Introduction Cytoreductive Surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC) is a radical strategy for the treatment of disseminated intra-abdominal cancers.1Complete cytoreduction combines multiple visceral and peritoneal resections to achieve macroscopic intra-abdominal tumour clearance. Combined with HIPEC, this aims to destroy residual microscopic tumour. We report the results of this technique and early survival data in a newly established UK Peritoneal Malignancy Unit, by a team trained to deliver the service.
Method For all patients undergoing peritoneal surgery (November 2011–February 2015) data was prospectively collected on demographics, severity of disease (Peritoneal Carcinomatosis Index-PCI), surgery undertaken, pathology, operating time, intra-operative blood loss, intensive care unit (ITU) stay, length of stay (LOS), completeness of cytoreduction (CC) and postoperative morbidity/mortality.
Results Of 49 patients operated on, Complete Cytoreduction was achieved in 41 patients (84%) (CC0–37: CC1–4: CC2–8) (median age 56 years, range 29–79). The pathology included were: 29 colorectal cancers (7 primary, 22 recurrent), 8 appendiceal adenocarcinoma, 3 ovarian tumours, 9 others.
Of the 41/49 CC0/1 patients, median PCI was 9 (0–29); median intra-operative time 9 h (4–12), median blood loss 1L (0–2.5L); median ITU stay: 4 days (1–11); median LOS: 16 days (5–75). Grade 3/4 (CTCAEv3) complications occurred in 15 patients (34%). 1 patient (2.2%) returned to theatre and there was no post-operative mortality. Median follow-up was 11.4 months (range 1.5–36.4). Kaplan-Meier predicted 1-year survival was 81% and 2-year survival was 68%.
Conclusion Results from our unit demonstrate that CRS/HIPEC can be performed safely by a team trained to deliver the service. Medium-term survival rates are acceptable, in patients who would have traditionally been considered as terminal, with 68% surviving 2 years. Morbidity rates are high, but with careful case selection and aggressive treatment of post-operative complications, there was no postoperative mortality in this series.
Disclosure of interest None Declared.
Esquivel J, Sticca R, Sugarbaker P, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: A consensus statement. Ann SurgOncol. 2007;14:128–133