Complications and Toxicities After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Abstract

The purpose of our study was to evaluate the perioperative complications, toxicity, mortality rates after cytoreductive surgery (CRS), and effects of hyperthermic intraperitoneal chemotherapy (HIPEC) used in the treatment of peritoneal surface malignancies. Between September 2007 and March 2012, we performed 118 CRS and HIPEC with the closed abdominal technique on 115 patients with peritoneal carcinomatosis (PC). Systemic toxicities were graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 criteria and were analyzed from a prospectively collected database. The mean age of patients was 53.4 (range, 20-82) years; 76.3% were female. PC was synchronous to primary cancer in 53.4% of patients, metachronous in 41.5%, and recurrent in 5.1% of the patients. PCI was ≥15 in 53.4% of the patients, and CC-0 cytoreduction was achieved in 68.5% of the patients. Perioperative mortality was observed in 9 (7.6%) patients. A total of 98 complications were observed in 46 (39.0%) patients, and 4 patients underwent 6 reoperations for perioperative surgical complications. We observed toxicity in 25.4% of the patients, nephrotoxicity in 18.6%, and hematological toxicity in 13.6% of patients. No significant difference was observed among age, gender, PCI and CC scores, origin of the primary tumor, and occurrence of toxicity and surgical complications. Prolonged operation times resulted in higher complication and/or toxicity rates (P<0.01). Cytoreductive surgery and HIPEC is a combined treatment strategy for peritoneal surface malignancies with acceptable complication and toxicity rates.