scholarly journals Hyperthermic intraperitoneal chemotherapy in primary peritoneal cancer: Our experience in a young male

Author(s):  
Rahul Sud ◽  
Arun Kumar Patra ◽  
Pradeep Jaiswal ◽  
Raj Mohan ◽  
P. K. Sindhu

Primary peritoneal carcinomatosis (PPC) is a rare tumor, described in the literature almost exclusively in women. Patients with peritoneal carcinomatosis were considered incurable with low survival rates. This underwent a paradigm shift with hyperthermic intraperitoneal chemotherapy (HIPEC) after optimal cytoreductive surgery which changed the entire scenario. This case report describes the management of a 28-year-old male patient who was diagnosed to have PPC when he presented with massive ascites, who underwent cytoreductive surgery combined with HIPEC in our hospital. This procedure was complex for both the surgical team due to an extensive surgery, but also the anesthetist during the hyperthermic phase where the chemotherapy was administered. The post-operative recovery in such a case is also many times stormy and requires extreme vigilance. We had major challenges such as prolonged surgery, massive blood loss, temperature management, maintaining adequate urine output, and post-operative critical care. Extensive pre-operative preparation and proper coordination with the multidisciplinary team led us to handle the condition satisfactorily. The PPC in a young patient itself is a rare which enthuses us to report the case.

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 ◽  
...  

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.


2020 ◽  
Vol 33 (06) ◽  
pp. 372-376
Author(s):  
Hideaki Yano

AbstractPeritoneal metastasis from colorectal cancer (PM-CRC) is used to be considered a systemic and fatal condition; however, it has been growingly accepted that PM-CRC can still be local disease rather than systemic disease as analogous to liver or lung metastasis.Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is now considered an optimal treatment for PM-CRC with accumulating evidence. There is a good reason that CRS + HIPEC, widely accepted as a standard of care for pseudomyxoma peritonei (PMP), could be a viable option for PM-CRC given a similarity between PM-CRC and PMP.Recent years have also seen that modern systemic chemotherapy with or without molecular targeted agents can be effective for PM-CRC. It is possible that neoadjuvant or adjuvant chemotherapy combined with CRS + HIPEC could further improve outcomes.Patient selection, utilizing modern images and increasingly laparoscopy, is crucial. Particularly, diagnostic laparoscopy is likely to play a significant role in predicting the likelihood of achieving complete cytoreduction and assessing the peritoneal cancer index score.


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