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. 2015 Sep 1;31(3):138-47.
doi: 10.5152/UCD.2015.2990. eCollection 2015.

Cytoreductive surgery (SRC) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinomatosis: Our initial experience and technical details

Koray Topgül  1 , Mehmet Bilge Çetinkaya  2 , N Çiğdem Arslan  3 , Mustafa Kemal Gül  4 , Murat Çan  5 , Mahmut Fikret Gürsel  5 , Dilek Erdem  4 , Zafer Malazgirt  5
Affiliations

Cytoreductive surgery (SRC) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinomatosis: Our initial experience and technical details

Koray Topgül et al. Ulus Cerrahi Derg. .

Abstract

Objective: The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature.

Material and methods: Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed.

Results: The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence.

Conclusion: Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.

Keywords: Peritoneal carcinomatosis; cytoreductive surgery; hipec.

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Figures

Figure 1.
Figure 1.
Mucin decompression in a patient with pseudomyxoma peritonei
Figure 2.
Figure 2.
Scoring systems used in candidate patients for surgery. Peritoneal Carcinomatosis Index defined by Sugarbaker (12) and Peritoneal Surface Disease Severity Score defined by Esquivel (35)
Figure 3.
Figure 3.
Intraoperative view of a patient judged as unresectable due to extensive small bowel involvement
Figure 4.
Figure 4.
Parietal peritonectomy and omental cake in a patient who underwent total peritonectomy
Figure 5.
Figure 5.
Removal of liver metastasis in the form of superficial invasion by stripping of Glisson capsule
Figure 6.
Figure 6.
Excision of nodules within small bowel mesentery
Figure 7.
Figure 7.
HIPEC application with closed abdominal technique (temporary closure of the abdomen leaving anastomoses for after HIPEC). Thin white cables are heat probes HIPEC: hyperthermic intraperitoneal chemotherapy
Figure 8.
Figure 8.
Obturator nerve and iliac vessels following pelvic peritonectomy and lymph node dissection
Figure 9.
Figure 9.
Completed right diaphragmatic peritonectomy, bare diaphragmatic fibers and excised specimen (blue arrow right kidney, black star right adrenal gland)
Figure 10.
Figure 10.
The algorithm used in our center in the approach of patients with peritoneal carcinomatosis HIPEC: hyperthermic intraperitoneal chemotherapy; ECOG: ECOG performance status; CT: computed tomography; PET/CT: positron emission tomography/computed tomography
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