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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Outcomes from a Single Tertiary Institution

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) is an effective but morbid procedure in the treatment of peritoneal carcinomatosis. We report our outcomes at a single tertiary institution.

Method

A total of 170 consecutive patients underwent CRS-HIPEC for peritoneal carcinomatosis between July 2007 and August 2012. The peritoneal cancer index (1–39) was used for peritoneal carcinomatosis (PC) staging. Mitomycin C (88.8 %) was administered intraperitoneally at 42 °C for 90 mins. Risk factors associated with major morbidities were analyzed. The Kaplan-Meier method was used for survival analyses.

Results

The mean age was 55.1 (±11.3) years, and the majority (77.1 %) of patients had complete cytoreduction (CC0-1). Tumor types included colorectal (n = 51, 30.0 %), appendiceal (n = 50, 29.4 %), pseudomyxoma peritonei (n = 16, 9.4 %), and other (n = 53, 31.2 %). Factors associated with major complications were estimated blood loss (>400 ml), length of stay (>1 week), intraoperative blood transfusion, operative time (>6 h), and bowel anastomosis. Intraoperative blood transfusion was the only independent prognostic factor on multivariate analysis (p = 0.031). Median follow-up was 15.7 months (±1.2). The recurrence rates for colorectal and appendiceal carcinoma at 1 and 3 years were 40 %, 53.5 % and 68 %, 79.1 %, respectively. The 1- and 3-year overall survival for colorectal and appendiceal carcinomatosis was 74.0 %, 32.5 % and 89.4 %, 29.3 %, respectively. Intraoperative peritoneal cancer index (PCI) score (>16) and need for blood transfusion were factors independently associated with poor survival (p < 0.05).

Conclusion

Our single institution experience of CRS/HIPEC procedures for peritoneal carcinomatosis demonstrates acceptable perioperative outcome and long-term survival. Optimal cytoreduction was achieved in the majority of cases. Intraoperative PCI > 16 was associated with poor survival. This series supports the safety of CRS-HIPEC in selected patients.

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Authors and Affiliations

  1. Mount Sinai Medical Center, New York, NY, USA

    Parissa Tabrizian, Ming-Jim Yang, Anya Romanoff, Spiros Hiotis, Umut Sarpel & Daniel M. Labow

  2. Morristown Medical Center, Morristown, New Jersey, USA

    Brian Shrager

  3. Department of Urology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA

    Ghalib Jibara

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  1. Parissa Tabrizian
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  2. Brian Shrager
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Correspondence to Parissa Tabrizian.

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Tabrizian, P., Shrager, B., Jibara, G. et al. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Outcomes from a Single Tertiary Institution. J Gastrointest Surg 18, 1024–1031 (2014). https://doi.org/10.1007/s11605-014-2477-5

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  • DOI: https://doi.org/10.1007/s11605-014-2477-5

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