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ABDOMINAL CANCER WITH PERITONEAL CARCINOMATOSIS TREATED BY PERITONECTOMY PROCEDURE AND INTRAPERITONEAL CHEMOHYPERTHERMIA
Glehen O., Peyrat P., Beaujard A., Caillot J.L., Francois Y., Gueugniaud P.Y., Garbit F., Bienvenu J., Vignal J., Gilly F.-N.
Summary. The aim of this study was to estimate the results of a phase I–II prospective study in which peritoneal carcinomatosis was managed with Peritonectomy Procedure (PP) associated with Intraperitoneal Chemohyperthermia (IPCH).
Methods: Twenty two patients were included for peritoneal carcinomatosis from colorectal cancer (14), ovarian cancer (2), peritoneal malignant mesothelioma (2), gallblader cancer (1), gastric cancer (1), appendiceal cancer (1) and peritoneal pseudomyxoma (1). Peritoneal carcinomatosis was mainly advanced disease (19 stage 3 and 4, 2 stage 2, 1 stage 1). All the patients underwent surgical resection of their primary tumor with PP as described by Sugarbaker and IPCH (with mitomycine C, cisplatinium or both). IPCH used in this study was a “closed sterile circuit” device with inflow temperatures ranging from 46 to 48°C. IPCH was performed on the same day as PP (12/22) or delayed (10/22).
Results: Significant down staging of peritoneal carcinomatosis was achieved for 18 patients. One patient died postoperatively while morbidity rate was 7/22 (2 long postoperative ileus, 2 grade 3 leucopenia, 2 anastomotic leakage and 1 biliary fistula).
Conclusions: PP combined with immediate IPCH is an aggressive treatment. Despite a high morbidity, this association appears to be an effective therapy in peritoneal carcinomatosis. Larger phase III studies are now needed to demonstrate its efficacy on long-term survival.