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Il Giornale di Chirurgia

La pelviperitonectomia con chemioipertermia intraoperatoria nella malattia neoplastica avanzata del colon-retto

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Background: Cytoreductive peritonectomy with hyperthermic intraoperative chemotherapy (HIPEC) is an established therapy for patients with gastrointestinal, gynaecological metastasised peritoneal carcinomatosis as well as primary peritoneal carcinomatous tumours. Surgical therapy of peritoneal surface malignancy from colorectal origin in combination with Hyperthermic Intraoperative Peritoneal Chemotherapy (HIPEC) has now become an established treatment approach in specialised centres. In this subset of patients hyperthermic intraperitoneal chemotherapy (HIPEC), after colo-rectal resection, may improve long-term survival. The available literature, in according with ours experience, suggests that, with appropriate patient selection, cytoreduction and HIPEC can be an effective therapy, particularly when all macroscopic tumor deposits are removed.
Methods: Over the period from Genuary 2006 to April 2009, 5 patients affected by colorectal cancer underwent HIPEC in the surgical division “V. Bonomo” of Bari Hospital, after adequate criteria selection.
Results: Median follow-up was 12 months. Complete clinical regression was achieved in all the 5 patients treated; 2 patiens are died for other causes, while the remaining 3 patients are alive, but 2 of these with abdominal recurrence.
Conclusions: This procedure requires a high level of expertise. HIPEC with Bevacizumab and 5-FU, following cytoreductive surgery and Folfox 4 (systemic Chemotherapy), is now an entire part of treatment of peritoneal dissemination of colorectal malignancy, and it’s possible to hope prolonged survival, while the pathologic subtype remains the dominant factor in survival.

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