Predicting Postoperative Morbidity Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CS+HIPEC) with Preoperative FACT-C (Functional Assessment of Cancer Therapy) and Patient-Rated Performance Status

2013 ◽  
Vol 20 (11) ◽  
pp. 3519-3526 ◽  
Author(s):  
Chukwuemeka U. Ihemelandu ◽  
Richard McQuellon ◽  
Perry Shen ◽  
John H. Stewart ◽  
Konstantinos Votanopoulos ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Functional Assessment ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Performance Status ◽  
Rated Performance

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy for the Treatment of Recurrent Endometrial Carcinoma Confined to the Peritoneal Cavity

2010 ◽  
Vol 20 (5) ◽  
pp. 809-814 ◽  
Author(s):  
Naoual Bakrin ◽  
Eddy Cotte ◽  
Anne Sayag-Beaujard ◽  
Daniel Raudrant ◽  
Sylvie Isaac ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Peritoneal Cavity ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Therapeutic Option ◽  
Performance Status ◽  
Early Recurrence ◽  
Gynecology And Obstetrics ◽  
Initial Surgery

Our objective was to determine if cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a feasible therapeutic option for treatment of peritoneal recurrence of endometrial carcinoma. Between August 2002 and May 2007, 5 patients with recurrent endometrial carcinoma confined to the peritoneal cavity who underwent CRS with HIPEC. Cisplatin (1 mg/kg) and mitomycin C (0.7 mg/kg) were perfused at an inflow temperature of 46 to 48°C for 90 minutes under systemic hypothermia (32°C). Of the 5 patients treated, histopathological type and International Federation of Gynecology and Obstetrics stage were as follows: IB endometrioid (n = 1), IIIA endometrioid (n = 1), IIIC endometrioid (n = 2), and IC endometrioid + pseudosarcomatoid component (n = 1). The mean interval from initial surgery to CRS with HIPEC was 47.5 months (10-120 months). In all patients, CRS was complete. One patient with pseudosarcomatoid component developed recurrent disease 10 months after surgery and died 2 months later. One patient experienced early recurrence with a malignant pleural effusion and died. Three patients are alive and disease free at 7, 23, and 39 months from surgery with good performance status. Regarding the toxicity of the procedure, highly selected patients with recurrent endometrial carcinoma confined to the peritoneal cavity may benefit from improved survival after CRS with HIPEC.

scholarly journals Two-step cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei with high peritoneal carcinomatosis index

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Bertrand Trilling ◽  
Alexandre Brind’Amour ◽  
Raphael Hamad ◽  
Jean-Francois Tremblay ◽  
Pierre Dubé ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Pseudomyxoma Peritonei ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Low Grade ◽  
Peritoneal Carcinomatosis Index ◽  
Second Surgery ◽  
Very High

Abstract Background Complete cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the only curative treatment for pseudomyxoma peritonei (PMP) arising from the appendix. High peritoneal carcinomatosis index (PCI) is associated with an increased risk of surgical complications. The objective of this study was to present the results of a planned two-step surgical strategy to decrease postoperative morbidity and improve resectability of patients with very high PCI. Methods All consecutive patients who underwent a planned two-step surgical approach for PMP between January 2012 and March 2020 were retrospectively included. This approach was offered for patients with low-grade PMP with PCI > 28 for which feasibility of a complete CRS in one operation was uncertain. The first surgery included a complete CRS of the inframesocolic compartment and omentectomy. HIPEC was delivered at the second surgery, after complete CRS of the supramesocolic compartment. Postoperative morbidity was assessed using the Clavien-Dindo classification and survival results were also collected. Results Eight patients underwent the two-step approach. The median PCI was 33 (29–39) and the median time between the two procedures was 111 days (90–212 days). One patient was deemed unresectable at the second surgery. The rate of major morbidity was 0% for the first step and 25% for the second step, with no mortality. Median follow-up was 53.8 months (3–73 months). Conclusion A two-step surgical management for low-grade PMP patients with very high PCI is safe and feasible, with acceptable postoperative morbidity and no compromise on oncological outcomes.

Peritoneal carcinomatosis of colorectal origin: Impact of ovarian metastases.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 604-604
Author(s):  
Laurent Ghouti ◽  
Amandine Pinto ◽  
Sylvain Kirzin
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Ovarian Metastasis ◽  
Ovarian Metastases ◽  
Colorectal Origin ◽  
Grade Iii

604 Background: To compare survival and morbidity in women treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal carcinomatosis with or without ovarian metastases (OM). Methods: A prospectively maintained database was analyzed to identify women treated by CRS- HIPEC between 2009 and 2015. Results: Among 62 included women, 39 had ovarian metastasis (63%) with comparable PCI (10 vs. 7 p=0.15). OM patients experienced more frequent grade III/IV postoperative morbidity (56.4% vs. 30% p=0.04), and postoperative haemoperitoneum (23.1% vs 4.3% p=0.07) leading to more frequent reoperation (36 vs. 21.7% p=0.2). Among OM patients, 20 (52 %) had undergone ovariectomy previously to CRS-HIPEC procedure. Haemoperitoneum (30% vs 15% p=0.4) and reoperation (45% vs. 26% p=0.2) were more frequent if previous OM resection had been performed as compared to synchronous. The 36-month survival (94.7 % vs 61.7 %) was significantly impaired by OM (p=0.007) and 36- month survival without recurrence was better when ovariectomy was performed during CRS- HIPEC (24 % vs. 5.5%, p=0.4). Conclusions: Survival and morbidity of patients with CRS-HIPEC for colorectal peritoneal carcinomatosis were impaired by the presence of OM and previous OM resection.

scholarly journals Clinical features and surgical outcomes of major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotheraphy

2020 ◽  
Vol 12 ◽  
pp. 175628722097592
Author(s):  
Özgül Düzgün ◽  
Murat Kalın ◽  
Resul Sobay ◽  
Ömer Faruk Özkan
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Urinary System ◽  
Urological Procedures ◽  
The Mean ◽  
Grade 3

Background: Urinary system resections and reconstructions are needed in peritoneal carcinomatosis due to abdominal malignancies. The effect of hyperthermic intraperitoneal chemotherapy on these urological procedures after reconstruction remains uncertain. The aim of the study is to evaluate major urological interventions during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in complex abdominal malignancies with peritoneal carcinomatosis. Methods: Forty-four cases underwent surgical intervention related to the urinary system among 208 cases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy because of peritoneal carcinomatosis. Urinary system procedures performed in these patients (radical-partial cystectomy, partial ureter resection ureteroneocystostomy, ureteroureterostomy, nephrectomy) were evaluated in terms of postoperative morbidity–mortality and survival. Results: Urinary system resections were performed during cytoreductive surgery in a total of 44 cases. The mean age was 54 years (20–73). Patients were diagnosed with peritoneal carcinomatosis due to colorectal cancer in 21 (47.8%), ovarian cancer in nine (20.4%), sarcomatosis in five (11.4%), cervical cancer in four (9%) and other cancers (mesothelioma, uterus, breast, gastric) in five (11.4%) cases. Total nephrectomy was performed in three cases and partial nephrectomy in one case. Cystectomy was performed in 21 cases; 16 of these were partial and five were total cystectomies. Ureteroureterocystostomy with double J was performed in four cases and ureteroneocystostomy in 12 cases. While Clavian–Dindo grade 3–4 complications were seen in nine cases (20.4%), three cases (6.8%) became exitus during the first 30-day follow-up. Conclusions: Although urinary system involvements have been regarded as inoperable in the past, we think that with adequate experience radical urinary interventions performed in suitable patients can be carried out with acceptable morbidity and mortality as seen in our series.

scholarly journals Comparison of 2 Perioperative Management Protocols and Their Influence on Postoperative Recovery after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Standard Parenteral Nutrition, Selective Bowel Decontamination and Suprapubic Catheters?

2018 ◽  
Vol 36 (5) ◽  
pp. 394-401 ◽  
Author(s):  
Fortuné M.K. Elekonawo ◽  
Manon M.D. van der Meeren ◽  
Geert A. Simkens ◽  
Johannes H.W. de Wilt ◽  
Ignace H. de Hingh ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Perioperative Care ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Perioperative Management ◽  
Postoperative Recovery ◽  
Selective Decontamination ◽  
Significant Difference

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with considerable postoperative morbidity, including ileus and infectious complications. Perioperative care is believed to be an important factor for the development and treatment of postoperative morbidity. Patients and Methods: Data on case-matched patients from a retrospective database of 2 Dutch HIPEC centres was compared. Patient selection and procedures were identical in both hospitals although perioperative management items differ slightly. In centre B, immediate total parenteral nutrition (TPN), suprapubic urine bladder catheter placement (SPCs) and selective decontamination of the digestive-tract are standard care for CRS-HIPEC patients, while in centre A, they are not. Results: From a total of 223 patients, 68 consecutive patients from centre B were compared to 68 matched patients from centre A. TPN was administered to 54.4% of patients in centre A because of prolonged ileus, whereas it was standard of care in centre B. In all, 105 (77.2%) patients experienced postoperative complications including 17.6% who had a grades III–IV complication. The incidence of grade III-V complications was 18 (26.4%) in centre A and 8 (11.8%) in centre B (p = 0.03). Median hospital stay was 12 days (7–84) in A and 11(6–80) in centre B (p = 0.546). Conclusions: Gastrointestinal recovery after CRS-HIPEC seems to take longer as compared to other surgical procedures. Between the 2 centres, a significant difference in severe complications was found, while standard TPN, selective bowel decontamination and SPCs were the only identified differences in perioperative care.

scholarly journals Two-step cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei with high peritoneal carcinomatosis index

2020 ◽  
Author(s):  
Bertrand Trilling ◽  
Alexandre Brind'Amour ◽  
Raphael Hamad ◽  
Jean-Francois Tremblay ◽  
Pierre Dubé ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Pseudomyxoma Peritonei ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Low Grade ◽  
Peritoneal Carcinomatosis Index ◽  
Second Surgery ◽  
Very High

Abstract Background Complete cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the only curative treatment for pseudomyxoma peritonei (PMP) arising from the appendix. High peritoneal carcinomatosis index (PCI) is associated with an increased risk of surgical complications. The objective of this study was to present the results of a planned two-step surgical strategy to decrease postoperative morbidity and improve resectability of patients with very high PCI.Methods All patients who underwent a planned two-step surgical approach for PMP between January 2012 and March 2020 were included. Data was retrospectively reviewed and analyzed. The first surgery included a complete CRS of the inframesocolic compartment and omentectomy. HIPEC was delivered at the second surgery, after complete CRS of the supramesocolic compartment. Postoperative morbidity was assessed using the Clavien-Dindo classification and survival results were also collected. Results Eight patients underwent the two-step approach. Seven had a low-grade disease and one had a high-grade disease. The median PCI was 33 (29-39) and the median time between the two procedures was 111 days. One patient was deemed unresectable at the second surgery. The rate of major morbidity was 0% for the first step and 25% for the second step, with no mortality. Median follow-up was 53.8 months. Conclusion A two-step surgical management for low-grade PMP patients with very high PCI is safe and feasible, with acceptable postoperative morbidity and no compromise on oncological outcomes.

Long-term survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy compared with hepatic resection for metastatic colorectal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 630-630 ◽  
Author(s):  
Aaron Udell Blackham ◽  
Greg B. Russell ◽  
John H. Stewart ◽  
Konstantinos Ioannis Votanopoulos ◽  
Edward Allen Levine ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Hepatic Resection ◽  
Metastatic Colorectal Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Performance Status ◽  
Term Survival ◽  
Disease Free

630 Background: Surgical resection of peritoneal metastases (PM) from colorectal cancer has been reported to yield outcomes similar to liver resection for hepatic metastases (HM). However recent data suggests PM may have a worse prognosis than other metastatic sites. Methods: A review of metastatic colorectal cancer patients obtained from prospective databases (1992-2010) comparing liver resection for HM to cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for PM. Results: 181 patients underwent hepatic resection and 182 patients underwent CS/HIPEC with a median follow-up of 55 and 106 months respectively. A margin-negative resection was obtained in 168 (93%) hepatic resections, while 89 patients (49%) with PM had complete cytorection of all gross disease (R0/R1). A comparison of these two groups demonstrated significant differences in age, pre-operative chemotherapy and performance status. Disease-free median survival was 15.2 months after hepatic resection and 9.9 months after CS/ HIPEC (p=0.02). The 5-year overall survival (OS) for HM patients was 33% with a median OS of 45.0 months; while 5-year OS was 23% and median OS was 32.3 months for PM patients (p=0.02). In a proportional hazards regression model, performance status and pre-operative chemotherapy had no significant effect on survival, while increased age (p=0.02) and PM (p=0.03) were associated with decreased OS. Postoperative morbidity was 38% versus 51% (p=0.04) and mortality was 3.0% versus 2.3% (p=0.73) in the HM and PM groups, respectively. Conclusions: Disease-free survival and OS are worse for patients who received complete cytoreduction and CS/HIPEC for PM compared to margin-negative liver resection for HM suggesting a more aggressive tumor biology in PM.

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