CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC) AS A TREATMENT OPTION FOR SELECTED PATIENTS WITH PERITONEAL CARCINOMATOSIS IN ADVANCED STAGE CANCER: A SINGLE CENTRE EXPERIENCE

Peritoneal carcinomatosis often occurs in the course of many gastrointestinal or gynaecological malignancies and patients are often left to palliative systemic chemotherapy with poor prognosis. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy offers improved outcome in selected patients. The performance of this complex procedure requires a specialized surgical institute and underlies a learning process reflected in higher percentage of complete cytoreduction and less surgical complications leading to shorter length of stay in intensive care unit and in hospital. A retrospective single-centre analysis was performed in 61 patients undergoing cytoreductive surgery and simultaneous hyperthermic intraperitoneal chemotherapy to evaluate morbidity and mortality in regard to preoperative peritoneal carcinosis index (PCI), completeness of cytoreduction score and age. The study included 61 patients who underwent 64 cytoreductive surgery and simultaneous hyperthermic intraperitoneal chemotherapy procedures between 2006 and 2013 in our department of surgery. There were 36 female patients (59%). The mean age was 58.2 years ((SD)= 12.0), mean PCI was 17.8 (SD=7.7). The principal origins of PC were colorectal adenocarcinoma (n=24), ovarian adenocarcinoma (n=14), gastric adenocarcinoma (n=9), peritoneal mesothelioma (n=8), pseudomyxoma peritonei(n=5), small bowel adenocarcinoma (n=2), and appendiceal carcinoid (n=1). Postoperative 30-day mortality and morbidity were 3.3% and 31.7%, respectively. There was a significantly higher rate of complete cytoreduction - 90.7% in period 2 compared to 34.1% in period 1. A multimodal approach combining CRS and HIPEC for patients with peritoneal carcinomatosis has been proven to offer long-term survival in a selected group of patients. A specialized team can perform this procedure with acceptable mortality and morbidity even in the process of implementation. A total of only 42 procedures in period 1 led to a significantly higher rate of complete cytoreductions with a trend towards less overall complications in period 2.