Κατεύθυνση Χειρουργική ΟγκολογίαLibrary of the School of Health Sciences
Διονύσιος Βώρος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Γ. Τούτουζας, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Θεοδώρου, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Η Κυτταρομειωτική Χειρουργική και η Υπέρθερμη Ενδοπεριτοναϊκή Χημειοθεραπεία στην αντιμετώπιση της περιτοναϊκής καρκινωμάτωσης. Η εμπειρία ενός Ευρωπαϊκά αναγνωρισμένου κέντρου.
Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy for the treatment of peritoneal carcinomatosis. The experience of a single, European certified, center.
Several gastrointestinal and gynecological malignancies have the potential to disseminate and grow in the peritoneal cavity. This condition is often associated with disease progression and poor prognosis. Moreover, overall survival in patients with peritoneal carcinomatosis is generally only slightly influenced by systemic chemotherapy. Therapeutic choices are very limited for these patients.
During the last three decades, the understanding of the biology and pathways of dissemination of tumors with intraperitoneal spread, and the understanding of the protective function of the peritoneal barrier against tumoral seeding, has prompted the concept that PC is a loco-regional disease and new promising methods have been proposed to improve loco-regional control of the disease and ultimately to increase survival.
The combination of aggressive cytoreductive surgery (CRS) to remove macroscopic disease, with intraperitoneal hyperthermic chemotherapy (HIPEC) to eliminate microscopic residual disease has brought promising results in the treatment of peritoneal carcinomatosis.
Material and Methods
This is a retrospective study of 348 patients with peritoneal carcinomatosis that were treated with cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) by the same surgeon in two different hospitals.
Ovarian cancer was the most frequent cause of peritoneal carcinomatosis in our patients (37%) followed by colorectal cancer (23%) and pseudomixoma peritonei (16%). Other causes were gastric cancer, endometrial cancer, peritoneal mesothelioma. Most of the patients were women (70%) with a median age of 54 years.
We studied morbidity and mortality of our patient group and overall survival. Furthermore, we focused our attention on HIPEC safety features and on the necessity of ICU for these patients.
Median survival of our patient group was 32 months, regardless the primary cancer site. Patients with peritoneal mesothelioma and pseudomixoma had the better median survival rates in comparison with the rest of the group. The lowest survival rates were recorded in patients with gastric cancer. Median survival rates were higher in patients with peritoneal cancer index (PCI) lower than 15.
First year survival was 87% and 45%, 22% for the second and third year respectively. Major complications, grade III and IV Clavien Dindo classification, were recorded in 39% of our patients and mortality was limited to 5%.
Cytoreductuve surgery (CRS) and HIPEC have proven to be a safe and valid method in the treatment of peritoneal carcinomatosis (PC), in specialized centers all over the world. Our center experience, place our hospital in the list of the specialized centers worldwide. We have reported excellent survival results with acceptable morbidity and mortality percentages.
Main subject category:
Peritoneal carcinomatosis, HIPEC, Ovarian cancer, Pseudomixoma peritonei, Peritoneal mesothelioma, Colon Cancer