Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal carcinomatosis. Preliminary results and cost from two centers in Greece.

PURPOSE: To report our preliminary experience in the combined treatment of peritoneal carcinomatosis (PC) using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). PATIENTS AND METHODS: This prospective study included patients with PC from gynaecological, gastric and colon cancer, treated in two centers. Cytoreductive surgery included the peritonectomy procedures described by Jacquet and Sugarbaker as well as multivisceral resections in order to achieve a complete macroscopical cancer eradication. The HIPEC that followed was performed via the open abdomen technique. RESULTS: Twenty-four patients (3 men and 21 women, mean age 60 years) were treated. Twelve patients had PC from ovarian cancer, 7 from colon, 3 from gastric and 2 from uterine cancer. The mean duration of the procedure was 7.83 h (range 5 -12.30). Macroscopically, complete cytoreduction (CC) was achieved in 18 (75%) patients. Two (8.3%) patients died in the first 30 days. The overall morbidity was 42% and 2 patients were reoperated. The mean follow up was 22 months (range 3-36). The overall 1-year survival was 59.1%; concerning the gynaecological cancers it was 53.8% (mean survival 11.7 months) and for gastrointestinal cancers it was 44.4% (mean survival 9.5 months). CONCLUSION: Our preliminary data suggest that the combined treatment of cytoreduction plus HIPEC for PC is associated with acceptable mortality and morbidity and offers an improved survival in these patients. An optimal patient selection and establishment of experienced centres are of paramount importance.

Long-term survival in advanced ovarian carcinoma following cytoreductive surgery with standard peritonectomy procedures.

The impact of cytoreductive surgery with standard peritonectomy procedures has not been extensively assessed in the treatment of advanced ovarian cancer. The aims of the study are to report the long-term results of patients with advanced ovarian cancer undergoing cytoreductive surgery with standard peritonectomy procedures and to identify the prognostic indicators that may affect outcome. The records of 74 women with advanced ovarian cancer were retrospectively reviewed. Clinical indicators were correlated to survival. The hospital mortality and morbidity rates were 13.5% and 28.4%, respectively. Complete or near-complete cytoreduction was possible in 78.4% of the patients. Overall 10-year survival rate was 52.5%. Complete cytoreductive surgery, small-volume tumor, low-grade tumor, the absence of distant metastases, the use of systemic adjuvant chemotherapy, performance status >70%, and limited extent of peritoneal carcinomatosis were favorable indicators of survival. Complete cytoreduction (P= 0.000) and treatment with systemic chemotherapy (P= 0.001) independently influenced survival. Recurrence was recorded in 37.8% of the patients and was independently influenced by the tumor grade (P= 0.037). Cytoreductive surgery with standard peritonectomy procedures followed by adjuvant chemotherapy offers long-term survival in women with advanced ovarian cancer who have limited peritoneal carcinomatosis and no distant and irresectable metastases.

Long-term results of surgical treatment of hydatid disease.

BACKGROUND/AIMS: Non-radical surgery is the preferred method of treatment of hydatid liver disease, and is associated with low mortality and recurrence rate. The purpose of the study is the retrospective analysis of the outcome of patients who were treated surgically in a single institution. MATERIAL AND METHODS: Between 1987 and 2005, 59 patients, mean age 58.2 +/- 15.9 (13-83) years, underwent surgery for liver hydatid disease. The patients were reassessed with physical examination, serological tests and radiological examination for the evaluation of the recurrence rate. RESULTS: Most cysts were solitary, the more frequently affecting the right lobe of the liver. Radical surgery was possible in four cases (6.8%) that were classified as PNM stage I. Partial cystectomy and omentoplasty was performed in 37 patients (62.7%) and external drainage with partial cystectomy in 18 patients (30.5%). The hospital morbidity was 27.2% and was found to be related to ASA class (p = 0.019). Hospital mortality was 5.1%. The median follow-up time was 94 (1-228) months and 45 out of 59 patients (76.3%) were reassessed, but no recurrence was recorded. There was no significant difference in morbidity, mortality, and hospital stay between partial cystectomy combined with external drainage or omentoplasty (p > 0.05). CONCLUSIONS: PNM staging seems to be a reliable tool in selecting patients with liver hydatid disease for non-radical or radical surgery. Omentoplasty is an easy and effective surgical method for the treatment of hepatic echinococcosis but is not different than partial cystectomy and external drainage in regard to morbidity, mortality, and recurrence.