Preliminary Experience and Morbidity Analysis of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) from a Tertiary Cancer Center in India.
BACKGROUND
Peritoneal carcinomatosis (PC) can arise directly from peritoneum (primary) or from regional spread of gastrointestinal and gynecological malignancies. It is often considered a terminal event. CRS/HIPEC procedure provides encouraging outcomes in select sub-set of patients with PC. In this study we present our initial experience of this combined procedure from a tertiary cancer care center in India.


METHODS
Between January 2014 to January 2015, 13 patients underwent CRS + HIPEC procedure at our center. Preoperative assessment for cytoreduction was done using contrast CT-scan of the abdomen and staging laparoscopy. All procedures were performed by the same surgical team. After cytoreduction, HIPEC was performed by closed method.


RESULTS
Median patient age was 52 and median PCI was 13.5 (5-21). Ovarian cancers were commonest origin of PC in our series. All patients had a complete cytoreduction with a median operative time of 8.3 hours. Postoperative ileus was the commonest adverse event. In the immediate postoperative period, major complications were observed in 23% (3/13) of our patients (1. intra-abdominal abscess 2. Septicemia and liver function derangement 3. Bowel obstruction which required a re-operation. Median hospital stay was 12 days (range 9-45 days) and there was no perioperative mortality.


CONCLUSIONS
Our initial results indicate that CRS + HIPEC procedure can be performed with acceptable morbidity and no mortality. Appropriate case selection by a multi-disciplinary team is vital to achieve complete cytoreduction and optimize outcomes.
Registrar, Department of Surgical Oncology, Apollo Speciality Hospitals , Chennai, India .
Naveen
N
Padmanabhan
Registrar, Department of Surgical Oncology, Apollo Speciality Hospitals , Chennai, India .
Barath Raj
BR
Kumar
Senior Registrar, Department of Surgical Oncology, Apollo Speciality Hospitals , Chennai, India .
Ansar Pullampara
AP
Pookunju
Head and Senior Consultant, Department, of Surgical Oncology, Apollo Speciality Hospitals , Chennai, India .
Ayyapan
A
Srinivasan
Senior Consultant, Department of Surgical Oncology, Apollo Speciality Hospitals , Chennai, India.
Vikash
V
Mahajan
Carcinomatosis; Colorectal neoplasm; Ovarian neoplasm; Regional chemoperfusion