[Treatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity and mortality and short-term follow-up].
BACKGROUND
In order to treat the peritoneal carcinomatosis from abdominal neoplasms has been recently proposed complete peritonectomy associated with IntraPeritoneal Hyperthermic Chemotherapy (IHPC).


OBJECTIVE
Estimate of postoperative morbidity and mortality and short-term outcome.


METHODS
Twenty-four patients with peritoneal carcinomatosis or positive cytology at peritoneal washing were treated in our Department from January 2005 to October 2007. Primary tumor was ovarian carcinoma in ten patients: four cases presented peritoneal surface malignancies (PSM) after any time from hysteroadnexectomy related to primary tumor, six cases synchronous PSM. Primary tumor was gastric cancer in seven patients: the peritoneal washing was positive in four cases and, during follow-up period after gastrectomy, other two cases presented PSM. One patient was previously treated with ovariectomy for ovaric mass that resulted a Krukenberg's tumor of gastric cancer. Primary tumor was pseudomixoma peritonei in four patients; cytoreductive surgery and IHPC was carried as first line therapy in only one patient. Three patients were previously treated for colon carcinoma. IHPC was carried out through abdominopelvic cavity for 60 minutes using a closed abdomen technique. The drugs used were Mitomycin C (3.3 mg/m2/L) and Cisplatin (25 mg/m2/L). The intracavitary mean temperature was 41.8 degrees C.


RESULTS
The mean Peritoneal Cancer Index (PCI) was 14. Postoperative major complications occurred in 7 cases (28%), postoperative minor complications occurred in 8 cases (32%). No patients died in the postoperative period. Mean hospital staying was 11.5 days ( 6-35 days). After a median follow-up of 8 months (range 2-34), 14 (58%) patients are alive and 13 are disease free.


CONCLUSIONS
Our experience is consistent with other studies for the high rate of postoperative morbidity associated with treatment, but we achieved best results on mortality and post-operative staying. CRS associated with IHPC is a good therapeutic option especially in ovaric-related carcinosis and PMP. It' s still debated whether it could be useful or not in colorectal related carcinosis, whereas there is a general agreement in the un uselessness of this technique in gastric cancer.
Minicozzi
Annamaria
A
I Divisione Clinicizzata di Chirurgia Generale, Ospedale Civile Maggiore, Verona Università degli Studi di Verona. annamaria.minicozzi@azosp.vr.it
Borzellino
Giuseppe
G
Momo
Emmanuel Nguefouet
EN
Segattini
Christian
C
Pitoni
Federica
F
Steccanella
Francesca
F
De Manzoni
Giovanni
G
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D016685:Mitomycin; D002945:Cisplatin