Treatment of the peritoneal carcinomatosis by cytoreductive surgery and Intraperitoneal Hyperthermic Chemotherapy (IHPC): Postoperative morbidity and mortality and short-term follow-up.

Abstract

BACKGROUND: In order to treat the peritoneal carcinomatosis from abdominal neoplasms has been recently proposed complete peritonectomy associated with IntraPeritoneal Hyperthermic Chemotherapy (IHPC).

AIM OF THE STUDY: Estimate of postoperative morbidity and mortality and short-term outcome.

METHODS: Twenty-four patients with peritoneal carcinomatosis or positive cytology at peritoneal washing were treated in our Department from January 2005 to October 2007. Primary tumor was ovarian carcinoma in ten patients: four cases presented peritoneal surface malignancies (PSM) after any time from hysteroadnexectomy related to primary tumor, six cases synchronous PSM. Primary tumor was gastric cancer in seven patients: the peritoneal washing was positive in four cases and, during follow-up period after gastrectomy, other two cases presented PSM. One patient was previously treated with ovariectomy for ovaric mass that resulted a Krukenberg’s tumor of gastric cancer. Primary tumor was pseudomixoma peritonei in four patients; cytoreductive surgery and IHPC was carried as first line therapy in only one patient. Three patients were previously treated for colon carcinoma. IHPC was carried out through abdominopelvic cavity for 60 minutes using a closed abdomen technique. The drugs used were Mitomycin C (3.3 mg/m2/L) and Cisplatin (25 mg/m2/L). The intracavitary mean temperature was 41.8°C.

RESULTS: The mean Peritoneal Cancer Index (PCI) was 14. Postoperative major complications occurred in 7 cases (28%), postoperative minor complications occurred in 8 cases (32%). No patients died in the postoperative period. Mean hospital staying was 11,5 days ( 6-35 days). After a median follow-up of 8 months (range 2-34), 14 (58%) patients are alive and 13 are disease free.

CONCLUSIONS: Our experience is consistent with other studies for the high rate of postoperative morbidity associated with treatment, but we achieved best results on mortality and post-operative staying. CRS associated with IHPC is a good therapeutic option especially in ovaric-related carcinosis and PMP. It’ s still debated whether it could be useful or not in colorectal related carcinosis, whereas there is a general agreement in the un uselessness of this technique in gastric cancer.