Hipec in the management of metachronous peritoneal carcinomatosis: A single-center retrospective analysis

Cytoreductive surgery (CRS) associated with hyperthermic intra-peritoneal chemotherapy (HIPEC) represents a potentially curative treatment for metachronous peritoneal carcinomatosis (MPC) secondary to colorectal carcinoma (CRC), ovarian cancer (OC), or pseudomixoma peritonei (PMP). However, CRS-HIPEC is still accompanied by a high morbidity. We retrospectively collected data and analysed the outcome of consecutive HIPEC procedures performed in our unit between 2002 and 2014. In the study period 41 patients (Pts) with MPC underwent CRS-HIPEC. Patient age was 57.7 ± 10.1 years (range 32–77), Female/Male: 34/7. The median follow-up was 22.6 months. The MPC was secondary to OC in 19 Pts (46%), CRC in 14 Pts (34%), and PMP in 8 Pts (20%). Closed HIPEC procedure was performed in the early phase of our experience in 11 Pts (26.8%). Cisplatin (43 mg/m2/l) and Adriamicin (15.25 mg/m2/l) were administered for OC, whereas Cisplatin (25.0 mg/m2/l) and Mitomycin C (3.3 mg/m2/l) for both CRC and PMP. HIPEC was performed for 60 min at 41 °C, and gastrointestinal anastomosis were completed after perfusion. The median operation time was 390 min (95%CI: 366–426). No death occurred in the intraoperative or early postoperative period. The median hospital stay was 15 days (95% CI: 14–22). The overall survival at 1, 3 and 5 years were 82%, 53% and 33%, respectively. Although no significant survival difference was observed by stratifying for closed vs. open HIPEC at 1 year (P = 0.0798) and 3 years (P = 0.0867), within these time-points the Kaplan–Meier curves showed a better cumulative survival probability for Pts who underwent the open procedure. In our experience, CRS-HIPEC has revealed to be an effective treatment for MPC from OC, CRC or PMP, with an admissible morbidity and mortality.