title: Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy in patients with peritoneal hepatocellular carcinoma.
abstract: OBJECTIVE
  The benefit of Sorafenib is not well described in patients with peritoneal hepatocellular carcinoma (HCC). Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown favorable outcomes in certain malignancies, their role in peritoneal HCC remains unknown. We present a series of patients with peritoneal HCC treated with CRS +/- HIPEC and evaluate their clinicopathologic characteristics and outcomes.
  
  
  METHODS
  Between 07/07-08/12, 14 patients with limited disease to the peritoneum underwent CRS. Seven of these patients received additional HIPEC treatment. Primary endpoint was overall survival.
  
  
  RESULTS
  Operative treatment was directed for metachronous peritoneal disease in the majority (92.8%) of patients. Mean intraoperative PCI was 9.9 (± 8.3) and complete mascroscopic cytoreduction (CCR 0-1) was achieved in all but one case. Overall major morbidity rate (Clavien-Dindo III-IV) at 30 days was 7.1%. One postoperative death occurred in a patient with extensive tumor burden (PCI = 33, CCR2). Median follow-up after initial surgery was 43.8 months and the median time to metachronous peritoneal recurrence was 23 months. Three-year recurrence rate after peritoneal resection was 100%. Median survival of the cohort CCR0-1 was 35.6 months.
  
  
  CONCLUSIONS
  Treatment of peritoneal HCC remains challenging and survival is poor. In well-selected candidates, however, CRS +/- HIPEC may prolong survival compared to systemic therapy alone in patients with peritoneal HCC.
authors.affiliation: Department of Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: Parissa
authors.initials: P
authors.lastname: Tabrizian
authors.forename: Bernardo
authors.initials: B
authors.lastname: Franssen
authors.forename: Ghalib
authors.initials: G
authors.lastname: Jibara
authors.forename: Robert
authors.initials: R
authors.lastname: Sweeney
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.forename: Myron
authors.initials: M
authors.lastname: Schwartz
authors.forename: Daniel
authors.initials: D
authors.lastname: Labow
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
keywords: cytoreductive surgery; hepatocellular carcinoma; hyperthermic intraperitoneal chemotherapy; peritoneal carcinomatosis