title: Iterative procedures combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal recurrence: postoperative and long-term results.
abstract: OBJECTIVE
  Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the best treatment of several peritoneal surface malignancies. Isolated peritoneal recurrence may be treated by iterative procedures. The aim of this study was to evaluate immediate postoperative and long-term results after iterative CRS-HIPEC.
  
  
  METHODS
  From 1990 to 2010, 30 patients with isolated peritoneal recurrence underwent iterative procedures combining CRS-HIPEC.
  
  
  RESULTS
  Origins of peritoneal carcinomatosis were ovarian, colorectal, pseudomyxoma peritonei, peritoneal mesothelioma, gastric cancer, cholangiocarcinoma, leiomyosarcoma, and primary peritoneal serous carcinoma. Median recurrence-free survival (RFS) was 16.2 months from the first procedure. After the second procedure, one (3.3%) postoperative death occurred. Severe morbidity following the second procedure was 40% versus 30% after the first procedure (P = 0.37). At most recent follow up, 11 patients were disease-free, 10 were alive with recurrence, and 9 were dead with recurrence. Five-year overall survival after initial CRS with HIPEC was 65%, and overall median survival from diagnosis was 140 months.
  
  
  CONCLUSIONS
  Iterative procedures combining CRS-HIPEC are feasible and allow long-term survival but may result in significant morbidity and mortality. Patients must be carefully selected, based on the following criteria: Origin of carcinomatosis, magnitude of first procedure, length of RFS, physiological age, co-morbidity, and possibility of complete cytoreduction.
authors.affiliation: Hospices Civils de Lyon, Service de Chirurgie Générale Thoracique et Endocrinienne, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Golse
authors.forename: Naoual
authors.initials: N
authors.lastname: Bakrin
authors.forename: Guillaume
authors.initials: G
authors.lastname: Passot
authors.forename: Faheez
authors.initials: F
authors.lastname: Mohamed
authors.forename: Delphine
authors.initials: D
authors.lastname: Vaudoyer
authors.forename: François-Nöel
authors.initials: FN
authors.lastname: Gilly
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
authors.forename: Eddy
authors.initials: E
authors.lastname: Cotte
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D018281:Cholangiocarcinoma / Q000556:secondary / Q000628:therapy; D015179:Colorectal Neoplasms / Q000473:pathology; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007890:Leiomyosarcoma / Q000556:secondary / Q000628:therapy; D008297:Male; D008654:Mesothelioma / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000473:pathology; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D011553:Pseudomyxoma Peritonei / Q000628:therapy; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome