Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy
BACKGROUND Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. A treatment plan combining cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy (HIIC) was devised and tested to treat such patients. The purpose of this study was to evaluate the morbidi...
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Published in | Cancer Vol. 77; no. 12; pp. 2622 - 2629 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Wiley Subscription Services, Inc., A Wiley Company
15.06.1996
Wiley-Liss |
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Abstract | BACKGROUND
Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. A treatment plan combining cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy (HIIC) was devised and tested to treat such patients. The purpose of this study was to evaluate the morbidity and mortality associated with this treatment approach.
METHODS
Sixty patients with peritoneal carcinomatosis from adenocarcinoma of the colon or appendix were included in the study. Extensive cytoreductive surgery was combined with heated intraperitoneal mitomycin in an intraoperative lavage technique followed by one cycle of early postoperative intraperitoneal 5‐fluorouracil. Eleven clinical variables were selected and statistically correlated with morbidity and mortality.
RESULTS
Twenty‐five complications occurred in 21 patients (morbidity = 35%). Morbidity related to gastrointestinal function included anastomotic leak (n = 6), bowel perforations (n = 5), bile leak (n = 3), and pancreatitis (n = 2). Four patients presented with severe hematologic toxicity (Grade 3 or 4). There were three cases of postoperative bleeding, one case of abdominal wound dehiscence, and one case of pulmonary embolism. Morbidity was significantly associated with three clinical factors: male sex, high intraabdominal temperature during HICC, and duration of the surgical procedure. Enteral complications (bowel fistula and anastomotic leak) occurred in patients with a significantly higher number of peritonectomy procedures and a significantly longer operation. Three patients died within 8 weeks after the procedure (mortality = 5%). Mortality was significantly associated with age and intraabdominal temperature.
CONCLUSIONS
Cytoreductive surgery combined with HICC is associated with a 35% morbidity rate and a 5% mortality rate. Extensive surgery (duration and number of peritonectomy procedures) and high intraabdominal temperature represent the major risk factors for postoperative morbidity and mortality of patients treated with this new therapeutic approach. Cancer 1996;77:2622‐9. |
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AbstractList | BACKGROUND
Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. A treatment plan combining cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy (HIIC) was devised and tested to treat such patients. The purpose of this study was to evaluate the morbidity and mortality associated with this treatment approach.
METHODS
Sixty patients with peritoneal carcinomatosis from adenocarcinoma of the colon or appendix were included in the study. Extensive cytoreductive surgery was combined with heated intraperitoneal mitomycin in an intraoperative lavage technique followed by one cycle of early postoperative intraperitoneal 5‐fluorouracil. Eleven clinical variables were selected and statistically correlated with morbidity and mortality.
RESULTS
Twenty‐five complications occurred in 21 patients (morbidity = 35%). Morbidity related to gastrointestinal function included anastomotic leak (n = 6), bowel perforations (n = 5), bile leak (n = 3), and pancreatitis (n = 2). Four patients presented with severe hematologic toxicity (Grade 3 or 4). There were three cases of postoperative bleeding, one case of abdominal wound dehiscence, and one case of pulmonary embolism. Morbidity was significantly associated with three clinical factors: male sex, high intraabdominal temperature during HICC, and duration of the surgical procedure. Enteral complications (bowel fistula and anastomotic leak) occurred in patients with a significantly higher number of peritonectomy procedures and a significantly longer operation. Three patients died within 8 weeks after the procedure (mortality = 5%). Mortality was significantly associated with age and intraabdominal temperature.
CONCLUSIONS
Cytoreductive surgery combined with HICC is associated with a 35% morbidity rate and a 5% mortality rate. Extensive surgery (duration and number of peritonectomy procedures) and high intraabdominal temperature represent the major risk factors for postoperative morbidity and mortality of patients treated with this new therapeutic approach. Cancer 1996;77:2622‐9. Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. A treatment plan combining cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy (HIIC) was devised and tested to treat such patients. The purpose of this study was to evaluate the morbidity and mortality associated with this treatment approach. Sixty patients with peritoneal carcinomatosis from adenocarcinoma of the colon or appendix were included in the study. Extensive cytoreductive surgery was combined with heated intraperitoneal mitomycin in an intraoperative lavage technique followed by one cycle of early postoperative intraperitoneal 5-fluorouracil. Eleven clinical variables were selected and statistically correlated with morbidity and mortality. Twenty-five complications occurred in 21 patients (morbidity = 35%). Morbidity related to gastrointestinal function included anastomotic leak (n=6), bowel perforations (n=5), bile leak (n=3), and pancreatitis (n=2). Four patients presented with severe hematologic toxicity (Grade 3 or 4). There were three cases of postoperative bleeding, one case of abdominal wound dehiscence, and one case of pulmonary embolism. Morbidity was significantly associated with three clinical factors: male sex, high intraabdominal temperature during HIIC, and duration of the surgical procedure. Enteral complications (bowel fistula and anastomotic leak) occurred in patients with a significantly higher number of peritonectomy procedures and a significantly longer operation. Three patients died within 8 weeks after the procedure (mortality = 5%). Mortality was significantly associated with age and intraabdominal temperature. Cytoreductive surgery combined with HIIC is associated with a 35% morbidity rate and a 5% mortality rate. Extensive surgery (duration and number of peritonectomy procedures) and high intraabdominal temperature represent the major risk factors for postoperative morbidity and mortality of patients treated with this new therapeutic approach. |
Author | Ettinghausen, Steven E. Stephens, Arvil D. Steves, Mark A. Sugarbaker, Paul H. Dalton, Rory R. Jacquet, Pierre Averbach, Andrew M. Chang, David |
Author_xml | – sequence: 1 givenname: Pierre surname: Jacquet fullname: Jacquet, Pierre – sequence: 2 givenname: Arvil D. surname: Stephens fullname: Stephens, Arvil D. – sequence: 3 givenname: Andrew M. surname: Averbach fullname: Averbach, Andrew M. – sequence: 4 givenname: David surname: Chang fullname: Chang, David – sequence: 5 givenname: Steven E. surname: Ettinghausen fullname: Ettinghausen, Steven E. – sequence: 6 givenname: Rory R. surname: Dalton fullname: Dalton, Rory R. – sequence: 7 givenname: Mark A. surname: Steves fullname: Steves, Mark A. – sequence: 8 givenname: Paul H. surname: Sugarbaker fullname: Sugarbaker, Paul H. |
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Keywords | Antineoplastic agent Human Intraperitoneal administration Carcinosis Mortality Intraoperative Malignant tumor Morbidity Antibiotic Chemotherapy Exeresis Heating Abdominal disease Surgery Pyrimidine derivatives Combined treatment Fluorine Organic compounds Peritoneum |
Language | English |
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Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. A treatment plan combining cytoreductive surgery and heated... Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. A treatment plan combining cytoreductive surgery and heated intraoperative... |
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SubjectTerms | Adult Aged Antineoplastic agents Antineoplastic Agents - administration & dosage Biological and medical sciences Carcinoma - drug therapy Carcinoma - surgery Carcinoma - therapy Combined treatments (chemotherapy of immunotherapy associated with an other treatment) complications Female Humans hyperthermia Hyperthermia, Induced Intraoperative Care intraperitoneal chemotherapy Male Medical sciences Middle Aged mitomycin C Multivariate Analysis Peritoneal Lavage Peritoneal Neoplasms - drug therapy Peritoneal Neoplasms - surgery Peritoneal Neoplasms - therapy Pharmacology. Drug treatments Time Factors Treatment Outcome |
Title | Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy |
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