World Journal of Surgery

, Volume 30, Issue 11, pp 2033–2040 | Cite as

Treatment of Peritoneal Carcinomatosis by Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemoperfusion (IHCP): Postoperative Outcome and Risk Factors for Morbidity

  • Franco Roviello
  • Daniele Marrelli
  • Alessandro Neri
  • Daniela Cerretani
  • Giovanni de Manzoni
  • Corrado Pedrazzani
  • Tommaso Cioppa
  • Giacomo Nastri
  • Giorgio Giorgi
  • Enrico Pinto
Article

Abstract

Background

Cytoreductive surgery with limited or extended peritonectomy associated with intraperitoneal hyperthermic chemoperfusion (IHCP) has been proposed for treatment of peritoneal carcinomatosis (PC) from abdominal neoplasms.

Methods

Fifty-nine patients with PC from abdominal neoplasms underwent 61 treatments using this technique from January 2000 to August 2005. Surgical debulking, completed by partial or total peritonectomy, was performed in most cases. In 16 patients with positive peritoneal cytology without macroscopic peritoneal disease, IHCP was performed in order to prevent peritoneal recurrence. IHCP was carried out throughout the abdominopelvic cavity for 60 minutes using a closed abdomen technique. Intra-abdominal temperature ranged between 41°C and 43°C; mitomycin C (25 mg/mq) and cisplatin (100 mg/mq) were the anticancer drugs generally used, and they were administered with a flow rate of 700–800 ml/minute.

Results

Mean hospital stay was 13 ± 7 (range 7–49) days. Postoperative complications occurred in 27 patients (44.3%); of these, major morbidity was observed in 17 (27.9%). The most frequent complications were wound infection (9 cases), grade 2 or greater hematological toxicity (5 cases), intestinal fistula (5 cases), and pleural effusion requiring drainage (5 cases). Reoperation was necessary in 5 patients (8.2%). One patient with multiorgan failure died in the postoperative period (mortality rate: 1.6%). Multivariate analysis of several variables identified completeness of cancer resection (CCR-2/3 vs. CCR-0/1, relative risk: 9.27) and age (relative risk: 1.06 per year) as independent predictors of postoperative morbidity. Preliminary follow-up data indicate that survival probability may be high in patients with ovarian or colorectal cancer and low in patients with gastric cancer.

Conclusions

IHCP combined with cytoreductive surgery involves a high risk of morbidity, but postoperative complications could be resolved favorably in most cases with correct patient selection and adequate postoperative care. Tumor residual and advanced age significantly increase the risk of morbidity after this procedure.

List of Abbreviations

PC

Peritoneal carcinomatosis

IHCP

Intraperitoneal hyperthermic chemoperfusion

CCR

Completeness of cancer resection

MOF

Multiorgan failure

Notes

Acknowledgments

This work was supported by grant from Fondazione Monte dei Paschi di Siena, 1999, Italy.

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Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Franco Roviello
    • 1
    • 5
  • Daniele Marrelli
    • 2
  • Alessandro Neri
    • 2
  • Daniela Cerretani
    • 3
  • Giovanni de Manzoni
    • 4
  • Corrado Pedrazzani
    • 2
  • Tommaso Cioppa
    • 2
  • Giacomo Nastri
    • 2
  • Giorgio Giorgi
    • 3
  • Enrico Pinto
    • 2
  1. 1.Department of Human Pathology and Oncology, Advanced Surgical Oncology UnitUniversity of SienaSienaItaly
  2. 2.Department of Human Pathology and Oncology, Surgical Oncology UnitUniversity of SienaSienaItaly
  3. 3.Department of PharmacologyUniversity of SienaSienaItaly
  4. 4.Department of General SurgeryUniversity of VeronaVeronaItaly
  5. 5.SienaItaly

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