Intraperitoneal Chemohyperthermia Using a Closed Abdominal Procedure and Cytoreductive Surgery for the Treatment of Peritoneal Carcinomatosis: Morbidity and Mortality Analysis of 216 Consecutive Procedures
Background: Peritoneal carcinomatosis has been regarded as a lethal clinical entity. Recently, aggressive treatments combining intraperitoneal chemohyperthermia (IPCH) with cytoreductive surgery have resulted in long-term survival in selected patients. The aim of this trial was to analyze the mortality and morbidity of 216 consecutive treatments of peritoneal carcinomatosis by IPCH by using a closed abdominal procedure combined with cytoreductive surgery.
Methods: Between February 1989 and August 2001, 207 patients who underwent 216 IPCH procedures using a closed abdominal procedure with mitomycin C, cisplatin, or both were prospectively studied.
Results: The postoperative mortality and morbidity rates were 3.2% and 24.5%, respectively. The most frequent complications were digestive fistula (6.5%) and hematological toxicity (4.6%). Morbidity was statistically linked with the carcinomatosis stage (P = .016), the duration of surgery (P = .005), and the number of resections and peritonectomy procedures (P = .042). Duration of surgery and carcinomatosis stage were the most common predictors of morbidity.
Conclusions: The frequency of complications after IPCH and cytoreductive surgery was mainly associated with the carcinomatosis stage and the extent of the surgical procedure. The IPCH closed abdominal procedure has shown an acceptable frequency of adverse events.
Morbidity Mortality Cytoreductive surgery Hyperthermia Intraperitoneal chemotherapy
Iitsuka Y, Kaneshima S, Tanida O, et al. Intraperitoneal free cancer cells and their viability in gastric cancer. Cancer 1979;44:1476–80.PubMedCrossRefGoogle Scholar
Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000;88:358–63.PubMedCrossRefGoogle Scholar
Gilly FN, Carry PY, Sayag AC, et al. Tolerance of intraperitoneal chemohyperthermia with mitomycin C: in vivo study in dogs. Int J Hyperthermia 1992;8:659–66.PubMedCrossRefGoogle Scholar
Beaujard AC, Glehen O, Caillot JL, et al. Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis. Cancer 2000;88:2512–9.PubMedCrossRefGoogle Scholar
Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 1996;77:2622–9.PubMedCrossRefGoogle Scholar
Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 1995;221:124–32.PubMedCrossRefGoogle Scholar
Esquivel J, Sugarbaker PH. Second-look surgery in patients with peritoneal dissemination from appendiceal malignancy: analysis of prognostic factors in 98 patients. Ann Surg 2001;234:198–205.PubMedCrossRefGoogle Scholar
Gilly FN, Beaujard A, Glehen O, et al. Peritonectomy combined with intraperitoneal chemohyperthermia in abdominal cancer with peritoneal carcinomatosis: phase I-II study. Anticancer Res 1999;19:2317–21.PubMedGoogle Scholar
Glehen O, Mithieux F, Osinsky D, et al. Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. J Clin Oncol 2003;21:799–806.PubMedCrossRefGoogle Scholar
Sayag-Beaujard AC, Francois Y, Glehen O, et al. Intraperitoneal chemo-hyperthermia with mitomycin C for gastric cancer patients with peritoneal carcinomatosis. Anticancer Res 1999;19:1375–82.PubMedGoogle Scholar
Gilly FN, Carry PY, Sayag AC, et al. Regional chemotherapy (with mitomycin C) and intra-operative hyperthermia for digestive cancers with peritoneal carcinomatosis. Hepatogastroenterology 1994;41:124–9.PubMedGoogle Scholar
Panteix G, Guillaumont M, Cherpin L, et al. Study of the pharmacokinetics of mitomycin C in humans during intraperitoneal chemohyperthermia with special mention of the concentration in local tissues. Oncology 1993;50:366–70.PubMedGoogle Scholar
Sayag AC, Gilly FN, Carry PY, et al. Intraoperative chemohyperthermia in the management of digestive cancers. A general review of literature. Oncology 1993;50:333–7.PubMedCrossRefGoogle Scholar
Glehen O, Peyrat P, Sayag-Beaujard AC, et al. Abdominal cancer with peritoneal carcinomatosis treated by peritonectomy procedures and intraperitoneal chemohyperthermia. Exp Oncol 2000;22:59–63.Google Scholar
Stephens AD, Alderman R, Chang D, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 1999;6:790–6.PubMedCrossRefGoogle Scholar
Witkamp AJ, de Bree E, Kaag MM, et al. Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin-C in patients with peritoneal carcinomatosis of colorectal origin. Eur J Cancer 2001;37:979–84.PubMedCrossRefGoogle Scholar
Porcheron J, Talabard JN, Breton C, et al. Intraperitoneal chemohyperthermia for peritoneal carcinomatosis: original modeling, clinical tolerance and results study about 30 patients. Hepatogastroenterology 2000;47:1411–8.PubMedGoogle Scholar
Mansvelt B, Bertrand C, Nockerman P, et al. Etude de toxicité et résultats de la chimio-hyperthermie intra-péritonéale chez 28 patients en carcinose péritonéale. Ann Chir 1997;51:60–7.PubMedGoogle Scholar
Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 2001;92:71–6.PubMedCrossRefGoogle Scholar
Cavaliere F, Perri P, Di Filippo F, et al. Treatment of peritoneal carcinomatosis with intent to cure. J Surg Oncol 2000;74:41–4.PubMedCrossRefGoogle Scholar