Surgical Results of Patients with Peritoneal Carcinomatosis Treated with Cytoreductive Surgery Using a New Technique Named Aqua Dissection

Y Yonemura,Y Endou,A Mizumoto,M Miura,A Elnemr,Yan Li,H Ishibashi

doi:10.1155/2012/521487

Abstract

During 2004 to 2011, 81, 420, and 166 patients with colorectal cancer (CRC), epithelial appendiceal neoplasm (APN), and gastric cancer (GC) with PC were treated with cytoreductive surgery (CRS) plus perioperative chemotherapy. CRS was performed by peritonectomy techniques using an aqua dissection. Results. Complete cytoreduction was done in 62/81 (76.5%), 228/420 (54.3%), and 101/166 (60.8%) of patients with CRC, APN, and GC. The main reasons of incomplete resections were involvement of all peritoneal regions and diffuse involvement of small bowel. The incidence (64%, 302/470) of CC-0 resection after introduction of an aqua dissection was significantly higher than before (42%, 82/197). A total of 41 (6.1%) patients died postoperatively. Major complication (grade 3-4 complications) occurred in 126 patients (18.9%). A reoperation was necessary in 36 patients (5.4%). By the multivariate analysis, PCI scores capable of serving as thresholds for favorable versus poor prognosis in each group and CC scores demonstrated as the independent prognostic factors. Conclusions. Peritonectomy using an aqua dissection improves the incidence of complete cytoreduction, and improves the survival of patients with PC. Patients with PCI larger than the threshold values should be treated with chemotherapy to improve the incidences of complete cytoreduction.

Highlights

The current state-of-the-art treatment for the peritoneal carcinomatosis (PC) from colorectal, appendiceal, and gastric cancers consists of a comprehensive management strategy using cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) [1,2,3,4,5]
CC-0,1 resections of colorectal and appendiceal neoplasm patients with PCI ≤ 20 were performed in 89.4% (59/66) and 86.2% (168/195), but that in gastric cancer patients was done only in 67.6% (100/148)
5.6% of gastric cancer patients with PCI ≥ 20 underwent CC-0,1 resections (1/18), but CC-0,1 resections in colorectal and appendiceal neoplasm patients were performed in 20.0% (3/15) and 26.6% (60/165), respectively

Summary

Introduction

The current state-of-the-art treatment for the peritoneal carcinomatosis (PC) from colorectal, appendiceal, and gastric cancers consists of a comprehensive management strategy using cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) [1,2,3,4,5]. Patients with a low tumor volume, well/moderately differentiated tumors, and complete cytoreduction may potentially benefit from combined treatment. No survival benefit has been reported by cytoreduction alone [3]. Complete cytoreduction is sometimes difficult in patients with deep invasion into the liver hilum, lesser omentum, pelvic structures, liver parenchyma, or diffuse involvement of the mesentery and serosa of small bowel. Even by the most experienced surgeons in the world, the incidences of complete cytoreduction are reported 77% (617/802) [4]. The complete cytoreduction rate depends on the selection criteria for the CRS and the ability and experiences of the surgeons. Our Gastroenterology Research and Practice surgical techniques for the complete yet safe cytoreduction and the results after CRS will be reported; 81 (42.9%), 420 (72.7%) and 166 (51.5%)

Methods

Results

Conclusion