Peritonectomy for peritoneal carcinomatosis: long-term outcomes from a single Brazilian institution.
BACKGROUND
The objective of this study was to evaluate the long-term outcomes of a single institution, Hospital Sírio-Libanes in São Paulo, Brazil, regarding the treatment of peritoneal carcinomatosis.


METHODS
Between October 2002 and October 2006, 46 consecutive patients were treated with radical cytoreduction and hyperthermic peritoneal chemotherapy. There were 21 patients with peritoneal surface malignancy (PSM) from colorectal origin (among whom 8 had an appendiceal primary), 15 with ovarian carcinomas, 2 with primary peritoneal mesotheliomas, and 8 with other cancers. The median age was 49 years (range 18-77 years). All patients were followed for a median of 20 months. Demographic data, tumor histology, the peritoneal carcinomatosis index (PCI), operative procedures (extension of resection, lymphadenectomy), and hyperthermic intraperitoneal chemotherapy (HIPEC) characteristics (drugs, temperature, duration) were prospectively recorded. Perioperative mortality and morbidity and the long-term outcome were assessed.


RESULTS
Complete cytoreduction was achieved in 45 patients. The median PCI was 11, and the mean operating time was 17 h. There were no procedure-related deaths, but major morbidity was observed in 52% and included fistulas, abscesses, and hematologic complications. The overall Kaplan-Meier 4-year estimated survival was 56%. Among patients with PSM from colorectal carcinoma, the estimated 3-year survival was 70%. Nine (42%) patients had a recurrence, three with peritoneal disease. The median disease-free-interval was 16 months. The ovarian cancer patients had an estimated 4-year survival rate of 75% and median disease-free survival duration of 21 months.


CONCLUSIONS
Cytoreductive surgery with HIPEC may improve survival of selected patients with peritoneal carcinomatosis, with acceptable morbidity.
Akaishi
Eduardo
E
Department of Surgical Oncology, São Paulo University School of Medicine (LIM62); Centro de Oncologia, Hospital Sirio Libanes, Rua Dona Adma Jafet, 91, CEP 01308-050, São Paulo, SP, Brazil. eduardoakaishi@uol.com.br
Teixeira
Frederico
F
Katayama
Marcelo
M
Mizumoto
Nelson
N
Costa
Frederico P
FP
Buzaid
Antonio Carlos
AC
Hoff
Paulo M
PM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001063:Appendiceal Neoplasms / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D010537:Peritoneum / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents