Technology of intraperitoneal chemotherapy administration: a survey of techniques with a review of morbidity and mortality.
Peritoneal metastases are a common sequela of gastrointestinal malignancy. The treatment of peritoneal metastases through use of aggressive surgical cytoreduction including peritonectomy, coupled with IPHC has now been reported in several large single institution series. The available literature suggests that in experienced hands and with appropriate patient selection, cytoreduction, and IPHC can be an effective therapy, particularly when all macroscopic tumor deposits are removed. Different techniques involving the administration of intraperitoneal chemotherapy have been reported including early postoperative, closed intraoperative, the open or coliseum technique, and the open technique using a PCE device. All techniques have been associated with low mortality and morbidity that is significant, but generally consistent with other major surgical procedures. Commonly reported complications of IPHC include prolonged ileus, fistula, abscess, and thrombosis. In theory, the coliseum and PCE techniques may have less associated morbidity due to improved heat distribution, however, this remains to be definitively proven in a controlled clinical trial. Such controlled studies are critical to defining the best techniques of IPHC administration and the appropriate role for this treatment regimen in patients with peritoneal metastases.
Sarnaik
Amod A
AA
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Sussman
Jeffrey J
JJ
Ahmad
Syed A
SA
Lowy
Andrew M
AM
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral / Q000379:methods*; D007432:Intraoperative Period; D007813:Laparotomy / Q000379:methods; D008297:Male; D019990:Perioperative Care; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents