Does Hyperthermic Intraperitoneal Perfusion Affect the Outcome After Cytoreductive Surgery?

Abstract

Outcomes of hyperthermic intraperitoneal chemoperfusion (HIPEC) added to cytoreductive surgery were studied in experimental and clinical settings. 32 female Wistar rats with peritoneal carcinomatosis were used in the experiment. Rats were randomized into 4 groups (8 rats each): I – control group; II – cytoreduction; III – hyperthermic intraperitoneal perfusion without drugs (HIPEP); IV – cytoreduction + HIPEP. In clinical part of the study 7 patients with pseudomixoma peritonei underwent cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC). As the result of the experiment post-operative morbidity taken as post-operative complications and the restoration of body weight after surgery was more severe in animals who received combination of cytoreductive surgery + HIPEP compared to animals who received the surgery or HIPEP alone. The median survival of rats in the control group, cytoreduction, HIPEP and cytoreduction + HIPEP were 8.5, 25 (p=0.007 compared to control), 23.5 (p=0.003 compared to control) and 19.5 (p=0.034 compared to control) days respectively. In clinical part of the study post-operative complications were registered in 2 patients, one of them died on day 12 after the surgery. The pattern of complications was mainly determined by the volume of cytoreductive surgery. Two more patients died due to the tumor progression. Four patients are currently alive with follow-up 4−28 months. Cytoreductive surgery combined with HIPEC should be performed in patients with pseudomyxoma peritonei to increase their survival time. Morbidity from this approach has to be reduced by formulating the strategy of optimal cytoreduction in the studies including larger number of patients.