Annals of Surgical Oncology

, Volume 11, Issue 4, pp 387–392 | Cite as

Reduced Morbidity Following Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemoperfusion

  • Syed A. Ahmad
  • Joseph Kim
  • Jeffrey J. Sussman
  • Debbie A. Soldano
  • Linda J. Pennington
  • Laura E. James
  • Andrew M. Lowy
Original Articles

Abstract

Background: Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IPHC) are an aggressive treatment for patients with peritoneal based malignancies or those with peritoneal dissemination of select histology. Although promising, this therapeutic regimen has been associated with significant morbidity, long hospital stays, and, in some reports, moderate risk for perioperative mortality. Recent experience suggests that these outcomes may be improved.

Methods: Thirty-three patients underwent cytoreductive surgery and intraperitoneal hyperthermic perfusion during the period of December 1999 to July 2002. All patients underwent resection by a three-surgeon team, followed by IPHC with an open technique. Peritonectomy was performed with the goal of total gross excision of disease.

Results: Thirty-five procedures were performed in 33 patients (20 female) with a mean age of 49 years (range, 26–72). Complete cytoreduction was achieved in 22 cases (63%), and in 6 cases (17%) residual disease was <4 mm. There were nine major perioperative complications (27%) and no perioperative deaths. The median hospital stay was 11 days.

Conclusions: These results demonstrate that cytoreductive surgery and IPHC can be performed with morbidity and mortality rates in line with those of other major oncologic operations. Employment of a three-surgeon approach, limited peritonectomy, and an open technique may help to reduce the morbidity from this aggressive treatment. Continued investigation of this promising treatment regimen is warranted.

Key Words:

Appendiceal carcinoma Cytoreduction Hyperthermia Intraperitoneal chemotherapy Peritoneal carcinomatosis 

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REFERENCES

  1. 1.
    Sugarbaker PH, Schellinx MET, Chang D, Koslowe P, von Meyerfeldt M. Peritoneal carcinomatosis from adenocarcinoma of the colon. World J Surg 1996; 20: 585–92.PubMedCrossRefGoogle Scholar
  2. 2.
    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
  3. 3.
    Loggie BW, Fleming RA, McQuellon RP, Russell GB, Geisinger KR. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin. Am Surg 2000; 66: 561–8.PubMedGoogle Scholar
  4. 4.
    Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Seminin Surg Oncol 1998; 14: 254–61.CrossRefGoogle Scholar
  5. 5.
    Ceelen WP, Hesse U, de Hemptinne B, Pattyn P. Hyperthermic intraperitoneal chemoperfusion in the treatment of locally advanced intra-abdominal cancer. Br J Surg 2000; 87: 1006–15.PubMedCrossRefGoogle Scholar
  6. 6.
    Sugarbaker PH, Zhu BW, Sese GB, Shmookler B. Peritoneal carcinomatosis from appendiceal cancer: results in 69 patients treated by cytoreductive surgery and intraperitoneal chemotherapy. Dis Colon Rectum 1993; 36: 323–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Yonemura Y, Fujimora T, Fushida S, et al. Hyperthermo-chemotherapy combined with cytoreductive surgery for the treatment of gastric cancer with peritoneal dissemination. World J Surg 1991; 15: 530–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Sugarbaker PH, Chang D. Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 1999; 6: 727–31.PubMedCrossRefGoogle Scholar
  9. 9.
    Esquivel J, Sugarbaker PH. Clinical presentation of the pseudomyxoma peritonei syndrome. Br J Surg 2000; 87: 1414–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Esquivel J, Vidal-Jove J, Steves MA, Sugarbaker PH. Morbidity and mortality of cytoreductive surgery and intraperitoneal chemotherapy. Surgery 1993; 113: 631–6.PubMedGoogle Scholar
  11. 11.
    Butterworth SA, Panton ONM, Klaassen DJ, Shah AM, McCregor GI. Morbidity and mortality associated with intraperitoneal chemotherapy for pseudomyxoma peritonei. Am J Surg 2002; 183: 529–32.PubMedCrossRefGoogle Scholar
  12. 12.
    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 open technique. Ann Surg Oncol 1999; 6: 790–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Culliford AT, Brooks AD, Sharma S, et al. Surgical debulking and intraperitoneal chemotherapy for established peritoneal metastases from colon and appendix cancer. Ann Surg Oncol 2001; 8: 787–95.PubMedCrossRefGoogle Scholar
  14. 14.
    Witkamp AJ, de Bree E, Kaag MM, van Slooten GW, van Coevorden F, Zoetmulder FAN. Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg 2001; 88: 458–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Verwaal VJ, Ruth SV, de Bree E, Slooten GWV, Tinteren VH, Boot H, Zoetmulder FAN. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003; 21: 3737–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Sugarbaker PH. Peritonectomy procedures. Ann Surg 1995; 221: 29–42.PubMedCrossRefGoogle Scholar
  17. 17.
    Spratt JS, Adcock RA, Muskovin M, Sherrill W, McKeown J. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Can Res 1980; 40: 256–60.Google Scholar
  18. 18.
    Fumagalli U, Trabucchi E, Soligo M, et al. Effects of intraperitoneal chemotherapy on anastomotic healing in the rat. J Surg Res 1991; 50: 82–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Esquivel J, Angulo F, Bland RK, Stephens AD, Sugarbaker PH. Hemodynamic and cardiac function parameters during heated intraperitoneal chemotherapy using the open “open technique”. Ann Surg Oncol 2000; 7: 296–300.PubMedCrossRefGoogle Scholar
  20. 20.
    Stuart OA, Stephens AD, Welch L, Sugarbaker PH. Safety monitoring of the open technique for heated intraperitoneal chemotherapy with mitomycin C. Ann Surg Oncol 2002; 9: 186–91.PubMedCrossRefGoogle Scholar
  21. 21.
    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 intraperitoneal chemotherapy. Cancer 1996; 77: 2622–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Sugarbaker PH. Pseudomyxoma peritonei syndrome. Adv Surg 1997; 30: 233–80.Google Scholar
  23. 23.
    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
  24. 24.
    Witkamp AJ, de Bree E, Kaag MM, van Slooten GW, van Coevorden, Zoetmulder FAN. Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg 2001; 88: 459–63.Google Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • Syed A. Ahmad
    • 1
    • 2
  • Joseph Kim
    • 1
  • Jeffrey J. Sussman
    • 1
  • Debbie A. Soldano
    • 1
  • Linda J. Pennington
    • 1
  • Laura E. James
    • 1
  • Andrew M. Lowy
    • 1
  1. 1.Department of Surgery, Division of Surgical OncologyUniversity of Cincinnati College of MedicineCincinnati
  2. 2.Division of Surgical Oncology, Department of SurgeryUniversity of Cincinnati College of MedicineCincinnati

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