- Email: [email protected]
Hipec in the management of metachronous peritoneal carcinomatosis: A single-center retrospective analysis
ABSTRACTS In conclusion, cytoreductive surgery + HIPEC seems to be effective in recurrent PC from EOC. First relapse after 6 months from systemic chemotherapy and complete cytoreduction are favorable prognostic factors. http://dx.doi.org/10.1016/j.ejso.2016.04.046
PERITONEAL CARCINOSIS Abstract 77 Su r g i c a l cyt o re duc t i o n a nd hy pe r t he r mi c i nt r a p er i to ne a l chemotherapy in patients affected by recurrent or persistent peritoneal carcinomatosis form epithelial ovarian cancer with high peritoneal cancer index values: Our single center experience N. Vernaccini1, B. Stefano1, S. Bertozzi1, S. Calandra1, M. Pighin1, A.P. Londero2, A. Risaliti1, E.M. Pasqual1 1 Department of Surgery, AOU “Santa Maria della Misericordia”, Udine, Italy 2 Unit of Obstetrics and Gynecology, S Polo Hospital, Monfalcone, Italy Extended recurrent or persistent peritoneal carcinomatosis in patients affected by ovarian cancer previously treated by surgery and chemotherapy is highly lethal. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) and surgical cytoreduction (SCR) in these patients is still debated. This study evaluates the outcomes of patients submitted to rescue CRS and HIPEC for peritoneal carcinomatosis from ovarian cancer with a peritoneal cancer index (PCI) greater than 20. This study considered patients affected by advanced epithelial ovarian cancer (EOC) who were proposed CRS and HIPEC in our Department between January 2005 and December 2014 and that presented a confirmed intraoperative PCI greater than 20. The following data were collected: patient characteristics, primary cancer histology, preoperative staging by imaging, intraoperative staging by PCI and CCR (completeness cytoreduction rate), postoperative complications, and survival. Data were analysed by R (version 3.1.2). 14 women affected by recurrent or persistent peritoneal disease underwent SCR were collected. In 5 cases surgery was performed in emergency for occlusion or sub-occlusion and HIPEC was not performed while in 9 cases CRS was planned and HIPEC was therefore performed. Intra-operative PCI was similar between the two groups, being 26.11 (2.57) in the group treated with HIPEC and 25 (5.48) in the group without HIPEC (p ¼ 0.686). CCR 1 and 2 were respectively achieved in 57.1% and 42.9% of cases. No reintervention was required and four women required blood transfusion or parenteral nutrition during hospitalization. Among patients who did not receive HIPEC the three months overall survival (OS) was 60.0% (95% C.I. 29.3e100.0%) and at six months none was alive, while in the group with planned CRS and palliative HIPEC, the three month survival was 77.8% (95% C.I. 54.9e100.0%) and the one year OS was 55.6% (95% C.I. 31.0e99.7%) (p < 0.05). In the univariate Cox analysis the group without HIPEC had a lower OS than the group treated with HIPEC HR 6.2 (95% C.I. 1.1e33.7) (p < 0.05) and the same significant result was obtained in the multivariate analysis HR 19.4 (95% C.I. 1.6e235.3) (p < 0.05). Our experience encourages CRS and HIPEC in persistent or recurrent extended peritoneal carcinomatosis with an intraoperative PCI greater than 20, even if it should represent a tailored treatment strategy after a proper preoperative selection. http://dx.doi.org/10.1016/j.ejso.2016.04.047
PERITONEAL CARCINOSIS Abstract 83 Hipec in the management of metachronous peritoneal carcinomatosis: A single-center retrospective analysis V. Belgrano, G. Santori, S. Di Domenico, F. De Cian IRCCS IST S.MARTINO, Genova, Italy
S215 Cytoreductive surgery (CRS) associated with hyperthermic intra-peritoneal chemotherapy (HIPEC) represents a potentially curative treatment for metachronous peritoneal carcinomatosis (MPC) secondary to colorectal carcinoma (CRC), ovarian cancer (OC), or pseudomixoma peritonei (PMP). However, CRS-HIPEC is still accompanied by a high morbidity. We retrospectively collected data and analysed the outcome of consecutive HIPEC procedures performed in our unit between 2002 and 2014. In the study period 41 patients (Pts) with MPC underwent CRS-HIPEC. Patient age was 57.7 10.1 years (range 32e77), Female/Male: 34/7. The median follow-up was 22.6 months. The MPC was secondary to OC in 19 Pts (46%), CRC in 14 Pts (34%), and PMP in 8 Pts (20%). Closed HIPEC procedure was performed in the early phase of our experience in 11 Pts (26.8%). Cisplatin (43 mg/m2/l) and Adriamicin (15.25 mg/ m2/l) were administered for OC, whereas Cisplatin (25.0 mg/m2/l) and Mitomycin C (3.3 mg/m2/l) for both CRC and PMP. HIPEC was performed for 60 min at 41 C, and gastrointestinal anastomosis were completed after perfusion. Results: The median operation time was 390 min (95%CI: 366e426). No death occurred in the intraoperative or early postoperative period. Five Pts (12%) underwent relaparotomy: 3 Pts (7%) for anastomotic leakage, and 2 Pts (5%) for intrabdominal abscess. The most frequent post-surgery complications (95% of Pts) were nausea and vomiting that were successfully treated with standard antiemetics. Anemia requiring blood transfusion occurred in 51% of Pts. Pleural effusion was developed in 7 Pts (17%), persistent hyperpyrexia in 6 Pts (15%), transient renal failure in 4 Pts (10%), and sepsis in 2 Pts (5%), by requiring in all cases an ICU admission. The median hospital stay was 15 days (95% CI: 14e22). The overall survival at 1, 3 and 5 years were 82%, 53% and 33%, respectively. Although no significant survival difference was observed by stratifying for closed vs. open HIPEC at 1 year (P ¼ 0.0798) and 3 years (P ¼ 0.0867), within these time-points the KaplaneMeier curves showed a better cumulative survival probability for Pts who underwent the open procedure. Conclusions: In our experience, CRS-HIPEC has revealed to be an effective treatment for MPC from OC, CRC or PMP, with an admissible morbidity and mortality. http://dx.doi.org/10.1016/j.ejso.2016.04.048
FAST TRACK IN SURGICAL ONCOLOGY 14 FAST TRACK IN SURGICAL ONCOLOGY Abstract 84 Trans-oral robotic surgery of parapharyngeal space tumours F. Longo, C. Aversa, E. Pavone, S. Villano, M.G. Maglione, F. Ionna Istituto Nazionale Tumori di Napoli “Fondazione G. Pascale”, Napoli, Italy Parapharyngeal space (PPS) is a complex anatomic area, and tumours involving it are usually due to expansion into the space by tumours arising from adjacent tissue. Neoplasms arising in the PPS are quite rare, representing less than 1% of all head and neck tumours. Salivary gland tumours, (mainly pleomorphic adenomas), account for 40e50% of PPS lesions and generally are located in the prestyloid space. Several surgical approaches (trans-cervical, trans-oral, trans-parotid, trans-mandibular ones) have been described in the management of PPS tumors, but recently trans-oral robotic surgery (TORS) with the daVinci robot has become useful in head and neck surgery to provide a minimally invasive procedure. The preliminary experience of the Department of Maxillo-facial and ENT Surgery of Istituto Nazionale Tumori di Napoli “Fondazione G. Pascale”, (Napoli, Italy) in the treatment of pleomorphic adenoma of PPS by TORS is reported. Preoperative diagnosis by fine needle aspiration biopsy (Fnab) and magnetic resonance imaging (MRI) are mandatory in planning of the correct surgical approach. Benefits and risks of TORS are analysed.
PERITONEAL CARCINOSIS Abstract 77 Su r g i c a l cyt o re duc t i o n a nd hy pe r t he r mi c i nt r a p er i to ne a l chemotherapy in patients affected by recurrent or persistent peritoneal carcinomatosis form epithelial ovarian cancer with high peritoneal cancer index values: Our single center experience N. Vernaccini1, B. Stefano1, S. Bertozzi1, S. Calandra1, M. Pighin1, A.P. Londero2, A. Risaliti1, E.M. Pasqual1 1 Department of Surgery, AOU “Santa Maria della Misericordia”, Udine, Italy 2 Unit of Obstetrics and Gynecology, S Polo Hospital, Monfalcone, Italy Extended recurrent or persistent peritoneal carcinomatosis in patients affected by ovarian cancer previously treated by surgery and chemotherapy is highly lethal. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) and surgical cytoreduction (SCR) in these patients is still debated. This study evaluates the outcomes of patients submitted to rescue CRS and HIPEC for peritoneal carcinomatosis from ovarian cancer with a peritoneal cancer index (PCI) greater than 20. This study considered patients affected by advanced epithelial ovarian cancer (EOC) who were proposed CRS and HIPEC in our Department between January 2005 and December 2014 and that presented a confirmed intraoperative PCI greater than 20. The following data were collected: patient characteristics, primary cancer histology, preoperative staging by imaging, intraoperative staging by PCI and CCR (completeness cytoreduction rate), postoperative complications, and survival. Data were analysed by R (version 3.1.2). 14 women affected by recurrent or persistent peritoneal disease underwent SCR were collected. In 5 cases surgery was performed in emergency for occlusion or sub-occlusion and HIPEC was not performed while in 9 cases CRS was planned and HIPEC was therefore performed. Intra-operative PCI was similar between the two groups, being 26.11 (2.57) in the group treated with HIPEC and 25 (5.48) in the group without HIPEC (p ¼ 0.686). CCR 1 and 2 were respectively achieved in 57.1% and 42.9% of cases. No reintervention was required and four women required blood transfusion or parenteral nutrition during hospitalization. Among patients who did not receive HIPEC the three months overall survival (OS) was 60.0% (95% C.I. 29.3e100.0%) and at six months none was alive, while in the group with planned CRS and palliative HIPEC, the three month survival was 77.8% (95% C.I. 54.9e100.0%) and the one year OS was 55.6% (95% C.I. 31.0e99.7%) (p < 0.05). In the univariate Cox analysis the group without HIPEC had a lower OS than the group treated with HIPEC HR 6.2 (95% C.I. 1.1e33.7) (p < 0.05) and the same significant result was obtained in the multivariate analysis HR 19.4 (95% C.I. 1.6e235.3) (p < 0.05). Our experience encourages CRS and HIPEC in persistent or recurrent extended peritoneal carcinomatosis with an intraoperative PCI greater than 20, even if it should represent a tailored treatment strategy after a proper preoperative selection. http://dx.doi.org/10.1016/j.ejso.2016.04.047
PERITONEAL CARCINOSIS Abstract 83 Hipec in the management of metachronous peritoneal carcinomatosis: A single-center retrospective analysis V. Belgrano, G. Santori, S. Di Domenico, F. De Cian IRCCS IST S.MARTINO, Genova, Italy
S215 Cytoreductive surgery (CRS) associated with hyperthermic intra-peritoneal chemotherapy (HIPEC) represents a potentially curative treatment for metachronous peritoneal carcinomatosis (MPC) secondary to colorectal carcinoma (CRC), ovarian cancer (OC), or pseudomixoma peritonei (PMP). However, CRS-HIPEC is still accompanied by a high morbidity. We retrospectively collected data and analysed the outcome of consecutive HIPEC procedures performed in our unit between 2002 and 2014. In the study period 41 patients (Pts) with MPC underwent CRS-HIPEC. Patient age was 57.7 10.1 years (range 32e77), Female/Male: 34/7. The median follow-up was 22.6 months. The MPC was secondary to OC in 19 Pts (46%), CRC in 14 Pts (34%), and PMP in 8 Pts (20%). Closed HIPEC procedure was performed in the early phase of our experience in 11 Pts (26.8%). Cisplatin (43 mg/m2/l) and Adriamicin (15.25 mg/ m2/l) were administered for OC, whereas Cisplatin (25.0 mg/m2/l) and Mitomycin C (3.3 mg/m2/l) for both CRC and PMP. HIPEC was performed for 60 min at 41 C, and gastrointestinal anastomosis were completed after perfusion. Results: The median operation time was 390 min (95%CI: 366e426). No death occurred in the intraoperative or early postoperative period. Five Pts (12%) underwent relaparotomy: 3 Pts (7%) for anastomotic leakage, and 2 Pts (5%) for intrabdominal abscess. The most frequent post-surgery complications (95% of Pts) were nausea and vomiting that were successfully treated with standard antiemetics. Anemia requiring blood transfusion occurred in 51% of Pts. Pleural effusion was developed in 7 Pts (17%), persistent hyperpyrexia in 6 Pts (15%), transient renal failure in 4 Pts (10%), and sepsis in 2 Pts (5%), by requiring in all cases an ICU admission. The median hospital stay was 15 days (95% CI: 14e22). The overall survival at 1, 3 and 5 years were 82%, 53% and 33%, respectively. Although no significant survival difference was observed by stratifying for closed vs. open HIPEC at 1 year (P ¼ 0.0798) and 3 years (P ¼ 0.0867), within these time-points the KaplaneMeier curves showed a better cumulative survival probability for Pts who underwent the open procedure. Conclusions: In our experience, CRS-HIPEC has revealed to be an effective treatment for MPC from OC, CRC or PMP, with an admissible morbidity and mortality. http://dx.doi.org/10.1016/j.ejso.2016.04.048
FAST TRACK IN SURGICAL ONCOLOGY 14 FAST TRACK IN SURGICAL ONCOLOGY Abstract 84 Trans-oral robotic surgery of parapharyngeal space tumours F. Longo, C. Aversa, E. Pavone, S. Villano, M.G. Maglione, F. Ionna Istituto Nazionale Tumori di Napoli “Fondazione G. Pascale”, Napoli, Italy Parapharyngeal space (PPS) is a complex anatomic area, and tumours involving it are usually due to expansion into the space by tumours arising from adjacent tissue. Neoplasms arising in the PPS are quite rare, representing less than 1% of all head and neck tumours. Salivary gland tumours, (mainly pleomorphic adenomas), account for 40e50% of PPS lesions and generally are located in the prestyloid space. Several surgical approaches (trans-cervical, trans-oral, trans-parotid, trans-mandibular ones) have been described in the management of PPS tumors, but recently trans-oral robotic surgery (TORS) with the daVinci robot has become useful in head and neck surgery to provide a minimally invasive procedure. The preliminary experience of the Department of Maxillo-facial and ENT Surgery of Istituto Nazionale Tumori di Napoli “Fondazione G. Pascale”, (Napoli, Italy) in the treatment of pleomorphic adenoma of PPS by TORS is reported. Preoperative diagnosis by fine needle aspiration biopsy (Fnab) and magnetic resonance imaging (MRI) are mandatory in planning of the correct surgical approach. Benefits and risks of TORS are analysed.