International Journal of Colorectal Disease

, Volume 22, Issue 11, pp 1295–1300 | Cite as

Multimodality treatment of peritoneal carcinomatosis from colorectal cancer: first results of a new German centre for peritoneal surface malignancies

  • P. Piso
  • M. H. Dahlke
  • N. Ghali
  • I. Iesalnieks
  • M. Loss
  • F. Popp
  • P. von Breitenbuch
  • A. Agha
  • S. A. Lang
  • F. Kullmann
  • H. J. Schlitt
Original Article



The presence of peritoneal carcinomatosis arising from colorectal cancer is associated with a poor prognosis. It was the purpose of this study to analyze morbidity, mortality, and survival after major cytoreductive surgery and intraperitoneal chemotherapy.

Materials and methods

Thirty-two patients with peritoneal carcinomatosis were operated between April 2004 and June 2006 with the aim of complete macroscopical cytoreduction. All had a primary colorectal carcinoma. Surgery in these patients was followed by hyperthermic intraperitoneal chemotherapy (HIPEC) consisting of mitomycin C and doxorubicin. Data were analyzed retrospectively.


Of all patients, 16 had appendix and 16 non-appendiceal colorectal carcinoma. A macroscopically complete cytoreduction was achieved in 24 patients by parietal and visceral peritonectomy procedures. All resections were combined with HIPEC. Overall morbidity was 34%. Most frequent surgical complications were intestinal obstruction (4/32), enteric fistula (2/32), pancreatitis (2/32), and bile leakage (2/32). One patient presented grade 4 renal toxicity. There was no hospital mortality. The median follow-up was 12 months. The 1-year overall survival rate is 96%. All patients after complete cytoreduction are still alive.


Cytoreductive surgery combined with HIPEC is associated with an acceptable morbidity and low mortality. Complete cytoreduction may improve survival, particularly in well-selected patients having a low tumor volume and no extra-abdominal metastases.


Peritoneal carcinomatosis 


  1. 1.
    Minsky BD, Mies C, Rich TA, Recht A, Chaffey JT (1988) Potentially curative surgery of colon cancer: patterns of failure and survival. J Clin Oncol 6:106–118CrossRefPubMedGoogle Scholar
  2. 2.
    Chu DZD, Lang NP, Thompson C, Osteen PK, Westbrook KC (1989) Peritoneal carcinomatosis in nongynecologic malignancy. Cancer 63:364–367CrossRefPubMedGoogle Scholar
  3. 3.
    Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363CrossRefPubMedGoogle Scholar
  4. 4.
    Folprecht G, Lutz MP, Schoffski P et al (2006) Cetuximab and irinotecan/5-fluorouracil is a safe combination for the first line treatment of patients with epidermal growth factor receptor expressing metastatic colorectal carcinoma. Ann Oncol 17:450–456CrossRefPubMedGoogle Scholar
  5. 5.
    Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sugarbaker PH (2003) Carcinomatosis—is cure an option? J Clin Oncol 5:762–764CrossRefGoogle Scholar
  7. 7.
    Verwaal V, van Ruth S, de Bree E et al (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21:3737–3743CrossRefPubMedGoogle Scholar
  8. 8.
    Glehen O, Kwiatkowski F, Sugarbaker PH et al (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 22:3284–3292CrossRefPubMedGoogle Scholar
  9. 9.
    Sugarbaker PH, Jablonski KA (1995) Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 221:124–1323CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sugarbaker PH, Chang D (1999) Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 6(8):727–731CrossRefPubMedGoogle Scholar
  11. 11.
    Verwaal V, van Ruth S, Witkamp A et al (2005) Long-term survival of peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol 12(1):65–71CrossRefPubMedGoogle Scholar
  12. 12.
    Glehen O, Mithieux F, Osinsky D et al (2003) Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. J Clin Oncol 21:799–806CrossRefPubMedGoogle Scholar
  13. 13.
    Elias D, Antoun S, Goharin A et al (2000) Research on the best chemohyperthermia technique of treatment of peritoneal carcinomatosis after complete resection Int J Surg Investig 1:431–439PubMedGoogle Scholar
  14. 14.
    Elias D, Matsuhisa T, Sideris L et al (2004) Heated intra-operative intraperitoneal oxaliplatin plus irinotecan after complete resection of peritoneal carcinomatosis: pharmacokinetics, tissue distribution and tolerance. Ann Oncol 15:1558–1565CrossRefPubMedGoogle Scholar
  15. 15.
    Gonzalez Bayon L, Gonzalez Moreno S, Ortega Perez G (2006) Safety considerations for operating room personnel during hyperthermic intraperitoneal chemotherapy perfusion. Eur J Surg Oncol 6:619–625CrossRefGoogle Scholar
  16. 16.
    Sugarbaker PH, Mora JT, Carmignani P et al (2005) Update on chemotherapeutic agents utilized for perioperative intraperitoneal chemotherapy. Oncologist 10:112–122CrossRefPubMedGoogle Scholar
  17. 17.
    Sugarbaker PH, Stuart OA, Carmignani PC (2006) Pharmacokinetic changes induced by the volume of chemotherapy solution in patients treated with hyperthermic intraperitoneal mitomycin C. Cancer Chemother Pharmacol 57:703–708CrossRefPubMedGoogle Scholar
  18. 18.
    Stephens AD, Aldermann R, Chang D et al (2000) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative chemotherapy using the Coliseum technique. Ann Surg Oncol 6:790–796CrossRefGoogle Scholar
  19. 19.
    Schmidt U, Dahlke MH, Klempnauer J et al (2005) Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 31:53–58CrossRefPubMedGoogle Scholar
  20. 20.
    Glehen O, Osinksy D, Cotte E et al (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10:853–869CrossRefGoogle Scholar
  21. 21.
    Piso P, Bektas H, Werener U et al (2001) Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. Eur J Surg Oncol 27:286–290CrossRefPubMedGoogle Scholar
  22. 22.
    Witkamp AJ, de Bree E, Kaag MM et al (2001) Extensive cytoreductive surgery followed by intraoperative hyperthermic intraperitoneal chemotherapy with mitomycin C in patients with peritoneal carcinomatosis of colorectal origin. Eur J Cancer 37:979–984CrossRefPubMedGoogle Scholar
  23. 23.
    Elias D, Blot F, El Otmany A et al (2001) Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 92:71–76CrossRefPubMedGoogle Scholar
  24. 24.
    Pilati P, Mocellin S, Rossi CR et al (2003) Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis arising from colon adenocarcinoma. Ann Surg Oncol 10:508–513CrossRefPubMedGoogle Scholar
  25. 25.
    Glehen O, Cotte E, Schreiber V et al (2004) Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin. Br J Surg 91:747–754CrossRefPubMedGoogle Scholar
  26. 26.
    Shen P, Hawksworth J, Lovato J et al (2004) Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol 11:178–186CrossRefPubMedGoogle Scholar
  27. 27.
    Kekmanovic DM, Pavlov MJ, Ceranic MS et al (2005) Treatment of peritoneal carcinomatosis from colorectal cancer by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg 31:147–152CrossRefGoogle Scholar
  28. 28.
    McQuellon, Loggie BW, Lehman AB et al (2003) Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol 10:155–162CrossRefPubMedGoogle Scholar
  29. 29.
    Koppe MJ, Boerman OC, Oyen WJG et al (2006) Peritoneal carcinomatosis of colorectal cancer—incidence and current treatment strategies. Ann Surg 243:212–222CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Moran BJ, Meade B, Murphy E (2006) Hyperthermic intraperitoneal chemotherapy and cytoreductive surgery for peritoneal carcinomatosis of colorectal origin: a novel treatment strategy with promising results in selected patients. Colorect Dis 8:544–550CrossRefGoogle Scholar
  31. 31.
    Matheme H, Hannsson J, Berglund A, Pahlman L, Glimelius B, Nygren P, Graf W (2004) Improved survival in patients with peritoneal metastases from colorectal cancer: a preliminary study. Br J Cancer 90:403–407CrossRefGoogle Scholar
  32. 32.
    Jaquet P, Sugarbaker PH (1996) Clinical research methodologies on diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374CrossRefGoogle Scholar
  33. 33.
    Esquivel J, Sticca R, Sugarbaker PH et al (2007) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Ann Surg Oncol 14:128–133CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • P. Piso
    • 1
    • 3
  • M. H. Dahlke
    • 1
  • N. Ghali
    • 1
  • I. Iesalnieks
    • 1
  • M. Loss
    • 1
  • F. Popp
    • 1
  • P. von Breitenbuch
    • 1
  • A. Agha
    • 1
  • S. A. Lang
    • 1
  • F. Kullmann
    • 2
  • H. J. Schlitt
    • 1
  1. 1.Department of SurgeryUniversity of RegensburgRegensburgGermany
  2. 2.Department of Internal Medicine IUniversity of RegensburgRegensburgGermany
  3. 3.Klinik und Poliklinik für ChirurgieKlinikum der Universität RegensburgRegensburgGermany

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