Cytoreductive surgery with limited or extended peritonectomy associated with intraperitoneal hyperthermic chemoperfusion (IHCP) has been proposed for treatment of peritoneal carcinomatosis (PC) from abdominal neoplasms.
Fifty-nine patients with PC from abdominal neoplasms underwent 61 treatments using this technique from January 2000 to August 2005. Surgical debulking, completed by partial or total peritonectomy, was performed in most cases. In 16 patients with positive peritoneal cytology without macroscopic peritoneal disease, IHCP was performed in order to prevent peritoneal recurrence. IHCP was carried out throughout the abdominopelvic cavity for 60 minutes using a closed abdomen technique. Intra-abdominal temperature ranged between 41 degrees C and 43 degrees C; mitomycin C (25 mg/mq) and cisplatin (100 mg/mq) were the anticancer drugs generally used, and they were administered with a flow rate of 700-800 ml/minute.
Mean hospital stay was 13 +/- 7 (range 7-49) days. Postoperative complications occurred in 27 patients (44.3%); of these, major morbidity was observed in 17 (27.9%). The most frequent complications were wound infection (9 cases), grade 2 or greater hematological toxicity (5 cases), intestinal fistula (5 cases), and pleural effusion requiring drainage (5 cases). Reoperation was necessary in 5 patients (8.2%). One patient with multiorgan failure died in the postoperative period (mortality rate: 1.6%). Multivariate analysis of several variables identified completeness of cancer resection (CCR-2/3 vs. CCR-0/1, relative risk: 9.27) and age (relative risk: 1.06 per year) as independent predictors of postoperative morbidity. Preliminary follow-up data indicate that survival probability may be high in patients with ovarian or colorectal cancer and low in patients with gastric cancer.
IHCP combined with cytoreductive surgery involves a high risk of morbidity, but postoperative complications could be resolved favorably in most cases with correct patient selection and adequate postoperative care. Tumor residual and advanced age significantly increase the risk of morbidity after this procedure.
"Currently, at the intraoperative abdominal examination, peritoneal seeding is found in 10–20% of patients scheduled for potentially curative resection and in 40% of those at stage II-III [15, 18, 19]; 20–50% of patients treated with radical surgery will develop postoperatory peritoneal recurrence , and intraperitoneal spread of tumour cells is observed in 54% of patients who died of recurrence after surgery in advanced GC . "
[Show abstract][Hide abstract] ABSTRACT: Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death in the world; 53-60% of patients show disease progression and die of peritoneal carcinomatosis (PC). PC of gastric origin has an extremely inauspicious prognosis with a median survival estimate at 1-3 months. Different studies presented contrasting data about survival rates; however, all agreed with the necessity of a complete cytoreduction to improve survival. Hyperthermic intraperitoneal chemotherapy (HIPEC) has an adjuvant role in preventing peritoneal recurrences. A multidisciplinary approach should be empowered: the association of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), cytoreductive surgery (CRS), HIPEC, and early postoperative intraperitoneal chemotherapy (EPIC) could increase the rate of completeness of cytoreduction (CC) and consequently survival rates, especially in patients with Peritoneal Cancer Index (PCI) ≤6. Neoadjuvant chemotherapy may improve survival also in PC from GC and adjuvant chemotherapy could prevent recurrence. In the last decade an interesting new drug, called Catumaxomab, has been developed in Germany. Two studies showed that this drug seems to improve progression-free survival in patients with GC; however, final results for both studies have still to be published.
International Journal of Surgical Oncology 02/2014; 2014:912418. DOI:10.1155/2014/912418
[Show abstract][Hide abstract] ABSTRACT: A peritoneal surface malignancy is one of an assortment of tumors that result in widespread peritoneal involvement, can affect multiple organs, and may arise from the appendix, colon, rectum, stomach, ovaries, or peritoneal lining. The combined treatment modality of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has gained recognition as a promising, potentially life-extending surgical treatment option for the management of peritoneal surface malignancies. This type of surgical treatment is not without risks and complications, often resulting in the formation of fistulas and the need for a diverting ostomy. This article presents a review of peritoneal surface malignancies, cytoreductive surgery, the perioperative management of the surgical patient with focus on complications and implications for the WOC nurse providing care for patients undergoing this complex surgical treatment.
Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 07/2010; 37(4):379-85. DOI:10.1097/WON.0b013e3181e399fe · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article is to offer a concise review on the use of cytoreductive surgery (CRS) plus intraperitoneal hyperthermic chemotherapy (IPHC) for the treatment of peritoneal carcinomatosis (PC). Traditionally, PC was treated with systemic chemotherapy alone with very poor response and a median survival of less than 6 mo. With the establishment of several phase II studies, a new trend has been developed toward the use of CRS plus IPHC as a standard method for treating selected patients with PC, in whom sufficient cytoreduction could be achieved. In spite of the need for more high quality phase III studies, there is now a consensus among many surgical oncology experts throughout the world about the use of this new treatment strategy as standard care for colorectal cancer patients with PC. This review summarizes the current status and possible progress in future.
World Journal of Gastroenterology 03/2008; 14(8):1159-66. · 2.37 Impact Factor
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