Cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis from pseudomyxoma peritonei

AIM: To investigate the most important aspects of hyperthermic intraperitoneal chemotherapy (HIPEC) that has been accepted as the standard treatment for pseudomyxoma peritonei (PMP), with special regard to morbidity, overall survival (OS) and disease free survival (DFS) over 10 years

Chirurgia citoriduttiva associata a chemioterapia intraperitoneale in ipertermia (HIPEC) nel trattamento della carcinosi peritoneale di origine colorettale

Purpose:To confirm the findings from international literature that aggressive cytoreduction in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is superior to standard treatment in patients with peritoneal carcinomatosis of colorectal cancer origin. Patients and Methods: From October 1996 to March 2009, 411operations for Peritoneal carcinomatosis (PC) were performed; in 232 cases cytoreduction plus HIPEC, was carried out. 72 operations for carcinosis of colorectal origin were perfomed: 44 cytoreduction plus HIPEC, 12 cytoreduction+EPIC (early postoperative intraperitoneal chemotherapy) and 16 debulking or explorative laparoscopies/laparotomies were performed. For the present study we considered only the 44 patients with PC of colorectal origin that were treated with citoreductive surgery, peritonectomy and HIPEC with semi-closed abdomen technique. Results: Morbidity rate was 31.8%; reintervention was necessary in 6 cases. Perioperative mortality was 2.2%. At univariate analysis, residual nodules larger than 2.5 mm (CCR-2) (P = 0.013) and Peritoneal Cancer Index (PCI) >16 (P=0.033) were associated with a higher incidence of postoperative complications. In our experience the patients treated with Oxaliplatin and with PCI<16 show an acceptable result with a median survival time of 27 months.Conclusion: Cytoreduction followed by HIPEC improves survival in patients with peritoneal carcinomatosis of colorectal origin. The correct patient selection reduce morbidity and mortality. Completeness of citoreduction (CCR) has proven to be the most important prognostic factor predictive of survival also in our experience

Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy used as treatment of colo-rectal carcinomatosis: a multicentric study

The aim of this study is to assess the morbidity and mortality related to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colo-rectal carcinomatosis. A retrospective multi-institutional study from seven Italian Centers was performed. One hundred and seventy-two patients, submitted to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) to treat carcinomatosis of colorectal origin, were recorded. Postoperative morbidity was evaluated in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Post-operative mortality was evaluated as patients' death within 60 days from surgical procedures. Predictors of morbidity were evaluated with univariate and multivariate analyses. Post-operative morbidity occurred in 83 patients (48.3%): grades 1-2 in 29 cases (16.9%), and grades 3-4 in 54 (31.4%). Mortality occurred in four cases (2.3%). Number of anastomoses (OR 1.45; 95% CI 1.05-2.00; p = 0.024), number of blood transfusions (OR 1.31; 95% CI 1.11-1.54; p = 0.001) and chemotherapy regimen [Oxaliplatin (OX): OR 2.87; 95% CI 1.22-6.75; p = 0.015] remained, in multivariate analysis, in a statistically significant correlation with overall morbidity. The only variable that was proven to have statistically significant correlation with 3-4 morbidity was the number of blood transfusions (OR 1.25; 95% CI 1.07-1.46; p = 0.005). Morbidity and mortality do not preclude the use of CRS plus HIPEC in the treatment of peritoneal carcinomatosis of colorectal origin

Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: preliminary analysis of a multicentre study

19nononeAim: To assess the incidence of morbidity and mortality of Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy. Patients and Methods: A retrospective multicentric study was performed. Six hundred and eighty-three patients were recorded. Predictors of morbidity and mortality were evaluated with univariate and multivariate analysis. Results: In univariate analysis, older age, Eastern Cooperative Oncology Group score, a greater value of Peritoneal Cancer Index (PCI) and sub-optimal cytoreduction were correlated with higher mortality, while older age, presence of ascites, ovarian origin of carcinomatosis, closed technique, a greater value of PCI, longer operative time and sub-optimal cytoreduction were predictors of higher morbidity. In multivariate analysis, older age and a greater value of PCI were correlated with higher mortality; older age, ovarian origin of tumor, presence of ascites, closed technique and longer operative time were predictors of higher morbidity. Conclusion: Careful patient selection has to be performed to improve clinical outcomes.mixedMacrì, Antonio; Arcoraci, Vincenzo; Belgrano, Valerio; Caldana, Marina; Cioppa, Tommaso; Costantini, Barbara; Cucinotta, Eugenio; De Cian, Franco; De Iaco, Pierandrea; De Manzoni, Giovanni; Di Giorgio, Angelo; Fleres, Francesco; Muffatti, Francesca; Orsenigo, Elena; Pinna, Antonio Daniele; Roviello, Franco; Sammartino, Paolo; Scambia, Giovanni; Saladino, EdoardoMacrì, Antonio; Arcoraci, Vincenzo; Belgrano, Valerio; Caldana, Marina; Cioppa, Tommaso; Costantini, Barbara; Cucinotta, Eugenio; De Cian, Franco; De Iaco, Pierandrea; De Manzoni, Giovanni; Di Giorgio, Angelo; Fleres, Francesco; Muffatti, Francesca; Orsenigo, Elena; Pinna, Antonio Daniele; Roviello, Franco; Sammartino, Paolo; Scambia, Giovanni; Saladino, Edoard

Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: preliminary analysis of a multicentre study

Aim: To assess the incidence of morbidity and mortality of Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy. Patients and Methods: A retrospective multicentric study was performed. Six hundred and eighty-three patients were recorded. Predictors of morbidity and mortality were evaluated with univariate and multivariate analysis. Results: In univariate analysis, older age, Eastern Cooperative Oncology Group score, a greater value of Peritoneal Cancer Index (PCI) and sub-optimal cytoreduction were correlated with higher mortality, while older age, presence of ascites, ovarian origin of carcinomatosis, closed technique, a greater value of PCI, longer operative time and sub-optimal cytoreduction were predictors of higher morbidity. In multivariate analysis, older age and a greater value of PCI were correlated with higher mortality; older age, ovarian origin of tumor, presence of ascites, closed technique and longer operative time were predictors of higher morbidity. Conclusion: Careful patient selection has to be performed to improve clinical outcomes