P0147 Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis at st luke’s medical center: 2-Year experience from a pilot study

Abstract

Background Cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS + HIPEC) is an evolving treatment option for peritoneal carcinomatosis. Several large centres have consistently shown a significant survival advantage in patients subjected to this aggressive procedure despite its associated morbidity. We present the survival outcomes of patients with peritoneal carcinomatosis who were treated with CRS + HIPEC at St Luke’s Medical Center as an early experience in the Philippines. Methods This prospective, phase 2 single-institution study was done on a series of patients with peritoneal carcinomatosis from primary or recurrent epithelial ovarian cancer, colorectal, and appendiceal adenocarcinoma. Patients underwent CRS with or without HIPEC from January 2012 to December 2013. Patient demographics, tumour histology, peritoneal carcinomatosis index, surgical details, and clinical outcomes were prospectively recorded and reviewed. Findings A total of 35 patients were enrolled with 38 cytoreductive surgeries (35 primary, three secondary) with 28 HIPEC procedures. There were 25 patients with gynaecological peritoneal carcinomatosis (23 ovarian, two tubal), seven with colorectal peritoneal carcinomatosis (three appendiceal), and three patients with sarcomatosis. Cytoreduction was completed in 31 patients with a median PCI of 20. Mean operating time was 7.87 h with an average of four major resections/CRS. Major morbidity was observed in 34.29% which included anastomotic leaks, fistulae, and abscesses with a 17.14% reoperation rate. Mortality rate is 5.7% due to cardiogenic shock and pulmonary embolism. With a median follow-up of 7 months, mean overall survival was 16.38 ± 1.89 months with a median disease free survival of 13 months (95% confidence interval 5.65–20.82). The overall 1 year survival rate was 73% (ovarian peritoneal carcinomatosis 73%, colorectal peritoneal carcinomatosis 67%, and appendiceal peritoneal carcinomatosis 100%). Interpretation Long-term survival of patients with peritoneal carcinomatosis is only achieved with CRS + HIPEC, which carries a significant but acceptable morbidity. The clinical outcomes observed in this early experience approximate those reported in the literature.