Abdominal and concomitant thoracic HIPEC, named HITAC : Technique and post-operative courses

Abstract

Introduction: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the preferred treatment for selected patients with carcinomatosis. When diaphragmatic involvement occurs, partial diaphragm resection (DR) is necessary to achieve complete cytoreduction (CC-0). In cases of macroscopic pleural invasion detected during CRS, abdominal and intrathoracic HIPEC (HITAC) through the diaphragm may be considered if pleural and peritoneal CC0 can be obtained.

Objectives: To report the combined procedure technique, postoperative course, morbidity, and long-term outcomes.

Methods: A monocentric database was used to identify cases.

Results: Seven synchronous HITAC cases were identified. Median PCI was 12 (3-39). Inflow catheter placement was behind the spleen, with outflow in the right thorax. Four patients had anastomosis and two splenectomy. Oxaliplatin was used in 4 HITAC, mitomycin in 1, and cisplatin in 2. Surgery lasted a median of 580mins (300-720), with extubation 2-4h post-op, or on day 1. Median thoracic drainage on day 1 was 657mL (300-1600), decreasing by day 3. Median drain removal was on day 8 (7-17), with hospital stay of 12 days (8-16). One patient had a postoperative pancreatic fistula and pneumonia, while the remaining 6 had no major complications. One-month residual pleural effusion was noted in one case. No pleural recurrence was observed for PMP, with a median follow-up of 88 months (30-166).

Conclusions: Combined HIPEC and intrathoracic chemotherapy is feasible without major risks. Thoracic drainage can produce high volumes postoperatively. Favorable long-term outcomes are observed in low-grade PMP.