Modified selection criteria for complete cytoreductive surgery plus HIPEC based on peritoneal cancer index and small bowel involvement for peritoneal carcinomatosis of colorectal origin

2014 ◽  
Vol 40 (11) ◽  
pp. 1467-1473 ◽  
Author(s):  
D. Elias ◽  
A. Mariani ◽  
A.-S. Cloutier ◽  
F. Blot ◽  
D. Goéré ◽  
...  
Keyword(s):  
Small Bowel ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Selection Criteria ◽  
Peritoneal Cancer Index ◽  
Peritoneal Cancer ◽  
Bowel Involvement ◽  
Colorectal Origin

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Peritoneal Carcinomatosis: Initial Experience in Oaxaca, Mexico

2012 ◽  
Vol 78 (9) ◽  
pp. 942-946 ◽  
Author(s):  
Rolando GarcÍA-Matus ◽  
Carlos Alberto HernÁNdez-HernÁNdez ◽  
Omar Leyva-GarcÍA ◽  
Sergio Vásquez-Ciriaco ◽  
Guillermo Flores-Ayala ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Recurrent Ovarian Cancer ◽  
Initial Experience ◽  
Peritoneal Cancer ◽  
Duration Of Surgery ◽  
Crs And Hipec

Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multi-modality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at “Hospital Regional de Alta Especialidad de Oaxaca,” Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.

scholarly journals Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis Secondary to Mucinous Adenocarcinoma of the Appendix

2015 ◽  
Vol 100 (1) ◽  
pp. 21-28 ◽  
Author(s):  
David S. Sparks ◽  
Bradley Morris ◽  
Wen Xu ◽  
Jessica Fulton ◽  
Victoria Atkinson ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Disease Free Survival ◽  
Effective Treatment Option ◽  
Peritoneal Cancer ◽  
Heated Intraperitoneal Chemotherapy ◽  
Retrospective Clinical Study ◽  
Grade 3

Abstract Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a radical but effective treatment option for select peritoneal malignancies. We sought to determine our early experience with this method for peritoneal carcinomatosis secondary to mucinous adenocarcinomas of appendiceal origin. As such, we performed a retrospective clinical study of 30 consecutive patients undergoing CRS with planned HIPEC at the Princess Alexandra Hospital, between June 2009 to December 2012, with mucinous adenocarcinomas of the appendix. CRS was performed in 30 patients, 13 received HIPEC intraoperatively and 17 received early postoperative intra-peritoneal chemotherapy (EPIC) in addition. Mean age was 52.3 years and median hospital stay was 26 days (range 12–190 days). Peritoneal cancer index scores were 0–10 in 6.7% of patients, 11–20 in 20% of patients and >20 in 73.3% of patients. Complete cytoreduction was achieved overall in 21 patients. In total, 106 complications were observed in 28 patients. Ten were grade 3-A, five were grade 3-B and one grade-5 secondary to a fatal PE on day 97. In patients who received HIPEC, there was no difference in disease-free survival (P = 0.098) or overall survival (P = 0.645) between those who received EPIC versus those who did not. This study demonstrates that satisfactory outcomes with regards to morbidity and survival can be achieved with CRS and HIPEC, at a single-centre institution with growing expertise in the technique. Our results are comparable with outcomes previously described in the international literature.

scholarly journals Prognostic Factors of Peritoneal Metastases from Colorectal Cancer following Cytoreductive Surgery and Perioperative Chemotherapy

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Yutaka Yonemura ◽  
Emel Canbay ◽  
Haruaki Ishibashi
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Complete Cytoreduction ◽  
Perioperative Chemotherapy ◽  
Peritoneal Cancer ◽  
Colorectal Origin ◽  
Grade 3 ◽  
Cox Hazard Model

Background. Prolonged survival of patients affected by peritoneal metastasis (PM) of colorectal origin treated with complete cytoreduction followed by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) has been reported. However, two-thirds of the patients after complete cytoreduction and perioperative chemotherapy (POC) develop recurrence. This study is to analyze the prognostic factors of PM from colorectal cancer following the treatment with cytoreductive surgery (CRS) + POC.Patients and Methods. During the last 8 years, 142 patients with PM of colorectal origin have been treated with CRS and perioperative chemotherapy. The surgical resections consisted of a combination of peritonectomy procedures.Results. Complete cytoreduction (CCR-0) was achieved at a higher rate in patients with peritoneal cancer index (PCI) score less than 10 (94.7%, 71/75) than those of PCI score above 11 (40.2%, 37/67). Regarding the PCI of small bowel (SB-PCI), 89 of 94 (91.5%) patients with ≤2 and 22 of 48 (45.8%) patients with SB-PCI ≥ 3 received CCR-0 resection (P<0.001). Postoperative Grade 3 and Grade 4 complications occurred in 11 (7.7%) and 14 (9.9%). The overall operative mortality rate was 0.7% (1/142). Cox hazard model showed that CCR-0, SB-PCI ≤ 2, differentiated carcinoma, and PCI ≤ 10 were the independent favorite prognostic factors.Conclusions. Complete cytoreduction, PCI, SB-PCI threshold, and histologic type were the independent prognostic factors.

Selection Criteria for Complete Cytoreduction after Cytoreductive Surgery for Peritoneal Surface Malignancy: Lessons Learned from Our First Series of Patients

2011 ◽  
Vol 77 (4) ◽  
pp. 430-437
Author(s):  
Shaun Mckenzie ◽  
Avo Artinyan ◽  
Alicia D. Holt ◽  
Julio Garcia-Aguilar ◽  
Joshua Ellenhorn ◽  
...  
Keyword(s):  
Small Bowel ◽  
Cytoreductive Surgery ◽  
Selection Criteria ◽  
Peritoneal Cancer Index ◽  
Univariate Analysis ◽  
Lessons Learned ◽  
Complete Cytoreduction ◽  
Peritoneal Surface Malignancy ◽  
Peritoneal Surface ◽  
Incomplete Cytoreduction

The appropriate selection criteria for complete cytoreduction in patients with peritoneal surface malignancies have not been determined. We performed a retrospective analysis of all patients receiving cytoreductive surgery (CRS) during the study period of 2004 to 2008 to determine appropriate selection criteria for successful complete cytoreduction. During the study period, 38 patients underwent attempted CRS. Cytoreduction was scored complete, incomplete, or not reported in 53 per cent (n = 20), 37 per cent (n = 14), and 11 per cent (n = 4), respectively. Median overall survival for compete and incomplete cytoreduction was 56 months versus 5 months ( P = 0.011), respectively. Compared with incomplete cytoreduction, patients receiving complete cytoreduction were more likely to have a lower Peritoneal Cancer Index (PCI) and not have received preoperative systemic chemotherapy (CT). Univariate analysis verified PCI greater than 20 (hazard ratio [HR], 0.048; CI, 0.004 to 0.515; P = 0.01) and CT (HR, 0.17; 0.004 to 0.77; P = 0.021) as predictors of incomplete cytoreduction. Small bowel (100%), periportal region (33%), and mesentery (27%) were the most common sites of residual disease. In conclusion, PCI less than 20 and the need for preoperative chemotherapy should be strongly considered when selecting patients with peritoneal surface malignancy for attempted cytoreduction. Early evaluation of the small bowel, mesentery, and periportal region for resectability prevents unnecessary surgery.

Influence of bevacizumab on early postoperative complications after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal origin.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 601-601
Author(s):  
Clarisse Eveno ◽  
Olivier Glehen ◽  
Diane Goéré ◽  
Anne-Claire Lukaszewicz ◽  
Guillaume Passot ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Complete Cytoreduction ◽  
Preoperative Treatment ◽  
Delayed Healing ◽  
Colorectal Origin

601 Background: Increasingly patients with IV stage colorectal cancer received systemic chemotherapy combined with targeted therapy among which bevacizumab. In neoadjuvant situation, a delay of at least 6 weeks between discontinuation of bevacizumab and surgery is recommended, not to increase the risk of complications (delayed healing, bleeding) related to bevacizumab. The goal of this study was to analyze the potential impact of bevacizumab on early morbidity after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal carcinomatosis of colorectal origin. Methods: From 2004 to 2010, in three hospitals, 183 patients treated with complete cytoreduction followed by HIPEC for colorectal carcinomatosis, received preoperative treatment. It was either systemic chemotherapy alone (Chemo group, n = 100) or by chemotherapy combined with bevacizumab (Beva group, n = 83). Results: Both patient groups were comparable in the extent of carcinomatosis, assessed on peritoneal cancer index means (10.4 vs 10, p> 0.05), number of resected organs (4.3 vs 3.8, p> 0.05), operative time (420 vs. 380 minutes, p> 0.05) and volume of blood loss (470 vs 510ml, p> 0.05). The median time from discontinuation of bevacizumab and HIPEC was 7 weeks (6-10), always greater than 6 weeks. Nine patients postoperatively died, 4 (4%) in the chemo group and 5 (6%) in the beva group (ns). Grade 3 to 5 complication rate was higher in the beva group (25 vs 12%, p <0.05). Whatever the hospital, complications that may be related to bevacizumab occurred more frequently in patients in the beva group: with more digestive fistulas (18 vs 8%, p <0.05), deep abscesses (13 vs 3 %, p <0.01) and delayed healing (11 vs 2%, p <0.02). Conclusions: Administration of bevacizumab before surgery with complete cytoreduction followed by HIPEC for carcinomatosis colorectal is associated with increased morbidity, probably due to multiple organ resections performed during the surgery. The oncologic benefit of bevacizumab before HIPEC remains to be evaluated.

scholarly journals Accuracy of radiologic– laparoscopic peritoneal carcinomatosis categorization in the prediction of surgical outcome

2019 ◽  
Vol 92 (1100) ◽  
pp. 20190163 ◽  
Author(s):  
Shimaa Abdalla Ahmed ◽  
Hisham Abou-Taleb ◽  
Noha Ali ◽  
Dalia M. Badary
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Predictive Value ◽  
Peritoneal Cancer Index ◽  
Characteristic Curve ◽  
Optimal Cytoreduction ◽  
Debulking Surgery ◽  
Peritoneal Cancer ◽  
Interval Debulking Surgery ◽  
The Impact

Objective: To evaluate the agreement between multiple detector CT (MDCT) and laparoscopy in the preoperative categorization of peritoneal carcinomatosis, and to determine the impact of this categorization on the prediction of cytoreduction status. Methods: This prospective study included 80 consecutive females with primary ovarian cancer eligible for cytoreductive surgery (CRS). MDCT and diagnostic laparoscopy were performed prior to surgery for assessment of peritoneal carcinomatosis extent. Based on PCI (peritoneal cancer index) score, carcinomatosis was categorized into three groups. Categorization agreement between CT and laparoscopy was assessed and compared with the intraoperative-histopathologically proven PCI. Impact of PCI categorization on cytoreduction status was also evaluated. Results: The overall agreement between CT and laparoscopy in preoperative peritoneal carcinomatosis categorization was good (K =0.71-0.79) in low category group and excellent in both moderate and large group (interclass correlation coeeficient = 0.89–0.91). (p<0.01) Optimal cytoreduction was achieved in 62/80 (77.5%) patients, PCI < 20 was detected in 48/62 (77.4%), pre-operative PCI < 20 correctly predicted optimal cytoreductive surgery (OCS) in 40/48 (83.3%) cases. Suboptimal cytoreduction was performed in 18/80 (22.5%) patients. PCI > 20 was detected in (10/18) 55.6%, preoperative CT and laparoscopy PCI > 20 correctly predicted SCS in 8/10 (80%) cases. The area under receiver operating characteristic curve showed that PCI cut-off <20 was the best predictor of OCS with an accuracy 85%, sensitivity 97%, specificity 40%, negative predictive value 76%, and positive predictive value 93%. Conclusion: Both laparoscopy and CT are equally effective in pre-operative peritoneal carcinomatosis categorization. PCI < 20 is accurate in the prediction of optimal cytoreduction. More than half of patients with suboptimal cytoreduction had PCI > 20 and interval debulking surgery can be recommended. Advances in knowledge: Both laparoscopy and CT are equally effective in pre-operative peritoneal carcinomatosis categorization. PCI < 20 is accurate in the prediction of optimal cytoreduction. More than half of patients with suboptimal cytoreduction had PCI > 20 and interval debulking surgery can be recommended.

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