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.

Bevacizumab before cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal origin: Analysis of early postoperative complication rate and long term follow-up.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3642-3642
Author(s):  
Clarisse Eveno ◽  
Guillaume Passot ◽  
Diane Goéré ◽  
Philippe Soyer ◽  
Etienne Gayat ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Disease Free Survival ◽  
Complete Cytoreduction ◽  
Control Group ◽  
Major Morbidity ◽  
Colorectal Origin

3642 Background: Patients with stage IV colorectal cancer and peritoneal carcinomatosis are increasingly treated with curative intent and perioperative systemic chemotherapy combined with targeted therapy.The aim of the study was to analyze the potential impact of bevacizumab on early morbidity and survival after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal carcinomatosis of colorectal origin. Methods: From 2004 to 2010, in three referral centers, 182 patients with colorectal carcinomatosis were treated with complete cytoreduction followed by HIPEC after either preoperative systemic chemotherapy alone or in combination with bevacizumab. Because there was no control on treatment allocation, propensity score methods were used to control this bias. Results: The median time from discontinuation of bevacizumab to HIPEC was 7 weeks (range, 6-10). Major morbidity was greater in the Beva group (34 vs. 19%, p=0.020). Nine patients died postoperatively: 5 (6.2%) in the Beva group (n=80) and 4 (3.9%) in the group treated with chemotherapy alone (n=102) (p=NS). The rate of digestive fistulas was greater in the Beva group, although not significant (18 vs. 10%, p=NS). After matching, the effect of Bevacizumab on major morbidity (including death) was found to be significant (OR = 2.28, 95% CI; 1.05 - 4.95) (p=0.04). No difference in median of overall and disease free survival was found between the two groups (12 and 36 month in Beva group vs. 14.3 and 49 month in the control group, p=NS). Conclusions: Administration of bevacizumab before surgery with complete cytoreduction followed by HIPEC for colorectal carcinomatosis is associated with 2-fold increased morbidity. The oncologic benefit of bevacizumab before HIPEC remains to be evaluated with prospective randomized study.

scholarly journals Gastric cancer: modern approaches and prospects of treatment for peritoneal carcinomatosis (literature review)

2022 ◽  
Vol 20 (6) ◽  
pp. 104-113
Author(s):  
V. A. Markovich ◽  
S. A. Tuzikov ◽  
E. O. Rodionov ◽  
N. V. Litvyakov ◽  
N. O. Popova ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Antitumor Agents ◽  
Peritoneal Cancer Index ◽  
Abdominal Cavity ◽  
Cochrane Library

Gastric cancer (gc) is one of the most common cancers worldwide. The majority of newly diagnosed gastric cancer cases present with distant metastases. Peritoneal carcinomatosis (pc) is the most unfavorable type of progression of primary gc, which occurs in 14–43 % of patients. The purpose of the study was to highlight modern approaches to the treatment of gc with pc. Material and methods. We analyzed 136 publications available from pubmed, medline, cochrane library, and elibrary databases. The final analysis included 46 studies that met the specified parameters. Results. The modern approaches to the treatment of gc with peritoneal carcinomatosis were reviewed, namely: cytoreductive surgery (crs), combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (crs/hipec); neoadjuvant intraperitoneal/systemic chemotherapy (nips) and pressurized intraperitoneal aerosol chemotherapy (pipac). The results of large randomized trials and meta-analyses were analyzed. Benefits and limitations of these trials were assessed. Conclusion. The peritoneal cancer index (pci) and the level of cytoreduction are two key prognostic factors for increasing the median overall survival. By reducing tumor volume through cytoreductive surgery, it is possible to allow tumor cells to re-enter the proliferative phase of the cell cycle and make them more sensitive to antitumor agents. The hematoperitoneal barrier is the main reason that prevents the effective delivery of drugs from the systemic bloodstream to the abdominal cavity, which is why the effect of systemic chemotherapy on peritoneal metastases is extremely limited. Intraperitoneal chemotherapy offers a more effective and intensive regional therapy, creating a so-called «depot» of a chemotherapy drug, thereby prolonging the effect of the administered drugs. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (crs + hipec) using the combination of surgical resection, cytotoxic chemotherapy, hyperthermic ablation of the tumor and hydrodynamic flushing, is a promising approach in the treatment of gc with peritoneal carcinomatosis.

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 RESULTS OF HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY AND CYTOREDUCTIVE SURGERY FOR PERITONEAL CARCINOMATOSIS OF COLORECTAL ORIGIN

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
M Merayo Alvarez ◽  
E Turienzo Santos ◽  
M García Munar ◽  
I Cifrián Canales ◽  
J L Rodicio Miravalles ◽  
...  
Keyword(s):  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Descriptive Analysis ◽  
Disease Free Interval ◽  
Free Interval ◽  
Colorectal Origin ◽  
Disease Free

Abstract INTRODUCTION Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is supported by clinical practice and published series as a fundamental treatment for increasing survival of selected patients with colorectal peritoneal carcinomatosis. The results were evaluated since having implemented a peritoneal oncological surgery program five years ago. MATERIAL AND METHODS Descriptive analysis was conducted to patients who had been diagnosed with peritoneal carcinomatosis from May 2014 to December 2020. 36 out of 100 patients who had undergone surgery were included in the CRS and HIPEC assessment and 6 patients without HIPEC, were excluded. RESULTS The mean preoperative PCI was 7.81±6.61 accomplishing complete cytoreduction CC 0-CC-1 in the 36 cases. An average of 1.86±1.22 peritonectomies were performed. Among procedures, complete pelviperitonectomy (11 patients) and liver metastasis resection (6 patients) should be noticed. Complications were presented in 16 patients (8 patients over Clavien Dindo&gt;III) and 6 required reinterventions due to hematoma (2) or anastomotic leak (2) mostly. The 4-year overall survival is 76.2% and the disease-free interval is 34 months within an average follow-up of 23 months. CONCLUSIONS The overall survival and disease-free interval rates are above the standards. Currently, peritoneal carcinomatosis might be considered a curative disease. The multidisciplinary assessment allows selecting patients who will benefit from surgery.

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