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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered via a modified perfusion system for peritoneal carcinomatosis of colorectal origin

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Abstract

Background and purpose

The long-term survival of patients with peritoneal carcinomatosis of colorectal origin has been achieved with cytoreductive surgery, which removes all macroscopic implants, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The current technology for administering intraperitoneal heated chemotherapy is expensive and, for some institutions, unaffordable. We conducted this study to assess the temperature stability provided by a modified, inexpensive system, to offer a simple and low cost alternative to the standard HIPEC delivery equipment.

Methods

Ten patients with histologically diagnosed peritoneal metastases of adenocarcinoma or pseudomyxoma peritonei underwent cytoreductive surgery and received HIPEC with 5-fluorouracil for 90 min, delivered via our modified system. The temperature was recorded from two probes: one in the inflow catheter and one in the outflow catheter. The intra-abdominal temperature was monitored meticulously to maintain it at between 41 and 42 °C.

Results

All patients underwent cytoreductive surgery and HIPEC using our modified delivery system. Temperature stability was achieved in all patients, with a mean of 41.4°. There were no thermal injuries associated with any of the ten perfusions. The mean hospital stay was 15 days and the median survival was 30 months.

Conclusion

Analysis of this data demonstrates that the uniform delivery of HIPEC at 41° with this modified system is feasible and safe. The outcome of the patients treated with cytoreductive surgery and HIPEC with this modified system compares favorably to other published series. Its low cost and simple design will give more patients with peritoneal carcinomatosis access to this treatment.

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Acknowledgments

We thank the Hospital de Cardiologia, Centro Medico Nacional “Siglo XXI” headed by Dr. Ruben Argüero, Dr. Careaga, Chairman of Cardiovascular Surgery and Dr. Reyes, Chairman of Perfusion Medicine, for invaluable support provided by lending us the cardiovascular pumps for this study.

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Authors and Affiliations

  1. Hospital de Oncologia, Department of Surgical Oncology, Colorectal service, Hospital de Oncologia Centro Medico Nacional “Siglo XXI” IMSS, Mexico City, Mexico

    Adrian Cravioto-Villanueva, Magdalena Cavazos, Pedro Luna-Perez, Hector Martinez-Gomez, María Lourdes Ramirez & Juan Solorzano

  2. Department of Cardiovascular Surgery, Perfusion Medicine, Centro Medico Nacional “Siglo XXI” IMSS, Hospital de Cardiologia, Mexico City, Mexico

    Juan Solorzano & Hermelindo Montiel

  3. Peritoneal Surface Malignancy Program, GI Surgical Oncology, St. Agnes Health Care, Baltimore, MD, USA

    Juan Solorzano & Jesus Esquivel

Authors
  1. Adrian Cravioto-Villanueva
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  2. Magdalena Cavazos
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  3. Pedro Luna-Perez
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  4. Hector Martinez-Gomez
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  5. María Lourdes Ramirez
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  6. Juan Solorzano
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  7. Hermelindo Montiel
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  8. Jesus Esquivel
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Correspondence to Adrian Cravioto-Villanueva.

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Cravioto-Villanueva, A., Cavazos, M., Luna-Perez, P. et al. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered via a modified perfusion system for peritoneal carcinomatosis of colorectal origin. Surg Today 46, 979–984 (2016). https://doi.org/10.1007/s00595-016-1335-3

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  • DOI: https://doi.org/10.1007/s00595-016-1335-3

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