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Reiterated hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinosis: Our single-center experience
996 stage migration. In such cases, cPCI does not represent a valid system for staging peritoneal carcinomatosis. Cytoreductive surgery plus HIPEC in the management of peritoneal carcinomatosis: Personal experience M. Malerba 1, * , S. Baldo 2 , C. Boccardo 1 , V. Basso 1 , F. Depaoli 1 , C. Ferretti1, C. Margarino1, M. Valenzano Menada3, F. De Cian1 1 Surgical Oncology, University of Genoa, Genoa, Italy 2 General Surgery, Santa Corona Hospital, ASL2 Savonese, Pietra Ligure (SV), Italy 3 Obstetrics and Gynecology, University of Genoa, Genoa, Italy * Corresponding author: Michele Malerba, Phone: +39 393336176260. E-mail address: [email protected] (M. Malerba). Background: Cytoreductive surgery (CS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is gaining acceptance in the treatment of peritoneal carcinomatosis. The procedure is associated with high morbidity and mortality rates, however. We report the experience of a regional referral center, underlining the good results obtained in terms of both reduction in complications and oncologic outcome. Methods: Between 2002 and 2008, 34 patients (median age, 57 years) underwent 35 CS-HIPEC combined procedures for gastrointestinal tract tumors, pseudomixoma peritonei, epithelial ovarian cancer, peritoneal mesothelioma and peritoneal sarcomatosis. In all patients we performed peritonectomy according to the Sugarbaker technique, along with other debulking procedures: 15 colic resections, 12 small bowel resections, 10 rectal anterior resections, 8 splenectomies, 2 distal pancreasectomies, and 1 partial gastrectomy. HIPEC was performed at an average intra-abdominal temperature of 41.3 C using mitomycin C, doxorubicin and cisplatin for a duration of 60 or 90 minutes. In 24 patients we used the closed abdomen technique and in 11 the open abdomen technique. Results: CCR-0 resection was achieved in 76% of patients, CCR-1 in 9%, and CCR-2 in 15%, with a median operating time of 388 minutes (range, 240-660). The median hospital stay was 14 days. The overall morbidity rate was 58.8%, with a World Health Organization (WHO) grade 3 and 4, and a morbidity rate of 28.57%. Perioperative and 30-day mortality was nil; only one death due to septic complications occurred at day 65. At a median follow up of 41 months, the 4-year overall survival (OS) rate was 20.7%. Unlike cancer of ovarian origin, cancer of gastrointestinal origin and a peritoneal cancer index (PCI) >9 were associated with a worse prognosis for both OS and progression-free survival (PFS). Conclusions: In a referral and high-volume surgical cancer center, CSHIPEC-related perioperative mortality and morbidity can be reduced with multidisciplinary patient management and correct patient selection. Our retrospective single-center series confirms the advantages in PFS and OS of the combined CS-HIPEC treatment in the management of peritoneal carcinomatosis, as reported in the literature. Reiterated hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinosis: Our single-center experience E.M. Pasqual1,*, S. Bacchetti1, S. Bertozzi1, A.P. Londero2 1 Department of Surgery, AOU Santa Maria della Misericordia, Udine, Italy 2 Clinic of Obstetrics and Gynecology, AOU Santa Maria della Misericordia, Udine, Italy * Corresponding author: Enricomaria Pasqual, Dipartimento di Chirurgia Azienda Ospedaliero-Universitaria di Udine, p.le Santa Maria della Misericordia 15, 33100 Udine. Tel.: +39 0432/559303; Fax 0432/559564 cel 347/2335937. E-mail address: [email protected] (E.M. Pasqual). Background: There is very little literature about the reiteration of hyperthermic intraperitoneal chemotherapy (HIPEC) and surgical cytoreduction (SCR) in patients with recurrent intraperitoneal cancer. This study evaluated the outcomes after repeated HIPEC.
ABSTRACTS Methods: The data were collected from patients who were offered SCR and HIPEC in our Department between January 2005 and December 2011. The variables were patient characteristics, primary cancer histology, preoperative staging by imaging, intraoperative staging according to the peritoneal cancer index (PCI) and the carcinosis cytoreduction score (CCS), postoperative complications, and survival. Data were analyzed using R (version 2.12.2). Results: Of the 72 patients (mean age, 61.0411.58 years) admitted to the Peritoneal Cancer Center, 52 were considered for SCR and HIPEC. Primary tumors were: colorectal cancer (n¼21); ovarian cancer (n¼20); gastric cancer (n¼8); and pseudomyxoma peritonei (n¼3). Intraoperatively, 13 patients were excluded from treatment because of unresectable hepatic metastases and unresectable intraperitoneal tumor. Ultimately, 39/52 (75%) underwent SCR and HIPEC. Optimal cytoreduction was obtained in 89.74% (35/39) of patients, allowing HIPEC with curative intent. The PCI was significantly lower in the patients submitted to HIPEC both after the first and the second SCR, and the CCS was significantly higher in those who did not receive HIPEC (P <0.05). There was no significant difference in 3-year overall survival between the patients who were operated but did not receive HIPEC, those who underwent surgery and HIPEC, and those who underwent a second operation but did not receive a second HIPEC (range, 32 to 44%), but overall survival was higher (>80%) in those who underwent two HIPEC procedures, and in this last group survival was higher even at 5 years (almost 40%). Conclusions: Our initial experience encourages SCR and HIPEC reiteration, which was found to be safe and effective and seems to improve patient survival. It should be considered a tailored treatment strategy after correct preoperative staging and patient selection.
Surgical morbidity and mortality in patients undergoing extended c yt o re d uc t i v e su r g e r y w i t h hyp e r t h e r m i c i n t r a p e r i t o n e a l chemotherapy D. Zambonin, M.D.*, C. Di Martino, M.D., S. Scaringi, M.D., B. Pesi, M.D., G. Batignani, M.D., F. Tonelli, M.D. * Corresponding author: Daniela Zambonin, Digestive Surgery Unit, Careggi University Hospital, Florence, Via Brambilla, 3 50134 Florence (IT). Tel.: +39 349 2804583. E-mail address: [email protected] (D. Zambonin). Background: Peritoneal carcinomatosis is considered a systemic metastatic condition with extremely poor prognosis. Combining cytoreductive surgery with intraperitoneal chemotherapy (CRS and HIPEC) has demonstrated encouraging results. The aim of our study was to evaluate morbidity, mortality and long-term survival in patients who underwent CRS and HIPEC. Methods: Twenty-seven patients underwent CRS and HIPEC from 1996 to 2011. The variables were age at surgery, diaphragmatic peritonectomy, digestive resection, liver resection, urinary resection and splenectomy. Results: Peritoneal carcinomatosis originated from ovarian, colorectal, pseudomyxoma peritonei, gastric cancer, and gallbladder cancer. Extended cytoreduction was carried out in almost all cases. HIPEC was performed using the closed abdomen technique in 10 patients and the open abdomen technique in 17. The mean age at surgery was 59 years. Digestive resection was performed in 21 (77.7%) patients, diaphragmatic peritonectomy in 15 (55.5%), urinary resection in 7 (25.9%), hepatic resection in 4 (14.8%) and splenectomy in 4 (14.8%). Major and minor complications occurred in 14 (51.9%) and in 11 (40.7%) patients, respectively. Major complications included persistent functional neuropathy (n¼1; 3.7%), rectovaginal fistula (n¼1; 3.7%), respiratory failure (n¼7; 25.9%), peritonitis (n¼3; 11.1%), hematemesis (n¼1; 3.7%), pulmonary embolism (n¼1; 3.7%), pancreatic fistula (n¼2; 7.4%), melena (n¼2; 7.4%), hematoma in spleen lodge (n¼1; 3.7%), acute pancreatitis (n¼1; 3.7%), hydropneumothorax (n¼4; 14.8%), blood transfusion (n¼9; 33.3%) and plasma transfusion (n¼7; 25.9%). Minor complications were urinary tract infection (n¼5; 18.5%), wound infection (n¼4; 14.8%), and positive blood culture isolates without
ABSTRACTS Methods: The data were collected from patients who were offered SCR and HIPEC in our Department between January 2005 and December 2011. The variables were patient characteristics, primary cancer histology, preoperative staging by imaging, intraoperative staging according to the peritoneal cancer index (PCI) and the carcinosis cytoreduction score (CCS), postoperative complications, and survival. Data were analyzed using R (version 2.12.2). Results: Of the 72 patients (mean age, 61.0411.58 years) admitted to the Peritoneal Cancer Center, 52 were considered for SCR and HIPEC. Primary tumors were: colorectal cancer (n¼21); ovarian cancer (n¼20); gastric cancer (n¼8); and pseudomyxoma peritonei (n¼3). Intraoperatively, 13 patients were excluded from treatment because of unresectable hepatic metastases and unresectable intraperitoneal tumor. Ultimately, 39/52 (75%) underwent SCR and HIPEC. Optimal cytoreduction was obtained in 89.74% (35/39) of patients, allowing HIPEC with curative intent. The PCI was significantly lower in the patients submitted to HIPEC both after the first and the second SCR, and the CCS was significantly higher in those who did not receive HIPEC (P <0.05). There was no significant difference in 3-year overall survival between the patients who were operated but did not receive HIPEC, those who underwent surgery and HIPEC, and those who underwent a second operation but did not receive a second HIPEC (range, 32 to 44%), but overall survival was higher (>80%) in those who underwent two HIPEC procedures, and in this last group survival was higher even at 5 years (almost 40%). Conclusions: Our initial experience encourages SCR and HIPEC reiteration, which was found to be safe and effective and seems to improve patient survival. It should be considered a tailored treatment strategy after correct preoperative staging and patient selection.
Surgical morbidity and mortality in patients undergoing extended c yt o re d uc t i v e su r g e r y w i t h hyp e r t h e r m i c i n t r a p e r i t o n e a l chemotherapy D. Zambonin, M.D.*, C. Di Martino, M.D., S. Scaringi, M.D., B. Pesi, M.D., G. Batignani, M.D., F. Tonelli, M.D. * Corresponding author: Daniela Zambonin, Digestive Surgery Unit, Careggi University Hospital, Florence, Via Brambilla, 3 50134 Florence (IT). Tel.: +39 349 2804583. E-mail address: [email protected] (D. Zambonin). Background: Peritoneal carcinomatosis is considered a systemic metastatic condition with extremely poor prognosis. Combining cytoreductive surgery with intraperitoneal chemotherapy (CRS and HIPEC) has demonstrated encouraging results. The aim of our study was to evaluate morbidity, mortality and long-term survival in patients who underwent CRS and HIPEC. Methods: Twenty-seven patients underwent CRS and HIPEC from 1996 to 2011. The variables were age at surgery, diaphragmatic peritonectomy, digestive resection, liver resection, urinary resection and splenectomy. Results: Peritoneal carcinomatosis originated from ovarian, colorectal, pseudomyxoma peritonei, gastric cancer, and gallbladder cancer. Extended cytoreduction was carried out in almost all cases. HIPEC was performed using the closed abdomen technique in 10 patients and the open abdomen technique in 17. The mean age at surgery was 59 years. Digestive resection was performed in 21 (77.7%) patients, diaphragmatic peritonectomy in 15 (55.5%), urinary resection in 7 (25.9%), hepatic resection in 4 (14.8%) and splenectomy in 4 (14.8%). Major and minor complications occurred in 14 (51.9%) and in 11 (40.7%) patients, respectively. Major complications included persistent functional neuropathy (n¼1; 3.7%), rectovaginal fistula (n¼1; 3.7%), respiratory failure (n¼7; 25.9%), peritonitis (n¼3; 11.1%), hematemesis (n¼1; 3.7%), pulmonary embolism (n¼1; 3.7%), pancreatic fistula (n¼2; 7.4%), melena (n¼2; 7.4%), hematoma in spleen lodge (n¼1; 3.7%), acute pancreatitis (n¼1; 3.7%), hydropneumothorax (n¼4; 14.8%), blood transfusion (n¼9; 33.3%) and plasma transfusion (n¼7; 25.9%). Minor complications were urinary tract infection (n¼5; 18.5%), wound infection (n¼4; 14.8%), and positive blood culture isolates without