scholarly journals Hemodynamic Monitoring During Heated Intraoperative Intraperitoneal Chemotherapy Using the FloTrac/Vigileo System

2015 ◽  
Vol 100 (6) ◽  
pp. 1033-1039 ◽  
Author(s):  
Christos Mavroudis ◽  
Leonidas Alevizos ◽  
Konstantinos M. Stamou ◽  
Theodosia Vogiatzaki ◽  
Savvas Eleftheriadis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Venous Pressure ◽  
Term Survival ◽  
Continuous Increase ◽  
Peritoneal Cancer ◽  
American Society ◽  
American Society Of Anesthesiologists

Cytoreductive surgery with HIPEC has provided a chance for long-term survival in selected patients. However, perioperative management remains a challenge for the anesthesiology team. The aim of this study was to evaluate the changes in hemodynamic parameters during hyperthermic intraperitoneal chemotherapy (HIPEC) using the FloTrac/Vigileo system. Forty-one consecutive patients undergoing cytoreductive surgery and HIPEC were enrolled. Heart rate (HR), esophageal temperature, and cardiac output (CO) steadily increased until the end of HIPEC. In the first half of HIPEC, systolic blood pressure (SBP) and central venous pressure (CVP) increased whereas systemic vascular resistance (SVR) decreased; SVR stabilized in the second half. Diastolic blood pressure (DBP), mean arterial pressure (MAP), and stroke volume (SV) showed no significant variation. Male gender was related to increased CVP, CO, and SV, and decreased SVR; age >55 years was related to increased SBP, and peritoneal cancer index (PCI) was correlated with HR, DBP, and SV. PCI >14 was associated with increased HR and decreased DBP and MAP. American Society of Anesthesiologists score >1 was related to decreased CO and SV. Patients undergoing HIPEC develop a hyperdynamic circulatory state because of the increased temperature, characterized by a steady decrease in SVR and continuous increase in HR and CO. FloTrac/Vigileo system may provide an easy-to-handle, noninvasive monitoring tool.

scholarly journals Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Colorectal Cancer

2020 ◽  
Vol 33 (06) ◽  
pp. 372-376
Author(s):  
Hideaki Yano
Keyword(s):  
Colorectal Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Metastasis ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Systemic Disease ◽  
Good Reason ◽  
Standard Of Care ◽  
Peritoneal Cancer

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.

Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer With Peritoneal Metastases (CYTO-CHIP study): A Propensity Score Analysis

2019 ◽  
Vol 37 (23) ◽  
pp. 2028-2040 ◽  
Author(s):  
Pierre-Emmanuel Bonnot ◽  
Guillaume Piessen ◽  
Vahan Kepenekian ◽  
Evelyne Decullier ◽  
Marc Pocard ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Peritoneal Metastases ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Peritoneal Cancer

PURPOSE Gastric cancer (GC) with peritoneal metastases (PMs) is a poor prognostic evolution. Cytoreductive surgery (CRS) yields promising results, but the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. Here we aimed to compare outcomes between CRS-HIPEC versus CRS alone (CRSa) among patients with PMs from GC. PATIENTS AND METHODS From prospective databases, we identified 277 patients with PMs from GC who were treated with complete CRS with curative intent (no residual nodules > 2.5 mm) at 19 French centers from 1989 to 2014. Of these patients, 180 underwent CRS-HIPEC and 97 CRSa. Tumor burden was assessed using the peritoneal cancer index. A Cox proportional hazards regression model with inverse probability of treatment weighting (IPTW) based on propensity score was used to assess the effect of HIPEC and account for confounding factors. RESULTS After IPTW adjustment, the groups were similar, except that median peritoneal cancer index remained higher in the CRS-HIPEC group (6 v 2; P = .003). CRS-HIPEC improved overall survival (OS) in both crude and IPTW models. Upon IPTW analysis, in CRS-HIPEC and CRSa groups, median OS was 18.8 versus 12.1 months, 3- and 5-year OS rates were 26.21% and 19.87% versus 10.82% and 6.43% (adjusted hazard ratio, 0.60; 95% CI, 0.42 to 0.86; P = .005), and 3- and 5-year recurrence-free survival rates were 20.40% and 17.05% versus 5.87% and 3.76% ( P = .001), respectively; the groups did not differ regarding 90-day mortality (7.4% v 10.1%, respectively; P = .820) or major complication rate (53.7% v 55.3%, respectively; P = .496). CONCLUSION Compared with CRSa, CRS-HIPEC improved OS and recurrence-free survival, without additional morbidity or mortality. When complete CRS is possible, CRS-HIPEC may be considered a valuable therapy for strictly selected patients with limited PMs from GC.

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 Uncommon indications for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

2017 ◽  
Vol 2 (3) ◽  
pp. 129-136 ◽  
Author(s):  
Francis Zheng Yi Yee ◽  
Grace Hwei Ching Tan ◽  
Claramae Shulyn Chia ◽  
Khee Chee Soo ◽  
Melissa Ching Ching Teo
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Transitional Cell ◽  
Granulosa Cell Tumor ◽  
Peritoneal Metastases ◽  
Peritoneal Cancer ◽  
Crs And Hipec ◽  
Uncommon Tumor

AbstractBackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed treatment for selected patients with peritoneal metastases (PM) arising from appendiceal, colorectal, epithelial ovarian, primary peritoneal and gastric cancers. However, the results of CRS with HIPEC remain unclear in PM from other tumor histologies.MethodsWe report a series of 10 patients who underwent CRS and HIPEC between 2006 and 2015, for PM arising from uncommon tumor origins.ResultsTen patients with PM from uncommon tumor origins underwent CRS and HIPEC. Median age was 46.5 years. Two patients had ovarian Sertoli-Leydig cell tumors (SLCT) and two had small bowel adenocarcinomas. The other histologies included: ovarian transitional cell carcinoma, ovarian granulosa cell tumor, endometroid adenocarcinoma, endocervical adenocarcinoma, synovial sarcoma, and ovarian leiomyosarcoma. Median peritoneal cancer index was 9 (2–18) and complete cytoreduction was achieved for all patients. Median follow-up was 14 months (2–100), and median time to recurrence from CRS and HIPEC was 16.0 months by Kaplan–Meier estimate. Four patients remain alive and disease-free, five are alive with disease, and one had died with disease. Median survival was not reached.ConclusionsEight of ten patients with peritoneal metastases in the above rare indications survived 10 months or more after CRS and HIPEC. These encouraging results are a rationale for prospective clinical trials in these tumor histologies.

scholarly journals Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review

2020 ◽  
Vol 9 (3) ◽  
pp. 748 ◽  
Author(s):  
Eliza W. Beal ◽  
Lorena P. Suarez-Kelly ◽  
Charles W. Kimbrough ◽  
Fabian M. Johnston ◽  
Jonathan Greer ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Retrospective Review ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Multivariable Analysis ◽  
Peritoneal Metastases ◽  
Peritoneal Cancer ◽  
Significant Difference

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000–2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.

scholarly journals Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin---801 Cases from a Single Institution in China

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Ao Xia ◽  
Xichao Zhai ◽  
Lubiao An ◽  
Bing Wang ◽  
Guanjun Shi ◽  
...  
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Pseudomyxoma Peritonei ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Univariate Analysis ◽  
Long Term Outcomes ◽  
Peritoneal Cancer ◽  
Tumor Debulking

Aim: As more and more centers has published their treatment results of pseudomyxoma peritonei (PMP) with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), the data from China is missing. Myxoma Department of Aerospace Hospital is the biggest center treating PMP in China. The purpose of this study is to report the early and long-term outcomes for PMP from this single center.Methods: 801 appendix-derived PMP out of 1008 consecutive patients treated in Myxoma Department of Aerospace Hospital between 2008 and 2019 were retrospectively analyzed.Results: Complete cytoreductive surgery (CCRS) was achieved in 240 (30%) patients with median PCI of 14(1~39), and the rest had maximal tumor debulking (MTD), HIPEC was implemented in 96.3% of CCRS and 78.6% of MTD. The major morbidity (grade III/IV) was 11.4% and the 30-day operative mortality is 0.7%. The 5- and 10-year OS of CCRS was 76.9% and 64.1%, which is significantly higher than MTD (5-, 10-year OS as 36.1%, 27.1%; p<0.001). On the univariate analysis, all prognostic factors (gender, PSS, interval time, prior chemotherapy, prior HIPEC, Peritoneal Cancer Index (PCI), completeness of cytoreduction (CC), HIPEC, pathology, present of serous ascites) were found to be associated with overall survival except for age. On multivariate analysis, only PCI>20, MTD, high pathologic grade and without HIPEC were independent factors predicting poorer prognosis.Conclusions: CCRS +HIPEC can benefit PMP well with controllable risks. MTD+HIPEC may benefit PMP as well when CCRS cannot be achieved after fully asscessment by an experienced peritoneal maglignacy center, but the surgery should be performed as limited as possible.

Delay of Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy in Patients with Appendiceal Neoplasm

2012 ◽  
Vol 78 (7) ◽  
pp. 745-748 ◽  
Author(s):  
Hatem El Halabi ◽  
Ryan Macdonald ◽  
Kimberly Studeman ◽  
Jennifer Francis ◽  
Carol Nieroda ◽  
...  
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Statistical Significance ◽  
Lymph Node Status ◽  
Peritoneal Cancer ◽  
Kaplan Meier ◽  
Heated Intraperitoneal Chemotherapy ◽  
Tumor Load ◽  
Prior Surgery

Cytoreductive surgery/heated intraperitoneal chemotherapy (CRS/HIPEC) has been shown to be effective for selected patients with advanced appendiceal cancer. We propose that delaying CRS/HIPEC leads to disease progression and affects outcome. A retrospective analysis of a prospective database was carried out. Patients were divided into two groups based on time from diagnosis to CRS/HIPEC (less than 6 months = early, greater than 6 months = delayed). Comparison was made of Peritoneal Cancer Index (PCI), Prior Surgery Score (PSS), complete cytoreduction (CC), and lymph node status. Overall survival (OS) was calculated using Kaplan-Meier estimates. Of 127 patients, 50 had disseminated peritoneal adenomucinosis and 77 had peritoneal mucinous carcinomatosis (PMCA). Of patients with PMCA, 41 had early CRS/HIPEC and 36 delayed. PCI was less than 20 in 46 and 17 per cent ( P = 0.007) of the early and delayed groups, respectively. CC was achieved in 88 and 61 per cent ( P = 0.009) of the early and delayed groups, respectively. PSS was (2 of 3) in 51 and 91 per cent ( P = 0.001) of the early and delayed groups, respectively. Five-year OS was 54 per cent for the early group and 45 per cent for the delayed group ( P = 0.2). Delaying CRS/HIPEC was associated with higher tumor load and lower chance for complete cytroreduction. Longer follow-up and larger numbers are needed to determine if OS difference will reach statistical significance.

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