Annals of Surgical Oncology

, Volume 11, Issue 4, pp 393–398 | Cite as

Peritonectomy and Intraperitoneal Hyperthermic Perfusion (IPHP): A Strategy That Has Confirmed its Efficacy in Patients with Pseudomyxoma Peritonei

  • Marcello Deraco
  • Dario Baratti
  • Maria Grazia Inglese
  • Biagino Allaria
  • Salvatore Andreola
  • Cecilia Gavazzi
  • Shigeki Kusamura
Original Articles

Abstract

Background: Pseudomyxoma peritonei (PMP) is a rare disease with a poor prognosis characterized by a complete redistribution of mucin within the peritoneal cavity. The aim of this multicentric study was to evaluate the survival, morbidity, toxicity, and mortality of patients with PMP treated by cytoreductive surgery (CRS) with intraperitoneal hyperthermic perfusion (IPHP).

Methods: Thirty-three patients with PMP (21 males and 12 females) were enrolled in a phase II clinical trial. One patient underwent surgery twice because of disease recurrence. CRS was performed with peritonectomy procedures. The closed abdomen technique was employed for IPHP with use of cisplatin (25 mg/m2/L) plus mitomycin-C (3.3 mg/m2/L) for 60 minutes under hyperthermic conditions (42.5°C).

Results: Thirty-one patients (92%) were optimally cytoreduced. Five-year overall survival, progression-free survival, and locoregional progression-free survival rates were 97%, 43%, and 59%, respectively. Grade II and grade III morbidity was observed in 5 patient (15%) and 6 patients (18%), respectively. There was one treatment-related death (3%), 21 days after treatment.

Conclusions: CRS associated with IPHP permitted complete tumor removal with an acceptable morbidity and mortality for patients with PMP. This study confirms the efficacy of the combined treatment in terms of long-term survival and local disease control.

Key Words:

Intraperitoneal hyperthermic perfusion Peritonectomy Pseudomyxoma peritonei 

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REFERENCES

  1. 1.
    Sugarbaker PH. Pseudomyxoma Peritonei: a cancer whose biology is characterized by a redistribution phenomenon. Ann Surg 1994; 219: 109–11.PubMedGoogle Scholar
  2. 2.
    Deraco M, Santoro N, Carraro O, et al. Peritoneal carcinomatosis: features of dissemination [review]. Tumori 1999; 85: 1–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Ronnett BM, Yan H, Kurman RJ, Shmookler BM, Wu L, Sugarbaker PH. Patients with pseudomyxoma peritonei associated with disseminated peritoneal adenomucinosis have a significantly more favorable prognosis than patients with peritoneal mucinous carcinomatosis. Cancer 2001; 92: 85–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM. Disseminated peritoneal adenomucinous and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei.” Am J Surg Pathol 1995;1390–408.Google Scholar
  5. 5.
    Sugarbaker PH. Cytoreductive surgery and intraperitoneal chemotherapy with peritoneal spread of cystadenocarcinoma. Eur J Surg 1991; 561 (Suppl): 75–82.Google Scholar
  6. 6.
    Panteix G, Guillamont 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Deraco M, Gronchi A, Mazzaferro V, et al. Feasibility of peritonectomy associated with intraperitoneal hyperthermic perfusion in patients with Pseudomyxoma peritonei. Tumori 2002; 88: 370–5.PubMedGoogle Scholar
  8. 8.
    Sugarbaker PH. Peritonectomy procedures. Ann Surg 1995; 221: 29–42.PubMedGoogle Scholar
  9. 9.
    Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet 2001; 358(9292): 1487–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Gomez Portilla A, Deraco M, Sugarbaker PH. Clinical pathway for peritoneal carcinomatosis from colon and rectal cancer: guidelines for current practice. Tumori 1997; 83: 725–8.PubMedGoogle Scholar
  11. 11.
    Deraco M, Rossi CR, Pennacchioli E, et al. Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion in the treatment of recurrent epithelial ovarian cancer: a phase II clinical study. Tumori 2001; 87: 120–6.PubMedGoogle Scholar
  12. 12.
    Norton L, Simon R. Tumor size, sensitivity to therapy, and design of treatment schedules. Cancer Treat Rep 1977; 61: 1307–17.PubMedGoogle Scholar
  13. 13.
    Sugarbaker PH, Graves T, De Bruijn EA, et al. Early postoperative intraperitoneal chemotherapy as an adjuvant therapy to surgery for peritoneal carcinomatosis from gastrointestinal cancer: pharmacological studies. Cancer Res, 1990; 50: 5790–4.Google Scholar
  14. 14.
    Rosenshein N, Blake E, McIntyre PA, et al. The effect of volume on the distribution of substances instilled into the peritoneal cavity. Gynecol Oncol 1978; 6: 106–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Arancia G, Crateri Trovalusci P, Mariutti G, Mondovi B. Ultrastructural changes induced by hyperthermia in Chinese hamster V79 fibroblasts. Int J Hyperthermia 1989; 5: 341–50.PubMedCrossRefGoogle Scholar
  16. 16.
    DuBose DA, Hinkle JR, Morehouse DH, Ogle PL. Model for environmental heat damage of the blood vessel barrier. Wilderness Environ Med 1998; 9: 130–6.PubMedGoogle Scholar
  17. 17.
    Gnant MF, Noll LA, Terrill RE, et al. Isolated hepatic perfusion for lapine liver metastases: impact of hyperthermia on permeability of tumor neovasculature. Surgery 1999; 126: 890–9.PubMedGoogle Scholar
  18. 18.
    Calderwood SK, Hahn GM. Thermal sensitivity and resistance of insulin-receptor binding. Biochim Biophys Acta 1983; 756: 1–8.PubMedGoogle Scholar
  19. 19.
    Xu M, Myerson RJ, Straube WL, et al. Radiosensitization of heat resistant human tumour cells by 1 hour at 41.1 degrees C and its effect on DNA repair. Int J Hyperthermia. 2002; 18: 385–403.PubMedCrossRefGoogle Scholar
  20. 20.
    Vaupel PW. The influence of tumor blood flow and microenvironmental factors on the efficacy of radiation, drugs and localized hyperthermia. Klin Padiatr 1997; 209: 243–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Engelhardt R. Hyperthermia and drugs. Rec Res Cancer Res 1987; 104: 136–203.Google Scholar
  22. 22.
    Ozols RF, Young RC. Ovarian cancer. Curr Probl Cancer 1987; 11: 57–122.PubMedCrossRefGoogle Scholar
  23. 23.
    Hettinga JV, Lemstra W, Meijer C, et al. Mechanism of hyperthermic potentiation of cisplatin action in cisplatin-sensitive and -resistant tumor cells. Br J Cancer 1997; 75: 1735–43.PubMedGoogle Scholar
  24. 24.
    Pestieau SR, Esquivel J, Sugarbaker PH. Pleural extension of mucinous tumor in patients with pseudomyxoma peritonei syndrome. Ann Surg Oncol 2000; 7: 199–203.PubMedCrossRefGoogle Scholar
  25. 25.
    Gough DB, Donohue JH, Schutt AJ, et al. Pseudomyxoma peritonei: long-term patient survival with an aggressive regional approach. JA. Ann Surg. 1994; 219: 112–9.CrossRefGoogle Scholar
  26. 26.
    Witkamp AJ, de Bree E, Kaag MM, van Slooten GW, van Coevorden F, Zoetmulder FA. Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg 2001; 88: 458–63.PubMedCrossRefGoogle Scholar
  27. 27.
    Sugarbaker PH, Chang D. Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 1999; 6(8): 727–31.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • Marcello Deraco
    • 1
    • 6
  • Dario Baratti
    • 1
  • Maria Grazia Inglese
    • 2
  • Biagino Allaria
    • 3
  • Salvatore Andreola
    • 4
  • Cecilia Gavazzi
    • 5
  • Shigeki Kusamura
    • 1
  1. 1.Department of Surgery, Melanoma and Sarcoma UnitNational Cancer Institute of MilanItaly
  2. 2.Department of AnesthesiologyNational Cancer Institute of MilanItaly
  3. 3.Department of Critical CareNational Cancer Institute of MilanItaly
  4. 4.Department of PathologyNational Cancer Institute of MilanItaly
  5. 5.Nutritional Care UnitNational Cancer Institute of MilanItaly
  6. 6.Unità Operativa Melanoma e SarcomaIstituto Nazionale per lo Studio e la Cura dei TumoriMilanItaly

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