Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Surface Malignancy: Experience with 501 Procedures
- 31 May 2007
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 204 (5), 943-953
- https://doi.org/10.1016/j.jamcollsurg.2006.12.048
Abstract
Peritoneal dissemination of abdominal malignancy (PSD) has a clinical course marked by bowel obstruction and death. We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (IPHC) to treat PSD. The purpose of this article was to review our experience with IPHC. A prospective database of patients undergoing IPHC has been maintained since 1991. Patients were uniformly evaluated and treated. Demographics, performance status, resection status, primary site, and experience quartile were compared with outcomes. Univariate and multivariate analyses were performed. A total of 460 patients underwent 501 IPHC procedures. Average age was 53.0 years, and 50.4% were women. The 30-day mortality rate was 4.8%, the complication rate was 43%, and median hospital stay was 9 days. Median followup was 55.4 months, median survival was 22.2 months, and 5-year survival rate was 27.8%. Factors correlating with improved survival were performance status (p = 0.0001), primary tumor (p = 0.0001), resection status (p = 0.0001), complications (p = 0.002), previous IPHC (p = 0.006), and experience quartile (p = 0.031). On multivariate analysis, primary tumor site, performance status, resection status, and development of complications (p < 0.001) predicted outcomes. Our experience demonstrated that preoperative criteria for better outcomes include primary tumor site and performance status. Completeness of resection and development of postoperative complications are also crucial, and outcomes have improved over time. Cytoreductive surgery and IPHC represent substantial improvements in outcomes compared with historic series and best-available systemic therapy. Longterm survival is possible for selected patients who undergo the procedure.Keywords
This publication has 54 references indexed in Scilit:
- Systematic Review on the Efficacy of Cytoreductive Surgery Combined With Perioperative Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis From Colorectal CarcinomaJournal of Clinical Oncology, 2006
- Appendiceal Neoplasms With Peritoneal Dissemination: Outcomes After Cytoreductive Surgery and Intraperitoneal Hyperthermic ChemotherapyAnnals of Surgical Oncology, 2006
- Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermiaThe Lancet Oncology, 2004
- Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix CancerAnnals of Surgical Oncology, 2001
- Quality of life after intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal carcinomatosisEuropean Journal of Surgical Oncology, 2001
- Phase II Trial of Debulking Surgery and Photodynamic Therapy for Disseminated Intraperitoneal TumorsAnnals of Surgical Oncology, 2001
- Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosisCancer, 2000
- Pseudomyxoma peritoneiBritish Journal of Surgery, 1998
- Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesotheliomaZeitschrift für Krebsforschung und Klinische Onkologie, 1992
- Effect of Heat on Induction and Repair of DNA Strand Breaks in X-irradiated CHO CellsInternational Journal of Radiation Biology, 1992