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Objective: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved good long-term results in patients with peritoneal surface malignancies (PSM). High complication rates associated with the procedure have been attributed to a steep learning curve and challenge centers attempting to initiate a treatment program.
Design: Retrospective review.
Setting: Academic Surgical Oncology Service
Patients: Patients evaluated for treatment of PSM.
Interventions: CRS and HIPEC.
Main Outcome Measures: Extent of surgery, selection criteria, complications.
Results: Since the initiation of a program to treat peritoneal surface malignancies in 3/2009, 54 of 117 (46%) of evaluated patients with peritoneal surface malignancies were taken for CRS and HIPEC. Reasons that patients were not selected for surgery were equally distributed between tumor biology, tumor burden, functional status, and patient preference. Primary tumor type was appendix (18, 33%), colon (10, 19%), mesothelioma (4, 7%), gastric (4, 7%) and other (18, 33%). The extent of cytoreduction was classified by EES 1 (27%), EES 2 (39%), and EES 3 (34%) procedures. All patients spent the first 48 hours in the Surgical Intensive Care Unit following the procedure. Median length of hospitalization was 13 days (range 4-48 days). Total parenteral nutrition was required in 12 (27%) patients. Therapy was associated with 30-day morbidity (14%) and mortality (2.3%). Quality of life returned to baseline in 3 to 6 months.
Conclusions: Initial results from a new program to treat PSM suggest that CRS and HIPEC can be performed with low morbidity and mortality. Good patient selection, careful operative technique, and multidisciplinary support (surgical intensive care and nutritional services) contributed to shortening the learning curve associated with this complex treatment regimen.