kim3, S.J. Lee4, S.C. Lee5, C.N. Kim6, W.J. Choi7 1 Dankook University Hospital, Department of Surgery, Cheoan, Chungnam, South Korea 2 Soonchunhyang University Hospital, Department of Surgery, Cheoan, Chungnam, South Korea 3 Chungnam National University School of Medicine, Department of Surgery, Daejeon, South Korea 4 Chungbuk National University School of Medicine, Department of Surgery, Cheongju, Chungbuk, South Korea 5 Daejeon St. Mary’s Hospital Catholic University, Department of Surgery, Daejeon, South Korea 6 Eulgi University Hospital, Department of Surgery, Daejeon, South Korea 7 Keongyang University Hospital, Department of Surgery, Daejeon, South Korea Background: Peritoneal carcinomatosis (PC) of colorectal origin, being detected in 10e15% of patients at the time of primary cancer resection,
ABSTRACTS and the first recurrence occurs in the peritoneum in 50% of patients after curative surgery. In 10e35% of all patients with recurrent disease, tumor recurrence is confined to the peritoneal surface only. Materials and methods: We performed peritonectomy and intra-peritoneal chemotherapy in 69 patients from December 2011 and Dec 2013. Among them 55 patients have PC of colorectal origin. Results: Mean age was 57(36w79) and 25 were female (26%). Peritoneal seeding was synchronously detected in 25 patients (45.4%) and 30 patients (54.6%) were previously diagnosed with peritoneal carcinomatosis. The peritoneal carcinomatosis arose from adenocarcinoma of the right colon in 23 (42%), and rectosigmoid in 21 (38%). The cell types of PC were well and moderately differentiated in 20 (36.4%), and mucinous in 15 (27.3%). Mean PCI was 15(1w35), and curative peritonectomy was possible in 35 patients (65%). EPIC as performed in 47 patient, and HIPEC was in 7, HIPEC + EPIC in 1 patient. The HIPEC was done with closed method. The chemotherapeutic agent used for EPIC was MMC for first day and 5-FU for another 4 days. With HIPEC, the agent used was MMC and 90 min perfusion, and the temperature was 42 w 43 C. Complication occurred in 25 patients (47%) and 12(22%) were complications above Grade 3. Mortality occurred in 7 patients (13%). Excluding the 7 mortality, 36 patients (68%) out of 46 patients were alive at the time of last follow up and 20 patients (38%) had no evidence of recurrence. Upon analyzing peritonectomy and the related factors, patients with metachronous peritoneal seeding (synchronous 48% vs metachronous 84%, p ¼ 0.010) and low PCI score (p ¼ 0.000) had greater chance of curative peritonectomy. Conclusions: Metachronously diagnosed peritoneal carcinomatosis and low PCI score had greater chance of curative peritonectomy, but shows high rate of complication and mortality. Therefore, we believe that this aggressive treatment should be performed in selected patients, considering the general condition of the patient and the extent of peritoneal seeding. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.419
430. Severe skeletal muscle depletion is associated with reoperation in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy J.L.A. Van Vugt1, H.J. Braam1, A. Vestering1, T.L. Bollen2, M.J. Wiezer1, B. Van Ramshorst1, D. Boerma1 1 St Antonius Hospital, General Surgery, Nieuwegein, Netherlands 2 St Antonius Hospital, Radiology, Nieuwegein, Netherlands Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) is an established treatment in patients with peritonitis carcinomatosis of colorectal cancer. However, severe complications are frequently reported. Muscle depletion is associated with impaired outcome after oncologic treatment. The goal of the current study was to determine the influence of severe skeletal muscle depletion in patients treated with CRS+HIPEC for peritoneal dissemination of colorectal cancer. Material and methods: A total of 142 patients with peritoneal disseminated colorectal carcinoma treated with CRS+HIPEC were enrolled into a database The cross-sectional muscle surface areas were measured at the level of the third lumbar vertebra on preoperative abdominal CT-scans and corrected for height (L3 muscle index (cm2/m2)). This is an easily obtainable and valid method to assess muscle depletion. Patients with severe muscle depletion (<10th percentile) were compared to the rest of the cohort. The only exclusion criterion was an non-assessable CT-scan. Results: In total 126 patients were included (mean age: 60.2 years, 67 females). The mean L3 index for women was 39.9 cm2/m2 (SD 4.9) and for men 52.7 cm2/m2 (SD 7.6). Twelve patients had severe muscle depletion with a mean L3 index of 35.6 (SD 4.7). Baseline characteristics did not significantly differ between patients with and without severe muscle depletion. Length of stay (median 9.5 vs. 10 days, p ¼ 0.93) and 30-day or inhospital mortality (0% vs. 2.6% p ¼ 0.57) were not significantly different. The reoperation rate was significantly higher in patients with severe muscle depletion compared to the other patients (50% vs. 17.5%, p ¼ 0.008).
429. Cytoreductive surgery with intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin D. Park1, H. Namgong1, M.J. Baek2, J.Y. Kim3, S.J. Lee4, S.C. Lee5, C.N. Kim6, W.J. Choi7 1 Dankook University Hospital, Department of Surgery, Cheoan, Chungnam, South Korea 2 Soonchunhyang University Hospital, Department of Surgery, Cheoan, Chungnam, South Korea 3 Chungnam National University School of Medicine, Department of Surgery, Daejeon, South Korea 4 Chungbuk National University School of Medicine, Department of Surgery, Cheongju, Chungbuk, South Korea 5 Daejeon St. Mary’s Hospital Catholic University, Department of Surgery, Daejeon, South Korea 6 Eulgi University Hospital, Department of Surgery, Daejeon, South Korea 7 Keongyang University Hospital, Department of Surgery, Daejeon, South Korea Background: Peritoneal carcinomatosis (PC) of colorectal origin, being detected in 10e15% of patients at the time of primary cancer resection,
ABSTRACTS and the first recurrence occurs in the peritoneum in 50% of patients after curative surgery. In 10e35% of all patients with recurrent disease, tumor recurrence is confined to the peritoneal surface only. Materials and methods: We performed peritonectomy and intra-peritoneal chemotherapy in 69 patients from December 2011 and Dec 2013. Among them 55 patients have PC of colorectal origin. Results: Mean age was 57(36w79) and 25 were female (26%). Peritoneal seeding was synchronously detected in 25 patients (45.4%) and 30 patients (54.6%) were previously diagnosed with peritoneal carcinomatosis. The peritoneal carcinomatosis arose from adenocarcinoma of the right colon in 23 (42%), and rectosigmoid in 21 (38%). The cell types of PC were well and moderately differentiated in 20 (36.4%), and mucinous in 15 (27.3%). Mean PCI was 15(1w35), and curative peritonectomy was possible in 35 patients (65%). EPIC as performed in 47 patient, and HIPEC was in 7, HIPEC + EPIC in 1 patient. The HIPEC was done with closed method. The chemotherapeutic agent used for EPIC was MMC for first day and 5-FU for another 4 days. With HIPEC, the agent used was MMC and 90 min perfusion, and the temperature was 42 w 43 C. Complication occurred in 25 patients (47%) and 12(22%) were complications above Grade 3. Mortality occurred in 7 patients (13%). Excluding the 7 mortality, 36 patients (68%) out of 46 patients were alive at the time of last follow up and 20 patients (38%) had no evidence of recurrence. Upon analyzing peritonectomy and the related factors, patients with metachronous peritoneal seeding (synchronous 48% vs metachronous 84%, p ¼ 0.010) and low PCI score (p ¼ 0.000) had greater chance of curative peritonectomy. Conclusions: Metachronously diagnosed peritoneal carcinomatosis and low PCI score had greater chance of curative peritonectomy, but shows high rate of complication and mortality. Therefore, we believe that this aggressive treatment should be performed in selected patients, considering the general condition of the patient and the extent of peritoneal seeding. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.419
430. Severe skeletal muscle depletion is associated with reoperation in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy J.L.A. Van Vugt1, H.J. Braam1, A. Vestering1, T.L. Bollen2, M.J. Wiezer1, B. Van Ramshorst1, D. Boerma1 1 St Antonius Hospital, General Surgery, Nieuwegein, Netherlands 2 St Antonius Hospital, Radiology, Nieuwegein, Netherlands Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) is an established treatment in patients with peritonitis carcinomatosis of colorectal cancer. However, severe complications are frequently reported. Muscle depletion is associated with impaired outcome after oncologic treatment. The goal of the current study was to determine the influence of severe skeletal muscle depletion in patients treated with CRS+HIPEC for peritoneal dissemination of colorectal cancer. Material and methods: A total of 142 patients with peritoneal disseminated colorectal carcinoma treated with CRS+HIPEC were enrolled into a database The cross-sectional muscle surface areas were measured at the level of the third lumbar vertebra on preoperative abdominal CT-scans and corrected for height (L3 muscle index (cm2/m2)). This is an easily obtainable and valid method to assess muscle depletion. Patients with severe muscle depletion (<10th percentile) were compared to the rest of the cohort. The only exclusion criterion was an non-assessable CT-scan. Results: In total 126 patients were included (mean age: 60.2 years, 67 females). The mean L3 index for women was 39.9 cm2/m2 (SD 4.9) and for men 52.7 cm2/m2 (SD 7.6). Twelve patients had severe muscle depletion with a mean L3 index of 35.6 (SD 4.7). Baseline characteristics did not significantly differ between patients with and without severe muscle depletion. Length of stay (median 9.5 vs. 10 days, p ¼ 0.93) and 30-day or inhospital mortality (0% vs. 2.6% p ¼ 0.57) were not significantly different. The reoperation rate was significantly higher in patients with severe muscle depletion compared to the other patients (50% vs. 17.5%, p ¼ 0.008).