Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis. Initial experience of a cancer center in Brazil

Abstract

2112 Background: Peritoneal Carcinomatosis (PC) may represent a terminal manifestation of malignant abdominal neoplasm. The natural history of PC showed a median survival time between 6 and 8 months. In the last decade the use of Cytoreductive Surgery (CS) with Perioperative Intraperitoneal Chemotherapy (PIC) has been associated with improvements in survival and quality of life. Methods: All patients had cytoreductive surgery and perioperative intraperitoneal chemotherapy. All anesthesic procedures, as well as, all peritonectomy procedures were performed by the same anesthesiologist and surgeon. A combination of Cisplatin and Doxorubicin were used for gynecological malignancies in perioperative time, followed by 5-day cycle of intraperitoneal Paclitaxel in the postoperative period. For PC from digestive tract malignancies perioperative chemotherapy with CDDP/Mytomicin were used. The duration of chemotherapy was 90 minutes with a temperature of 41 - 42°C. Results: The study included 26 patients (17 female and 9 male) between October 2002 and November 2004. The median age was 52(range 46–72)years. Nine patients had PC from colorectal cancer, 8 ovarian cancer, 3 peritoneal mesothelioma, 3 appendiceal adenocarcinoma, 1 peritoneal pseudomixoma, 1 suprarenal carcinoma and 1 hepatic fibrolamelar tumor. All patiens had complete cytoreductive surgery (C0). The median operative time was 14,2 hours. The median time in ICU was 1,6 days. Abdominal septic complications occurred in 6 patients. Others abdominal complications as digestive and urinary fistulas and abdominal collections occurred in 3 patients and were treated by nonoperative procedures. Febrile neutropenia, leukopenia and thrombocytopenia occurred in 6 patients.Postoperative complications had associated with heavily pretreated patients. No deaths occurred in this series. Conclusions: With a judicious patients’s selection, the aggressive treatment of cytorreductive surgery combined with perioperative intraperitoneal chemotherapy is feasible. In specialized centers, postoperative complications occurs in an acceptable level. No significant financial relationships to disclose.