Treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP). Postoperative complications and preliminary survival data

Background: 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. This study was aimed at evaluating our experience with special reference to morbid-mortality. Methods: Sixty-five patients with PC from abdominal neoplasms underwent 67 treatments using this technique from January 2000 to April 2006. Surgical debulking, completed by partial or total peritonectomy, was performed in most of the cases. IHCP was performed in 17 patients with positive peritoneal cytology without macroscopic peritoneal disease in order to prevent peritoneal recurrence. IHCP was carried out using a closed abdomen technique for 60 minutes; intra-abdominal temperature ranged between 41°C and 43°C; mitomycin C (25 mg/m2) and cisplatin (100 mg/m2) were the anticancer drugs generally used, and they were administered with a flow rate of 700-800 ml/min. Results: Mean duration of surgery was 7.8 ± 2.6 hours (range 3-18) and mean hospital stay was 13 ± 7 days (range 7-49). Postoperative complications occurred in 30 patients (45%); of these, major morbidity was observed in 18 cases (27%). The most frequent complications were wound infection (9 cases), grade-2 or more hematological toxicity (7 cases), intestinal fistula (6 cases) and pleural effusion requiring drainage (5 cases). Reoperation was necessary in 6 patients (9%). One patient with multiorgan failure died in the postoperative period (mortality rate: 1.5%). Multivariate analysis of several variables identified completeness of cancer resection (CCR-2/3 vs CCR-0/1, relative risk: 9) and age (relative risk: 1.1 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. Conclusions. With careful patient selection and adequate peri- and post-operative care, cytoreductive surgery and IHCP may be performed with an acceptable risk of morbidity and mortality. Completeness of cancerresection and age resulted to be independent predictors of postoperative morbidity.