High-quality results of cytoreductive surgery and heated intraperitoneal chemotherapy perfusion for carcinomatosis at a low volume institution.
OBJECTIVE
Maximal cytoreductive surgery (CS) with heated intraperitoneal chemotherapy perfusion (HIPEC) for peritoneal carcinomatosis can improve oncologic outcomes, but is associated with significant morbidity. Whether low-volume experience with CS/HIPEC results in acceptable outcomes is unknown.


METHODS
A retrospective review of all patients undergoing CS/HIPEC by a single surgeon. Experience was divided into first versus second 50 cases, and patient characteristics, operative details, and outcomes were compared.


RESULTS
Ninety patients underwent 100 CS/HIPEC procedures (mean age 57 years, 68% female). -Compared to the initial experience, the second 50 cases included more high grade tumors (68 vs. 52%) and greater disease burden (PCI 14.2 vs. 12.4). Operative times remained unchanged and mean blood loss decreased (978 vs. 684 ml). Hospital stay (mean 18.1 vs. 12.6 days), major complications (24 vs. 16%), and perioperative mortality (8 vs. 2%) declined. Overall median survival was 18 months and was longer with low grade tumors (26 vs. 16 months, P = 0.03).


CONCLUSIONS
Patients experienced reduced EBL, fewer major complications, and shorter hospital stay, despite having higher disease burden and higher grade tumors. This suggests that even low-volume experience with CS/HIPEC can lead to a trend in reduction of adverse perioperative events with acceptable oncologic outcomes.
Department of Surgery, Division of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington.
Swaroop R
SR
Bommareddi
Department of Surgery, Division of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington.
Vlad V
VV
Simianu
Department of Surgery, Division of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington.
Lisa V
LV
Mann
Department of Surgery, Division of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington.
Gary N
GN
Mann
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D065426:Cytoreduction Surgical Procedures; D005260:Female; D061846:Hospitals, Low-Volume; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
HIPEC; chemotherapy; cytoreductive surgery; peritoneal carcinomatosis; peritoneal surface disease