title: Reduced morbidity following cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion.
abstract: BACKGROUND
  Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IPHC) are an aggressive treatment for patients with peritoneal based malignancies or those with peritoneal dissemination of select histology. Although promising, this therapeutic regimen has been associated with significant morbidity, long hospital stays, and, in some reports, moderate risk for perioperative mortality. Recent experience suggests that these outcomes may be improved.
  
  
  METHODS
  Thirty-three patients underwent cytoreductive surgery and intraperitoneal hyperthermic perfusion during the period of December 1999 to July 2002. All patients underwent resection by a three-surgeon team, followed by IPHC with an open technique. Peritonectomy was performed with the goal of total gross excision of disease.
  
  
  RESULTS
  Thirty-five procedures were performed in 33 patients (20 female) with a mean age of 49 years (range, 26-72). Complete cytoreduction was achieved in 22 cases (63%), and in 6 cases (17%) residual disease was <4 mm. There were nine major perioperative complications (27%) and no perioperative deaths. The median hospital stay was 11 days.
  
  
  CONCLUSIONS
  These results demonstrate that cytoreductive surgery and IPHC can be performed with morbidity and mortality rates in line with those of other major oncologic operations. Employment of a three-surgeon approach, limited peritonectomy, and an open technique may help to reduce the morbidity from this aggressive treatment. Continued investigation of this promising treatment regimen is warranted.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA. ahmadsy@uc.edu
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Soldano
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Pennington
authors.forename: Laura E
authors.initials: LE
authors.lastname: James
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Lowy
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001063:Appendiceal Neoplasms / Q000628:therapy*; D002277:Carcinoma / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents