title: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: outcomes from a single tertiary institution.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) is an effective but morbid procedure in the treatment of peritoneal carcinomatosis. We report our outcomes at a single tertiary institution.
  
  
  METHODS
  A total of 170 consecutive patients underwent CRS-HIPEC for peritoneal carcinomatosis between July 2007 and August 2012. The peritoneal cancer index (1-39) was used for peritoneal carcinomatosis (PC) staging. Mitomycin C (88.8%) was administered intraperitoneally at 42 °C for 90 mins. Risk factors associated with major morbidities were analyzed. The Kaplan-Meier method was used for survival analyses.
  
  
  RESULTS
  The mean age was 55.1 (±11.3) years, and the majority (77.1%) of patients had complete cytoreduction (CC0-1). Tumor types included colorectal (n = 51, 30.0%), appendiceal (n = 50, 29.4 %), pseudomyxoma peritonei (n = 16, 9.4%), and other (n = 53, 31.2%). Factors associated with major complications were estimated blood loss (>400 ml), length of stay (>1 week), intraoperative blood transfusion, operative time (>6 h), and bowel anastomosis. Intraoperative blood transfusion was the only independent prognostic factor on multivariate analysis (p = 0.031). Median follow-up was 15.7 months (±1.2). The recurrence rates for colorectal and appendiceal carcinoma at 1 and 3 years were 40%, 53.5% and 68%, 79.1%, respectively. The 1- and 3-year overall survival for colorectal and appendiceal carcinomatosis was 74.0%, 32.5% and 89.4%, 29.3%, respectively. Intraoperative peritoneal cancer index (PCI) score (>16) and need for blood transfusion were factors independently associated with poor survival (p < 0.05).
  
  
  CONCLUSIONS
  Our single institution experience of CRS/HIPEC procedures for peritoneal carcinomatosis demonstrates acceptable perioperative outcome and long-term survival. Optimal cytoreduction was achieved in the majority of cases. Intraoperative PCI > 16 was associated with poor survival. This series supports the safety of CRS-HIPEC in selected patients.
authors.affiliation: Mount Sinai Medical Center, New York, NY, USA, ptabrizian@hotmail.com.
authors.forename: Parissa
authors.initials: P
authors.lastname: Tabrizian
authors.forename: Brian
authors.initials: B
authors.lastname: Shrager
authors.forename: Ghalib
authors.initials: G
authors.lastname: Jibara
authors.forename: Ming-Jim
authors.initials: MJ
authors.lastname: Yang
authors.forename: Anya
authors.initials: A
authors.lastname: Romanoff
authors.forename: Spiros
authors.initials: S
authors.lastname: Hiotis
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Labow
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D001063:Appendiceal Neoplasms / Q000473:pathology*; D001803:Blood Transfusion; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology; D006801:Humans; D006979:Hyperthermia, Induced; D007430:Intraoperative Care; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009364:Neoplasm Recurrence, Local / Q000556:secondary*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010051:Ovarian Neoplasms / Q000473:pathology; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011553:Pseudomyxoma Peritonei / Q000628:therapy*; D013274:Stomach Neoplasms / Q000473:pathology; D015996:Survival Rate; D062606:Tertiary Care Centers
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D016685:Mitomycin; D000077146:Irinotecan; D002166:Camptothecin