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Dott. Michele De Simone
CHIRURGIA E ONCOLOGIA
www.chirurgiaeoncologia.it
 
Dott. Michele De Simone

mail: info@chirurgiaeoncologia.it

 

 

 

CYTOREDUCTION, PERITONECTOMY AND HYPERTHERMIC ANTIBLASTIC PERIT

 

ABSTRACT

AIM:
In this study we analyze the most important aspects of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) that was been accepted as the standard treatment in pseudomyxoma peritonei (PMP) with special regard to morbility, Overall Survival (OV) and Disease free survival (DFS) in ten years experience.

METHODS
:

53 patients affected by PMP was undergoing in our institution to cytoreduction and HIPEC with "semi-closed" abdomen technique. Peritonectomy procedure and completeness of cytoreduction (CCR) was classified according to Sugarbaker criteria. Preoperative evaluation always included thoracic and abdominal CT scan to stage peritoneal disease and exclude distant metastases. 51 patients of our series were treated with a protocol based on administration of Cisplatinum 100 mg/sm plus C-Mitomycin 16 mg/sm, at a temperature of 41, 5°C for 60 minutes. Anastomoses were always performed at the end of HIPEC. Mean duration of surgery was (included HIPEC) 12 hours. Continuous monitoring of hepatic and renal functions and hydroelectrolitic balance were performed in the postoperative period.

RESULTS
:

24 (45%) patients presented postoperative complications: surgical morbidity was observed in 16 patients and 6 patients were re-operated. All the complications were successfully treated and no postoperative death were observed. The analysis of risk factors for postoperative morbidity rate was performed: gender, age, body surface, duration of surgery, Peritoneal Cancer Index (PCI) and tumor residual value (CC score) was considered as risk factors. No statistically significant correlationwas found at multivariate analysis: only the CC score was statistically significative. The overall survival (OS) in our experience was been 81,8%, with a disease-free survival (DFS) of 80% at 5 years and of 70% at 10 years respectively.

CONCLUSION
:

In our experience, even if HIPEC combined with cytoreductive surgery involves a high risk of morbidity, postoperative complications could be resolved favorably in most cases with correct patient selection and adequate postoperative care, thus minimizing mortality. The association of cytoreduction and HIPEC can be considered as the standard treatment for PMP. The OV e DFS results confirmed the validity of this combined approach for the treatment of this rare neoplasm. The impact of preoperative chemotherapy in OS, in our opinion, is due to a major aggressiveness of tumor in the patients treated.


Key Words: Peritonectomy, PMP, Pseudomyxoma peritonei, Hyperthermic perfusion, HIPEC.

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