Review of patients with peritoneal malignancy treated with peritonectomy and heated intraperitoneal chemotherapy.
BACKGROUND
Peritoneal dissemination of malignancy is usually considered incurable. The purpose of the present study was to evaluate the efficacy of intraperitoneal chemohyperthermia and cytoreductive surgery.


METHODS
The present article is a retrospective review of prospectively recorded data in 60 patients who underwent 71 peritonectomy procedures between January 1996 and May 2004. Hospital records, a database and department notes were studied. Conditions treated were pseudomyxoma peritoneii (PMP) and appendiceal cancer (23), mesothelioma (7), colorectal cancer (CRC, 15), ovarian cancer (6) and other forms of malignancy (9). Following cytoreductive surgery, early postoperative intraperitoneal chemotherapy (EPIC) was given in 47 procedures, five with added i.v. mitomycin C. In 34 procedures, heated intraperitoneal chemotherapy (HIPEC) was administered. A policy change was made from intravenous to intraperitoneal mitomycin C chemotherapy in December 2001. Peritoneal cancer index (PCI) was calculated for all procedures.


RESULTS
Of the procedures, 23 had PCI < or = 10, 37 had PCI of 11-20, and 11 had PCI > 20. The median operation time was 9 h. Blood units transfused and length of hospital stay have declined. Mortality was 4/60 patients (6.7%), caused by pancytopenia and sepsis. Morbidity occurred in 28/71 procedures. The 3-year survival rate for the HIPEC group was 71% compared with 28% for the no HIPEC group. In the complete excision group, the 3-year survival rate was 52% compared with 13% for the incomplete excision group. The 3-year survival rate for PMP and appendiceal cancer was 74%. The 2-year survival rate for ovarian cancer was 67%, mesothelioma 57%, and CRC 50%, respectively.


CONCLUSIONS
Morbidity is significantly associated with duration of surgery and units of blood transfused. Our findings are consistent with the international experience in patients treated with combined peritonectomy and HIPEC.
Hadi
Reema
R
University of New South Wales, Department of Surgery, Sydney, New South Wales, Australia.
Saunders
Vanessa
V
Utkina
Olga
O
Clingan
Philip
P
Kam
Peter
P
Links
Matthew
M
Morris
David L
DL
D000293:Adolescent; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001803:Blood Transfusion; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007263:Infusions, Parenteral; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery*; D011379:Prognosis; D011553:Pseudomyxoma Peritonei / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis
D000970:Antineoplastic Agents