[Experience of cytoreduction with peritonectomy and hyperthermic intraperitoneal chemotherapy in ovarian cancer]. / Experiencia de la citorreducción con peritonectomía y quimioterapia intraperitoneal hipertérmica en cáncer de ovario.

Background: Currently, epithelial ovarian cancer is diagnosed in advanced stages (EC IIIC) in 75-80% of cases worldwide. In this group of patients treatment with neoadjuvant chemotherapy is started, followed by interval cytoreduction of residual disease and even require peritonectomy with application of hyperthermic intraperitoneal chemotherapy (HIPEC). Objective: To identify the overall survival and progression-free survival associated with peritonectomy, in patients with peritoneal carcinomatosis secondary to ovarian cancer treated in the oncology gynecology service from January 2009 to January 2019 at the UMAE Hospital de Oncología Centro Médico Nacional Siglo XXI. Material and methods: Observational, descriptive, cross-sectional, retrospective study, information was obtained from the clinical file of patients treated with peritonectomy with the use of hyperthermic intraperitoneal chemotherapy in the gynecological oncology service from January 2009 to January 2019 at the UMAE Hospital de Oncología Centro Médico Nacional Siglo XXI. Results: Information was obtained from a total of 36 patients (n=100%), 36.1% received intraperitoneal chemotherapy and 63.8% underwent cytoreduction without the application of intraoperative chemotherapy. The most frequently used drug was cisplatin followed by mitomycin. There was no statistical significance when comparing both groups, however there was a trend in favor of the use of intraoperative chemotherapy by obtaining a greater number of months in terms of overall survival. Conclusion: Peritonectomy with hyperthermic intraperitoneal chemotherapy is an option in selected patients with advanced stage ovarian cancer in primary and recurrent surgery, as well as in patients with platinum-resistant ovarian cancer.

Introducción: en la actualidad, el cáncer de ovario epitelial se diagnostica en etapas avanzadas (EC IIIC) en 75-80% de los casos a nivel mundial. En este grupo de pacientes se inicia el tratamiento con quimioterapia neoadyuvante, seguida de citorreducción de intervalo de la enfermedad residual e incluso requieren de peritonectomía con aplicación de quimioterapia intraperitoneal hipertérmica (HIPEC). Objetivo: identificar la sobrevida global y sobrevida libre de progresión asociada a la realización de peritonectomía, en pacientes con carcinomatosis peritoneal secundario a cáncer de ovario tratadas en el servicio de Ginecología Oncológica de enero de 2009 a enero de 2019 en el Hospital de Oncología Centro Médico Nacional Siglo XXI (CMN SXXI). Material y métodos: estudio observacional, descriptivo, transversal, retrospectivo, se obtuvo información del expediente clínico de pacientes tratados con peritonectomía con uso de quimioterapia intraperitoneal hipertérmica en el servicio de Ginecología Oncológica de enero de 2009 a enero de 2019 en el Hospital de Oncología CMN SXXI. Resultados: se obtuvo información de un total de 36 pacientes (n = 100%), el 36.1% recibió quimioterapia intraperitoneal y al 63.8% se les realizó citorreducción sin la aplicación de quimioterapia intraoperatoria. El fármaco utilizado con mayor frecuencia fue el cisplatino seguido por mitomicina. No hubo significancia estadística al comparar ambos grupos, sin embargo hubo una tendencia a favor del uso de quimioterapia intraoperatoria al obtener un mayor número de meses en cuanto a sobrevida global. Conclusión: la peritonectomía con quimioterapia intraperitoneal hipertérmica es una opción en pacientes seleccionados de cáncer de ovario en etapa avanzada en cirugía primaria y recurrente, así mismo en paciente con cáncer de ovario platino-resistentes.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered via a modified perfusion system for peritoneal carcinomatosis of colorectal origin.

BACKGROUND AND PURPOSE: The long-term survival of patients with peritoneal carcinomatosis of colorectal origin has been achieved with cytoreductive surgery, which removes all macroscopic implants, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The current technology for administering intraperitoneal heated chemotherapy is expensive and, for some institutions, unaffordable. We conducted this study to assess the temperature stability provided by a modified, inexpensive system, to offer a simple and low cost alternative to the standard HIPEC delivery equipment. METHODS: Ten patients with histologically diagnosed peritoneal metastases of adenocarcinoma or pseudomyxoma peritonei underwent cytoreductive surgery and received HIPEC with 5-fluorouracil for 90 min, delivered via our modified system. The temperature was recorded from two probes: one in the inflow catheter and one in the outflow catheter. The intra-abdominal temperature was monitored meticulously to maintain it at between 41 and 42 °C. RESULTS: All patients underwent cytoreductive surgery and HIPEC using our modified delivery system. Temperature stability was achieved in all patients, with a mean of 41.4°. There were no thermal injuries associated with any of the ten perfusions. The mean hospital stay was 15 days and the median survival was 30 months. CONCLUSION: Analysis of this data demonstrates that the uniform delivery of HIPEC at 41° with this modified system is feasible and safe. The outcome of the patients treated with cytoreductive surgery and HIPEC with this modified system compares favorably to other published series. Its low cost and simple design will give more patients with peritoneal carcinomatosis access to this treatment.