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Erschienen in:
01.05.2014 | Original Article
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Outcomes from a Single Tertiary Institution
Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 5/2014
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Background
Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) is an effective but morbid procedure in the treatment of peritoneal carcinomatosis. We report our outcomes at a single tertiary institution.
Method
A total of 170 consecutive patients underwent CRS-HIPEC for peritoneal carcinomatosis between July 2007 and August 2012. The peritoneal cancer index (1–39) was used for peritoneal carcinomatosis (PC) staging. Mitomycin C (88.8 %) was administered intraperitoneally at 42 °C for 90 mins. Risk factors associated with major morbidities were analyzed. The Kaplan-Meier method was used for survival analyses.
Results
The mean age was 55.1 (±11.3) years, and the majority (77.1 %) of patients had complete cytoreduction (CC0-1). Tumor types included colorectal (n = 51, 30.0 %), appendiceal (n = 50, 29.4 %), pseudomyxoma peritonei (n = 16, 9.4 %), and other (n = 53, 31.2 %). Factors associated with major complications were estimated blood loss (>400 ml), length of stay (>1 week), intraoperative blood transfusion, operative time (>6 h), and bowel anastomosis. Intraoperative blood transfusion was the only independent prognostic factor on multivariate analysis (p = 0.031). Median follow-up was 15.7 months (±1.2). The recurrence rates for colorectal and appendiceal carcinoma at 1 and 3 years were 40 %, 53.5 % and 68 %, 79.1 %, respectively. The 1- and 3-year overall survival for colorectal and appendiceal carcinomatosis was 74.0 %, 32.5 % and 89.4 %, 29.3 %, respectively. Intraoperative peritoneal cancer index (PCI) score (>16) and need for blood transfusion were factors independently associated with poor survival (p < 0.05).
Conclusion
Our single institution experience of CRS/HIPEC procedures for peritoneal carcinomatosis demonstrates acceptable perioperative outcome and long-term survival. Optimal cytoreduction was achieved in the majority of cases. Intraoperative PCI > 16 was associated with poor survival. This series supports the safety of CRS-HIPEC in selected patients.