title: Hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: A single institution Indian experience.
abstract: Cytoreductive surgery followed by hyper- thermic intraperitoneal chemotherapy (HIPEC) has shown better oncological outcomes in peritoneal surface malignancies (PSM). We assessed the feasibility and perioperative outcomes of this procedure in Indian patients.
  
  
  
  In this prospective observational study from February 2013 to April 2015, we included 56 patients (41 females, 73.2%) with PSM. They had a good performance status, were either treatment-naïve or previously treated by surgery and systemic chemotherapy. They underwent cytoreductive surgery followed by HIPEC using a hyperthermia pump, with the temperature at 42 °C for 30-90 minutes. The chemotherapy regimen was based on the primary malignancy. Perioperative outcome data were collected and analysed. We also analysed the short-term oncological outcomes.
  
  
  
  Our patients included those with peritoneum confined ovarian carcinoma (32, 57.1%), colorectal carcinoma (9, 16.1%), pseudomyxoma peritonei (7, 12.5%), meso- thelioma (2, 3.6%), gastric carcinoma (2, 3.6%) and others (4, 7.1%). The median duration of surgery including HIPEC was 9 hours and the median hospital stay was 12 days. The median time for gastrointestinal recovery was 5 days. One-fifth of patients (11, 19.7%) required an extended stay in the inten- sive care unit. The most common grades 3 and 4 complications were hypocalcaemia 32.1%, hypokalaemia 32.1%, anaemia 21.4% and thrombocytopenia 7.1%. Major morbidity requiring surgical intervention occurred in 8.9% of patients. The 60-day operative mortality was 1.8%. At a median follow-up of 16 months, 7.1% developed peritoneal recurrence, 8.9% had systemic recurrence and 7.1% succumbed to the disease. Patients with platinum-resistant ovarian carcinomas had more peritoneal recurrence (3.6%).
  
  
  
  In patients with PSM, surgical cytoreduction and HIPEC is feasible and potentially beneficial. It can be done with low mortality and acceptable morbidity. It requires a dedicated team of surgeons, anaesthetists and intensivists and proper infrastructure.
authors.affiliation: Department of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru 560017, Karnataka, India.
authors.forename: S P
authors.initials: SP
authors.lastname: Somashekhar
authors.affiliation: Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru 560017, Karnataka, India.
authors.forename: G
authors.initials: G
authors.lastname: Prasanna
authors.affiliation: Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru 560017, Karnataka, India.
authors.forename: Rajshekhar
authors.initials: R
authors.lastname: Jaka
authors.affiliation: Department of Medical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru 560017, Karnataka, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Rauthan
authors.affiliation: Department of Anaesthesiology, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru 560017, Karnataka, India.
authors.forename: H S
authors.initials: HS
authors.lastname: Murthy
authors.affiliation: Department of Critical Care, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru 560017, Karnataka, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Karanth
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000628:therapy; D065426:Cytoreduction Surgical Procedures; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D007194:India; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000628:therapy*; D011183:Postoperative Complications; D011446:Prospective Studies; D055815:Young Adult