OUTCOMES OF CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (CRS/HIPEC) IN THE TREATMENT OF PRIMARY PERITONEAL CARCINOMA

Author(s):  
Victoria Eskay
Author(s):  
Armando Sardi ◽  
Arkadii Sipok ◽  
Teresa P. Díaz-Montes ◽  
Michelle Sittig ◽  
Carol Nieroda ◽  
...  

Primary peritoneal carcinoma (PPC) is rare tumor, traditionally treated with surgical debulking and systemic chemotherapy (SC) with 30% five-year survival rate. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may improve long-term survival. Thirty patients with PPC were identified. Twenty-three patients underwent CRS/HIPEC as initial treatment (group I) and 7 for recurrent disease (group II). Peritoneal cancer index (PCI), cytoreduction scores (CC), overall survival (OS) and progressionfree survival (PFS) were estimated using Kaplan-Meier survival analysis. FIGO stages II/III/IV at diagnosis were 2/20/7 (1 was not classified). Median time from diagnosis to CRS/HIPEC was 2 months and 8 months in groups I and II, respectively. PCI≥20 was seen in 16 (70%) and 4 (57%) in groups I and II, respectively. Complete cytoreduction (CC 0-1) was achieved in 30/32 (94%) CRS/HIPEC procedures. Median follow-up was 39 months (range: 11-250). PFS at 1, 3, 5-years was 80%, 75%, 59%, respectively. OS 1, 3, 5- years from CRS/HIPEC was 90%, 68%, 55%. CRS/HIPEC and adjuvant SC provides five-year survival rate higher than previously reported for PPC patients who received conventional therapy with surgical debulking and SC.


2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098326
Author(s):  
Myoung Hwa Kim ◽  
Young Chul Yoo ◽  
Sun Joon Bai ◽  
Kang-Young Lee ◽  
Nayeon Kim ◽  
...  

Objective We aimed to determine the physiological and hemodynamic changes in patients who were undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) cytoreductive surgeries. Methods This prospective, observational study enrolled 21 patients who were undergoing elective cytoreductive surgery with HIPEC at our hospital over 2 years. We collected vital signs, hemodynamic parameters including global end-diastolic volume index (GEVI) and extravascular lung water index (ELWI) using the VolumeView™ system, and arterial blood gas analysis from all patients. Data were recorded before skin incision (T1); 30 minutes before HIPEC initiation (T2); 30 (T3), 60 (T4), and 90 (T5) minutes after HIPEC initiation; 30 minutes after HIPEC completion (T6); and 10 minutes before surgery completion (T7). Results Patients showed an increase in body temperature and cardiac index and a decrease in the systemic vascular resistance index. GEDI was 715.4 (T1) to 809.7 (T6), and ELWI was 6.9 (T1) to 7.3 (T5). Conclusions HIPEC increased patients’ body temperature and cardiac output and decreased systemic vascular resistance. Although parameters that were extracted from the VolumeView™ system were within their normal ranges, transpulmonary thermodilution approach is helpful in intraoperative hemodynamic management during open abdominal cytoreductive surgery with HIPEC. Trial registry name: ClinicalTrials.gov Trial registration number: NCT02325648 URL: https://clinicaltrials.gov/ct2/results?cond=NCT02325648&term


2021 ◽  
Vol 47 (2) ◽  
pp. e14-e15 ◽  
Author(s):  
Fernando Arias-Amézquita ◽  
Eduardo Londoño-Schimmer ◽  
Jorge Miguel Otero-Bernal ◽  
Camilo Cétares ◽  
Martha Mora ◽  
...  

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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