title: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for gallbladder cancer: a retrospective review.
abstract: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) often prolongs survival in patients with peritoneal surface disease, yet is generally avoided in patients with peritoneal spread from gallbladder cancer as a result of its aggressive biologic behavior. Therefore, we reviewed our experience with CRS/HIPEC for patients with gallbladder cancer. We retrospectively evaluated the outcomes of CRS/HIPEC procedures performed from 1991 to 2013 using a prospectively maintained database of 1069 procedures. Patient and tumor characteristics, morbidity, mortality, and survival were reviewed. CRS/HIPEC was performed six times in five patients with peritoneal spread from gallbladder cancer. Patients were young (age 28 to 54 years) without pre-existing comorbidities. Eighty per cent had an Eastern Cooperative Oncology Group score of 0 or 1. At CRS, organs resected included omentum (n = 4), liver (n = 3), colon (n = 2), ovaries (n = 1), and diaphragm (n = 1). A complete macroscopic cytoreduction of intraperitoneal disease was achieved in every case. Clavien graded major morbidity was 17 per cent. There was no observed mortality. Median and 3-year survival were 22.4 months and 30 per cent, respectively. CRS/HIPEC may be performed safely in patients with peritoneal dissemination from gallbladder cancer. Carefully selected patients with low-volume disease amenable to complete cytoreduction may experience a meaningful survival benefit.
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Reese W
authors.initials: RW
authors.lastname: Randle
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.forename: Clancy J
authors.initials: CJ
authors.lastname: Clark
authors.forename: John H
authors.initials: JH
authors.lastname: Stewart
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Votanopoulos
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery*; D000008:Abdominal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D002945:Cisplatin / Q000627:therapeutic use; D003082:Colectomy; D003131:Combined Modality Therapy; D003964:Diaphragm / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology*; D006498:Hepatectomy; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009852:Omentum / Q000601:surgery; D010052:Ovariectomy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016685:Mitomycin; D002945:Cisplatin