title: Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center.
abstract: BACKGROUND
  Cytoreductive surgery (CS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinomatosis (PC) traditionally involves high perioperative morbidity and mortality. We report our experience performing CS-HIPEC in a high-volume regional perfusion program designed to limit morbidity and mortality.
  
  
  METHODS
  A total of 122 patients underwent 124 CS-HIPEC procedures. Common tumors treated with CS-HIPEC included appendiceal (38.5%), colorectal (24.6%), and ovarian cancers (13.1%), and peritoneal mesothelioma (12.3%). Complete cytoreduction was performed in all patients, with organ resections performed as necessary.
  
  
  RESULTS
  R0 resection was achieved in 28.7% of cases, R1 in 54.9%, and R2 in 16.4%. Median operative time was 460 minutes (range, 250-840 minutes), and median blood loss was 1150 mL (range, 10-14,000 mL). Median hospital and intensive care unit stays were 12 days (range, 6-50 days) and 3 days (range, 0-41 days), respectively. Grade 3 or 4 morbidity by National Cancer Institute criteria (major morbidity) was seen in 29.8% of cases, with overall morbidity 56.5%. Independent prognostic variables for major morbidity included number of anastomoses and degree of cytoreduction. In-hospital and 30-day mortality rates were 0% and 1.6%, respectively. The most favorable diagnosis was appendiceal cancer, for which 2-year survival was 66.7%, with lower-grade histologic subtypes of appendiceal cancer reaching 85.7% 2-year survival. Colorectal cancer had 2-year survival of 36.7%.
  
  
  CONCLUSIONS
  In a high-volume center with extensive experience treating peritoneal malignancies, perioperative mortality can be lowered to nearly zero, although morbidity remains high. CS-HIPEC procedures should be studied further in a controlled manner to help define their important role in the care of patients with PC.
authors: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. ngusani@psu.edu
authors: Niraj J
authors: NJ
authors: Gusani
authors: Sung W
authors: SW
authors: Cho
authors: Christos
authors: C
authors: Colovos
authors: Songwon
authors: S
authors: Seo
authors: Jan
authors: J
authors: Franko
authors: Scott D
authors: SD
authors: Richard
authors: Robert P
authors: RP
authors: Edwards
authors: Charles K
authors: CK
authors: Brown
authors: Matthew P
authors: MP
authors: Holtzman
authors: Herbert J
authors: HJ
authors: Zeh
authors: David L
authors: DL
authors: Bartlett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents