Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis: our initial experience of implementation and detailed technique

Objective: The aim of this study is to present our initial implementation experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the light of current literature. Material and methods: Data of 7 consecutive patients who were treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis in the National Research Center for Oncology and Transplantology, between October 2016 and December 2018 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and hyperthermic intraperitoneal chemotherapy-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed.  Results: The mean age was 47 (30-62). Three patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 3 patients, ovarian cancer in 2 patients and pseudomyxoma peritonei in 2 patients. The mean Peritoneal Carcinomatosis Index was 17 (3-32), with a mean operative time of 517 (366-710) minutes. Perioperative morbidity and mortality were observed in 2 (28,5%) and one patient (14.2%), respectively. During a mean follow up of 9,6 (3-26) months, overall and disease-free survival rates were 85,7% and 83,3%, respectively. One patient with colorectal cancer (after 12 months) had retro-abdominal recurrence. The remaining patients are being followed-up without any recurrence. Conclusion: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.