Chirurgia citoriduttiva associata a chemioterapia intraperitoneale in ipertermia (HIPEC) nel trattamento della carcinosi peritoneale di origine colorettale
Cioppa T., Vaira M., Bing C., D'Amico S., Caponi A., Fiorentini G., De Simone M.
Purpose:To confirm the findings from international literature that aggressive cytoreduction in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is superior to standard treatment in patients with peritoneal carcinomatosis of colorectal cancer origin.
Patients and Methods: From October 1996 to March 2009, 411operations for Peritoneal carcinomatosis (PC) were performed; in 232 cases cytoreduction plus HIPEC, was carried out. 72 operations for carcinosis of colorectal origin were perfomed: 44 cytoreduction plus HIPEC, 12 cytoreduction+EPIC (early postoperative intraperitoneal chemotherapy) and 16 debulking or explorative laparoscopies/laparotomies were performed.
For the present study we considered only the 44 patients with PC of colorectal origin that were treated with citoreductive surgery, peritonectomy and HIPEC with semi-closed abdomen technique.
Results: Morbidity rate was 31.8%; reintervention was necessary in 6 cases. Perioperative mortality was 2.2%. At univariate analysis, residual nodules larger than 2.5 mm (CCR-2) (P = 0.013) and Peritoneal
Cancer Index (PCI) >16 (P=0.033) were associated with a higher incidence of postoperative complications. In our experience the patients treated with Oxaliplatin and with PCI<16 show an acceptable result with a median survival time of 27 months.
Conclusion: Cytoreduction followed by HIPEC improves survival in patients with peritoneal carcinomatosis of colorectal origin. The correct patient selection reduce morbidity and mortality. Completeness of citoreduction (CCR) has proven to be the most important prognostic factor predictive of survival also in our experience.
