Original communication| Volume 113, ISSUE 6, P631-636, June 1993

Morbidity and mortality of cytoreductive surgery and intraperitoneal chemotherapy

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      Background. Peritoneal carcinomatosis has been regarded as a uniformly lethal clinical entity. Recently, dose-intensive treatments combining cytoreductive surgery and intraperitoneal chemotherapy have resulted in long-term survival in selected patients.
      Methods. This article reports the morbidity and mortality associated with this new treatment strategy in 45 consecutive treatments of 43 patients with peritoneal carcinomatosis treated during an 18-month interval.
      Results. The duration of median postoperative ileus was 21 days, and increased age of the patient and extent of cytoreduction caused an increased incidence of ileus. Twenty-one complications occurred in 17 patients (37.7%). Complications related to enteric function included fistula (n = 4), bile leak (n = 1), pancreatitis (n = 1), and anastomotic disruption (n = 1). There were two early and two late episodes of postoperative bleeding requiring reoperation. Six patients had pneumonia and one had deep vein thrombosis. There were no deaths. Six of the seven complications related to enteric function occurred in patients who had undergone induction intraperitoneal chemotherapy before cytoreductive surgery plus early postoperative intraperitoneal chemotherapy.
      Conclusions. As a result of these findings, induction intraperitoneal chemotherapy is only recommended for patients with low-volume intraabdominal cancer. In most patients surgical removal of peritoneal carcinomatosis before intraperitoneal chemotherapy is recommended. Because of the significant morbidity related to treatment of peritoneal carcinomatosis, careful patient selection and favorable long-term results of treatment are required.
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        • Jenkins J
        • Sugarbaker P.H.
        • Gianola F.J.
        • Myers C.H.
        Technical considerations in the use of intraperitoneal chemotherapy administered by Tenckhoff catheter.
        Surg Gynecol Obstet. 1982; 154: 858-864
        • Pfeifle C.E.
        • Howell S.B.
        • Markman M.
        • et al.
        Totally implantable system for peritoneal access.
        J Clin Oncol. 1984; 2: 1277-1280
        • Sugarbaker P.H.
        Clinical experience with a new totally implanted peritoneal access device: the Burron Intestoplant.
        Reg Cancer Treat. 1989; 1: 140-144
        • Sugarbaker P.H.
        • Graves T.
        • DeBruijn E.A.
        • et al.
        Early postoperative intraperitoneal chemotherapy as an adjuvant therapy to surgery for peritoneal carcinomatosis from gastrointestinal cancer: pharmacological studies.
        Cancer Res. 1990; 50: 5790-5794
        • McVie J.G.
        • Dikhoff T.
        • Van Der Heide J.
        • et al.
        Tissue concentration of platinum after intraperitoneal cisplatin administration in patients.
        in: 2nd ed. Proc Am Assoc Cancer Res. 20. 1985: 162
        • Ozols R.F.
        • Locker G.Y.
        • Doroshow J.H.
        • et al.
        Pharmacokinetics of Adriamycin and tissue penetration in murine ovarian cancer.
        Cancer Res. 1979; 39: 3209-3214
        • Park J.G.
        • Kramer B.S.
        • Steinberg S.M.
        • et al.
        Chemosensitivity testing of human colorectal carcinoma cell lines using a tetrazolium-based colorimetric assay.
        Cancer Res. 1987; 47: 5875-5879
        • Sugarbaker P.H.
        Peritoneal carcinomatosis from large bowel and appendical cancer: a new approach to treatment.
        Postgrad Adv Colorectal Surg. 1991; 11-X: 1-14
        • Tenckhoff H.
        2nd ed. Manual for chronic peritoneal dialysis. University of Washington School of Medicine, Seattle1974
        • Vidal-Jove J.
        • Sweatman T
        • Israel M
        • et al.
        A curative approach to malignant peritoneal mesothelioma.
        Reg Cancer Treat. 1991; 3: 269-274
        • Piver M.S.
        • Lele S.B.
        • Marchetti D.L.
        • et al.
        Effect on estimated three year survival and disease free survival of optimal debulking agent (<2 cm residual) plus induction cisplatin (DDP) followed by PAC chemotherapy for stage III and IV ovarian carcinoma.
        (Abstract)in: 2nd ed. Proc Am Soc Clin Oncol. 6. 1987: 111
        • van Oosterom A.T.
        • Jol C.
        • de Bruijn E.A.
        • et al.
        New trends in cancer chemotherapy with mitomycin C.
        in: Excerpta Medica, Amsterdam1987: 192-200
        • Sugarbaker P.H.
        Cytoreductive surgery and intraperitoneal chemotherapy with peritoneal spread of cystadenomocarcinoma.
        Eur J Surg Suppl. 1991; 561: 75-82
        • Sugarbaker P.H.
        Surgical treatment of peritoneal carcinomatosis.
        Can J Surg. 1989; 32: 164-170
        • Cunliffe W.J.
        • Sugarbaker P.H.
        Gastrointestinal malignancy: rationale for adjuvant therapy using early postoperative intraperitoneal chemotherapy.
        Br J Surg. 1989; 76: 1082-1090
        • Gianola F.J.
        • Sugarbaker P.H.
        • Barofsky I.
        • White D.E.
        • Meyers C.E.
        Toxicity studies of adjuvant intravenous versus intraperitoneal 5-FU in patients with advanced primary colon or rectal cancer.
        Am J Clin Oncol. 1986; 9: 403.10