title: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: initial experience in Oaxaca, Mexico.
abstract: Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of  these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multimodality  therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at "Hospital Regional de Alta Especialidad de Oaxaca," Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients  were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality  rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely  important when starting a center for PC.
authors.affiliation: Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca, México. rolandogarciamatus@yahoo.com.mx
authors.forename: Rolando
authors.initials: R
authors.lastname: García-Matus
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Hernández-Hernández
authors.forename: Omar
authors.initials: O
authors.lastname: Leyva-García
authors.forename: Sergio
authors.initials: S
authors.lastname: Vásquez-Ciriaco
authors.forename: Guillermo
authors.initials: G
authors.lastname: Flores-Ayala
authors.forename: Quetzalli
authors.initials: Q
authors.lastname: Navarro-Hernández
authors.forename: Gerardo
authors.initials: G
authors.lastname: Pérez-Bustamante
authors.forename: Norma Miriam
authors.initials: NM
authors.lastname: Valencia-Mijares
authors.forename: Jesus
authors.initials: J
authors.lastname: Esquivel
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D006979:Hyperthermia, Induced; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome