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Hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies using new hybrid CO2 system: preliminary experience in referral center

Updates in Surgery volume 71, pages 555–560 (2019)Cite this article

Abstract

The most frequent peritoneal surface malignancies originate principally by gastric cancer, colorectal cancer and ovarian cancer. Apart from the origin, peritoneal carcinosis (PC) is considered a negative prognostic factor. The hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal malignancies is considered an attractive method to deliver chemotherapy with enhanced effect directly at the tumor site. The use of such loco-regional approach has proved to improve prognosis of peritoneal carcinomatosis from different origins. Recently, new devices are suitable for loco-regional intraperitoneal chemotherapy as Peritoneal Recirculation System (PRS-1.0 Combat) with CO2 technology. This is a retrospective study with the aim to assess the perioperative outcomes using PRS. Seventeen patients were enrolled affected by colorectal or ovarian cancer. Complete cytoreduction (RT = 0) was achieved for all cases. Median operative time was 420 min (range: 335–665) and median drugs dose used for HIPEC was 137 mg/m2 (115–756). Median EBL was 200 ml (range 50–1000). Median post-operative hospital stay was 9 days (range: 4–24). Treatment-related early complications were recorded in 8 (47.0%) cases and were G1–G2 Major complications occurred in two (11.7%) cases. Considering our aim to test the PRS in different cases and in different pathologies, the results confirmed that the technique is feasible with good perioperative outcomes.

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References

  1. Caruso S, Rugolo S, Bandiera S et al (2007) Clitoral blood flow changes after surgery for stress urinary incontinence: pilot study on TVT versus TOT procedures. Urology 70:554–557. https://doi.org/10.1016/j.urology.2007.04.045

    Article  PubMed  Google Scholar 

  2. Caruso S, Cianci S, Vitale SG et al (2017) Effects of ultralow topical estriol dose on vaginal health and quality of life in postmenopausal women who underwent surgical treatment for pelvic organ prolapse. Menopause 24:900–907. https://doi.org/10.1097/GME.0000000000000851

    Article  PubMed  Google Scholar 

  3. Cicinelli E, Pinto V, Tinelli R et al (2007) Rapid endometrial preparation for hysteroscopic surgery with oral desogestrel plus vaginal raloxifene: a prospective, randomized pilot study. Fertil Steril 88(3):698–701. https://doi.org/10.1016/j.fertnstert.2006.11.151

    Article  CAS  PubMed  Google Scholar 

  4. Vitale SG, Sapia F, Rapisarda AMC et al (2017) Hysteroscopic morcellation of submucous myomas: a systematic review. Biomed Res Int 2017:6848250

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sturlese E, Triolo O, Grasso R et al (2017) Thromboembolism prophylaxis in laparoscopic surgery for gynecologic benign diseases. Results of a single center experience in 922 procedures. Ann Ital Chir 88:342–347

    PubMed  Google Scholar 

  6. Di Spiezio Sardo A, da Cunha Vieira M, Laganà AS et al (2017) combined systemic and hysteroscopic intra-amniotic injection of methotrexate associated with hysteroscopic resection for cervical pregnancy: a cutting-edge approach for an uncommon condition. Eur J Med 49:66–68. https://doi.org/10.5152/eurasianjmed.2017.16215

    Article  Google Scholar 

  7. Butticè S, Laganà AS, Mucciardi G et al (2016) Different patterns of pelvic ureteral endometriosis. What is the best treatment? Results of a retrospective analysis. Arch Ital Urol Androl 88(4):266–269. https://doi.org/10.4081/aiua.2016.4.266

    Article  PubMed  Google Scholar 

  8. Laganà AS, Vitale SG, Muscia V et al (2017) Endometrial preparation with dienogest before hysteroscopic surgery: a systematic review. Arch Gynecol Obstet 295:661–667. https://doi.org/10.1007/s00404-016-4244-1

    Article  PubMed  Google Scholar 

  9. Bellia A, Vitale SG, Laganà AS et al (2016) Feasibility and surgical outcomes of conventional and robot-assisted laparoscopy for early-stage ovarian cancer: a retrospective, multicenter analysis. Arch Gynecol Obstet 294:615–622. https://doi.org/10.1007/s00404-016-4087-9

    Article  PubMed  Google Scholar 

  10. Vitale SG, Rossetti D, Tropea A et al (2017) Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives. Updates Surg 69:29–34

    Article  PubMed  Google Scholar 

  11. Cignini P, Vitale SG, Laganà AS et al (2017) Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up. Updates Surg 69:75–82. https://doi.org/10.1007/s13304-017-0418-z

    Article  PubMed  Google Scholar 

  12. Chiofalo B, Palmara V, Laganà AS et al (2017) Fertility sparing strategies in patients affected by placental site trophoblastic tumor. Curr Treat Options Oncol 18:58

    Article  PubMed  Google Scholar 

  13. VITALE SG, La Rosa VL, Rapisarda AMC, LAGANA’ AS (2018) Fertility preservation in women with gynaecologic cancer: the impact on quality of life and psychological well-being. Hum Fertil 21:35–38. https://doi.org/10.1080/14647273.2017.1339365

    Article  Google Scholar 

  14. Laganà AS, La Rosa VL, Rapisarda AMC et al (2017) Psychological impact of fertility preservation techniques in women with gynaecological cancer. Ecancermedicalscience 11:ed62. https://doi.org/10.3332/ecancer.2017.ed62

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rossetti D, Vitale SG, Tropea A et al (2017) New procedures for the identification of sentinel lymph node: shaping the horizon of future management in early stage uterine cervical cancer. Updates Surg 69:383–388. https://doi.org/10.1007/s13304-017-0456-6

    Article  PubMed  Google Scholar 

  16. Tozzi R, Giannice R, Cianci S et al (2015) Neo-adjuvant chemotherapy does not increase the rate of complete resection and does not significantly reduce the morbidity of Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer. Gynecol Oncol 138:252–258. https://doi.org/10.1016/j.ygyno.2015.05.010

    Article  PubMed  Google Scholar 

  17. Vitale SG, Marilli I, Lodato M et al (2013) The role of cytoreductive surgery in advanced-stage ovarian cancer: a systematic review. Updates Surg. 65:265–270

    Article  PubMed  Google Scholar 

  18. Montori G, Coccolini F, Fugazzola P et al (2018) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in ovarian and gastrointestinal peritoneal carcinomatosis: results from a 7-year experience. J Gastrointest Oncol 9:241–253. https://doi.org/10.21037/jgo.2017.12.04

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cosentino F, Vizzielli G, Turco LC et al (2018) Near-infrared imaging with indocyanine green for detection of endometriosis lesions (Gre-Endo Trial): a pilot study. J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2018.02.023

    Article  PubMed  Google Scholar 

  20. Caruso S, Panella MM, Cianci S et al (2011) TOT does not affect the urethral sphincter innervation: a pilot study. Int Urogynecol J 22:739–742. https://doi.org/10.1007/s00192-011-1364-9

    Article  PubMed  Google Scholar 

  21. Lagana AS, Vitale SG, De Dominici R et al (2016) Fertility outcome after laparoscopic salpingostomy or salpingectomy for tubal ectopic pregnancy A 12 years retrospective cohort study. Ann Ital Chir 87:461–465

    PubMed  Google Scholar 

  22. Matarazzo MG, Cianci S, Rampello L et al (2013) Urethral sphincter innervation and clitoral blood flow after the transobturator (TOT) approach. Int Urogynecol J 24:621–625. https://doi.org/10.1007/s00192-012-1891-z

    Article  CAS  PubMed  Google Scholar 

  23. Rossitto C, Cianci S, Gueli Alletti S et al (2017) Laparoscopic, minilaparoscopic, single-port and percutaneous hysterectomy: comparison of perioperative outcomes of minimally invasive approaches in gynecologic surgery. Eur J Obstet Gynecol Reprod Biol 216:125–129. https://doi.org/10.1016/j.ejogrb.2017.07.026

    Article  CAS  PubMed  Google Scholar 

  24. Vitale SG, Laganà AS, Noventa M et al (2018) Transvaginal bilateral sacrospinous fixation after second recurrence of vaginal vault prolapse: efficacy and impact on quality of life and sexuality. Biomed Res Int 2018:1–6. https://doi.org/10.1155/2018/5727165

    Article  Google Scholar 

  25. Vitale SG, Caruso S, Rapisarda AMC et al (2016) Biocompatible porcine dermis graft to treat severe cystocele: impact on quality of life and sexuality. Arch Gynecol Obstet 293:125–131. https://doi.org/10.1007/s00404-015-3820-0

    Article  PubMed  Google Scholar 

  26. Laganà AS, Vitale SG, Trovato MA et al (2016) Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options. Biomed Res Int 2016:3617179

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gueli Alletti S, Rossitto C, Cianci S et al (2018) The Senhance™ surgical robotic system (“Senhance”) for total hysterectomy in obese patients: a pilot study. J Robot Surg 12:229–234. https://doi.org/10.1007/s11701-017-0718-9

    Article  PubMed  Google Scholar 

  28. Gueli Alletti S, Perrone E, Cianci S et al (2018) 3 mm Senhance robotic hysterectomy: a step towards future perspectives. J Robot Surg. https://doi.org/10.1007/s11701-018-0778-5

    Article  PubMed  Google Scholar 

  29. Rossitto C, Gueli Alletti S, Rotolo S et al (2016) Total laparoscopic hysterectomy using a percutaneous surgical system: a pilot study towards scarless surgery. Eur J Obstet Gynecol Reprod Biol 203:132–135. https://doi.org/10.1016/j.ejogrb.2016.05.007

    Article  PubMed  Google Scholar 

  30. Rapisarda AMC, Cianci A, Caruso S et al (2018) Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management. Arch Gynecol Obstet 297:1353–1375. https://doi.org/10.1007/s00404-018-4728-2

    Article  PubMed  Google Scholar 

  31. Rossitto C, Gueli Alletti S, Cianci S et al (2017) Reply. J Minim Invasive Gynecol 24:683–684. https://doi.org/10.1016/j.jmig.2017.02.001

    Article  PubMed  Google Scholar 

  32. Fagotti A, Costantini B, Gallotta V et al (2015) Minimally invasive secondary cytoreduction plus hipec versus open surgery plus HIPEC in isolated relapse from ovarian cancer: a retrospective cohort study on perioperative outcomes. J Minim Invasive Gynecol 22:428–432. https://doi.org/10.1016/j.jmig.2014.11.008

    Article  PubMed  Google Scholar 

  33. Gueli Alletti S, Rossitto C, Cianci S, Scambia G (2016) Telelap ALF-X total hysterectomy for early stage endometrial cancer: new frontier of robotic gynecological surgery. Gynecol Oncol 140:575–576. https://doi.org/10.1016/j.ygyno.2016.01.018

    Article  CAS  PubMed  Google Scholar 

  34. Gueli Alletti S, Rossitto C, Cianci S et al (2016) Telelap ALF-X vs standard laparoscopy for the treatment of early-stage endometrial cancer: a single-institution retrospective cohort study. J Minim Invasive Gynecol 23:378–383. https://doi.org/10.1016/j.jmig.2015.11.006

    Article  PubMed  Google Scholar 

  35. Gueli Alletti S, Rossitto C, Perrone E et al (2017) Needleoscopic conservative staging of borderline ovarian tumor. J Minim Invasive Gynecol 24:529–530. https://doi.org/10.1016/j.jmig.2016.10.009

    Article  PubMed  Google Scholar 

  36. Gallotta V, Conte C, Giudice MT et al (2017) Secondary laparoscopic cytoreduction in recurrent ovarian cancer: a large, single-institution experience. J Minim Invasive Gynecol 25:644–650

    Article  PubMed  Google Scholar 

  37. Gueli Alletti S, Vizzielli G, Lafuenti L et al (2018) Single-institution propensity-matched study to evaluate the psychological effect of minimally invasive interval debulking surgery versus standard laparotomic treatment: from body to mind and back. J Minim Invasive Gynecol 25:816–822

    Article  PubMed  Google Scholar 

  38. Golse N, Bakrin N, Passot G et al (2012) Iterative procedures combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal recurrence: postoperative and long-term results. J Surg Oncol 106:197–203. https://doi.org/10.1002/jso.23062

    Article  PubMed  Google Scholar 

  39. Petrillo M, De Iaco P, Cianci S et al (2016) Long-term survival for platinum-sensitive recurrent ovarian cancer patients treated with secondary cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol 23:1660–1665. https://doi.org/10.1245/s10434-015-5050-x

    Article  CAS  PubMed  Google Scholar 

  40. Vassos N, Förtsch T, Aladashvili A et al (2016) Repeated cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with recurrent peritoneal carcinomatosis. World J Surg Oncol 14:42. https://doi.org/10.1186/s12957-016-0804-x

    Article  PubMed  PubMed Central  Google Scholar 

  41. van Driel WJ, Koole SN, Sikorska K et al (2018) Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med 378:230–240. https://doi.org/10.1056/NEJMoa1708618

    Article  PubMed  Google Scholar 

  42. Alyami M, Gagniere J, Sgarbura O et al (2017) Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis. Eur J Surg Oncol 43:2178–2183. https://doi.org/10.1016/j.ejso.2017.09.010

    Article  PubMed  Google Scholar 

  43. Khosrawipour T, Khosrawipour V, Giger-Pabst U (2017) Pressurized intra peritoneal aerosol chemotherapy in patients suffering from peritoneal carcinomatosis of pancreatic adenocarcinoma. PLoS One 12:e0186709. https://doi.org/10.1371/journal.pone.0186709

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Sánchez-García S, Villarejo-Campos P, Padilla-Valverde D et al (2016) Intraperitoneal chemotherapy hyperthermia (HIPEC) for peritoneal carcinomatosis of ovarian cancer origin by fluid and CO2recirculation using the closed abdomen technique (PRS-1.0 Combat): a clinical pilot study. Int J Hyperth 32:488–495. https://doi.org/10.3109/02656736.2016.1152515

    Article  CAS  Google Scholar 

  45. Padilla-Valverde D, Sanchez-Garcia S, García-Santos E et al (2017) Usefulness of thermographic analysis to control temperature homogeneity in the development and implementation of a closed recirculating CO2chemohyperthermia model. Int J Hyperth 33:220–226. https://doi.org/10.1080/02656736.2016.1237679

    Article  CAS  Google Scholar 

  46. Sánchez-García S, Padilla-Valverde D, Villarejo-Campos P et al (2017) Hyperthermic chemotherapy intra-abdominal laparoscopic approach: development of a laparoscopic model using CO2 recirculation system and clinical translation in peritoneal carcinomatosis. Int J Hyperth 33:684–689. https://doi.org/10.1080/02656736.2017.1302100

    Article  Google Scholar 

  47. Fagotti A, Ferrandina G, Fanfani F et al (2006) A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol 13:1156–1161. https://doi.org/10.1245/ASO.2006.08.021

    Article  PubMed  Google Scholar 

  48. Sugarbaker PH, Chang D (1999) Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 6:727–731

    Article  CAS  Google Scholar 

  49. Sugarbaker PH (1996) Peritoneal carcinomatosis: principles of management. Springer, Boston

    Book  Google Scholar 

  50. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  51. Chiva LM, Gonzalez-Martin A (2015) A critical appraisal of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of advanced and recurrent ovarian cancer. Gynecol Oncol 136:130–135. https://doi.org/10.1016/j.ygyno.2014.11.072

    Article  Google Scholar 

  52. Tentes AAK, Spiliotis ID, Korakianitis OS et al (2011) Adjuvant perioperative intraperitoneal chemotherapy in locally advanced colorectal carcinoma: preliminary results. ISRN Surg 2011:529876. https://doi.org/10.5402/2011/529876

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Sammartino P, Sibio S, Biacchi D et al (2012) Prevention of peritoneal metastases from colon cancer in high-risk patients: preliminary results of surgery plus prophylactic HIPEC. Gastroenterol Res Pract 2012:141585. https://doi.org/10.1155/2012/141585

    Article  PubMed  PubMed Central  Google Scholar 

  54. Sammartino P, Sibio S, Biacchi D et al (2014) Long-term results after proactive management for locoregional control in patients with colonic cancer at high risk of peritoneal metastases. Int J Colorectal Dis 29:1081–1089. https://doi.org/10.1007/s00384-014-1929-4

    Article  CAS  PubMed  Google Scholar 

  55. Baratti D, Kusamura S, Iusco D et al (2017) Hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of primary curative surgery in patients with colorectal cancer at high risk for metachronous peritoneal metastases. Ann Surg Oncol 24:167–175. https://doi.org/10.1245/s10434-016-5488-5

    Article  PubMed  Google Scholar 

  56. Glehen O, Gilly FN, Arvieux C et al (2010) Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol 17:2370–2377. https://doi.org/10.1245/s10434-010-1039-7

    Article  PubMed  Google Scholar 

  57. Cianci S, Vizzielli G, Fagotti A et al (2018) A novel HIPEC technique using hybrid CO2 recirculation system: intra-abdominal diffusion test in a porcine model. Updates Surg. https://doi.org/10.1007/s13304-018-0557-x

    Article  PubMed  Google Scholar 

  58. Issels RD (2008) Hyperthermia adds to chemotherapy. Eur J Cancer 44:2546–2554. https://doi.org/10.1016/j.ejca.2008.07.038

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy

    Stefano Cianci

  2. Dipartimento di Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy

    Carlo Abatini

  3. Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Anna Fagotti & Giovanni Scambia

  4. Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy

    Benito Chiofalo

  5. Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy

    Alessandro Tropea & Antonio Biondi

  6. Dipartimento di Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Fabio Pacelli

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  1. Stefano Cianci
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  2. Carlo Abatini
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  3. Anna Fagotti
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  7. Giovanni Scambia
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  8. Fabio Pacelli
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Correspondence to Stefano Cianci.

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Cianci, S., Abatini, C., Fagotti, A. et al. Hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies using new hybrid CO2 system: preliminary experience in referral center. Updates Surg 71, 555–560 (2019). https://doi.org/10.1007/s13304-018-0578-5

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