Skip to main content

Advertisement

SpringerLink
Log in

Morbidity and Mortality of 109 Consecutive Cytoreductive Procedures with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Performed at a Community Hospital

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is playing an increasing role in the management of isolated peritoneal dissemination of gastrointestinal malignancies. Historically this surgery is associated with a high morbidity and mortality. Recognizing this, our study was developed to prospectively evaluate morbidity and mortality after cytoreductive surgery with HIPEC performed at a community hospital.

Methods

From January 19, 2005 to January 9, 2008, 109 consecutive patients successfully underwent cytoreductive surgery with HIPEC for peritoneal surface malignancies. All cases were performed by a single surgeon at a 323-bed community hospital. Using an institutional review board approved study we prospectively evaluated postoperative complications using the standard National Institutes of Health morbidity and mortality grading system.

Results

There was no 30-day or inpatient mortality. Overall grade III and IV morbidity was 30.2% (33 of 109 patients); 29.3% of the patients had at least one grade III complication, with the most common being postoperative anemia requiring a blood transfusion in 20 of the 109 patients (18.3%). Eight patients (7.3%) had wound infections, and three patients (2.7%) developed pneumonia. One patient required computerized tomography guided drainage of a pelvic abscess. There were 3 (2.7%) grade IV complications, with only one patient requiring reoperation.

Conclusions

Recent studies at tertiary medical centers have shown acceptable morbidity and mortality with this procedure. Our study demonstrates that this procedure can be safely performed in the community setting as well if surgeons, other medical professionals, and ancillary caregivers have great experience in this procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Verwaal VJ, van Ruth S, de Bree E et al (2003) 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 21:3737–3743

    Article  PubMed  Google Scholar 

  2. Glehen O, Kwiatkowski F, Sugarbaker PH et al (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 22:3284–3292

    Article  CAS  PubMed  Google Scholar 

  3. 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  PubMed  Google Scholar 

  4. Esquivel J, Sticca R, Sugarbaker P et al (2007) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 14:128–133

    CAS  Google Scholar 

  5. Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374

    CAS  PubMed  Google Scholar 

  6. Elias D, Delperro JR, Sideris L et al (2004) Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol 11:518–521

    Article  PubMed  Google Scholar 

  7. Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42

    CAS  PubMed  Google Scholar 

  8. de Bree E, Koops W, Kroger R et al (2006) Preoperative computed tomography and selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 32:65–71

    Article  PubMed  Google Scholar 

  9. de Bree E, Koops W, Kroger R et al (2004) Peritoneal carcinomatosis from colorectal or appendiceal origin: correlation of preoperative CT with intraoperative findings and evaluation of interobserver agreement. J Surg Oncol 86:64–73

    Article  PubMed  Google Scholar 

  10. Spratt JS, Adcock RA, Muskovin M et al (1980) Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res 40:256–260

    CAS  PubMed  Google Scholar 

  11. Pelz JO, Stojadinovic A, Nissan A et al (2008) Evaluation of a peritoneal surface disease severity score in patients with colon cancer with peritoneal carcinomatosis. J Surg Oncol 99:9–15

    Article  Google Scholar 

  12. Elias D, Goere D, Blot F et al (2007) Optimization of hyperthermic intraperitoneal chemotherapy with oxaliplatin plus irinotecan at 43°C after compete cytoreductive surgery: mortality and morbidity in 106 consecutive patients. Ann Surg Oncol 14:1818–1824

    Article  PubMed  Google Scholar 

  13. Roviello F, Marrelli D, Neri A et al (2006) Treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP): postoperative outcome and risk factors for morbidity. World J Surg 30:2033–2040

    Article  PubMed  Google Scholar 

  14. Chua TC, Yan TD, Saxena A et al (2009) Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure?: a systematic review of morbidity and mortality. Ann Surg 249:900–907

    Article  PubMed  Google Scholar 

  15. Kusamura S, Younan R, Baratti D et al (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 106:1144–1153

    Article  PubMed  Google Scholar 

  16. Elias D, Blot F, El Otmany A et al (2001) Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 92:71–76

    Article  CAS  PubMed  Google Scholar 

  17. Glehen O, Osinsky D, Cotte E et al (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10:863–869

    Article  CAS  PubMed  Google Scholar 

  18. Schmidt U, Dahlke MH, Klempnauer J et al (2005) Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 31:53–58

    Article  CAS  PubMed  Google Scholar 

  19. Sugarbaker PH, Alderman R, Edwards G et al (2006) Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol 13:635–644

    Article  PubMed  Google Scholar 

  20. Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363

    Article  CAS  PubMed  Google Scholar 

  21. Miner TJ, Shia J, Jaques DP et al (2005) Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg 241:300–308

    Article  PubMed  Google Scholar 

  22. Deraco M, Baratti D, Inglese MG et al (2004) Peritonectomy and intraperitoneal hyperthermic perfusion (IPHP): a strategy that has confirmed its efficacy in patients with pseudomyxoma peritonei. Ann Surg Oncol 11:393–398

    Article  PubMed  Google Scholar 

  23. Shen P, Levine EA, Hall J et al (2003) Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis. Arch Surg 138:26–33

    Article  CAS  PubMed  Google Scholar 

  24. Smeenk RM, Verwaal VJ, Zoetmulder FA (2007) Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg 94:1408–1414

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Würzburg, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany

    Alexander G. Kerscher

  2. Department of Surgery, Saint Agnes Healthcare, 900 Caton Avenue, Baltimore, MD, 21229, USA

    Jared Mallalieu, Allison Pitroff, Friderike Kerscher & Jesus Esquivel

Authors
  1. Alexander G. Kerscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jared Mallalieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Allison Pitroff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Friderike Kerscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jesus Esquivel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jesus Esquivel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kerscher, A.G., Mallalieu, J., Pitroff, A. et al. Morbidity and Mortality of 109 Consecutive Cytoreductive Procedures with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Performed at a Community Hospital. World J Surg 34, 62–69 (2010). https://doi.org/10.1007/s00268-009-0281-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0281-2

Keywords

Search

Navigation