| Cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis from pseudomyxoma peritonei. | |
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MedLine Citation:
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PMID: 19058307 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: To investigate the most important aspects of hyperthermic intraperitoneal chemotherapy (HIPEC) that has been accepted as the standard treatment for pseudomyxoma peritonei (PMP), with special regard to morbidity, overall survival (OS) and disease free survival (DFS) over 10 years. METHODS: Fifty-three patients affected by PMP underwent cytoreduction (CCR) and HIPEC with a "semi-closed" abdomen technique in our institution. The peritonectomy procedure and completeness of CCR were classified according to Sugarbaker criteria. Preoperative evaluation always included thoracic and abdominal CT scan to stage peritoneal disease and exclude distant metastases. Fifty-one patients in our series were treated with a protocol based on administration of cisplatinum 100 mg/m(2) plus mitomycin C 16 mg/m(2), at a temperature of 41.5 degrees centigrade for 60 min. Anastomoses were always performed at the end of HIPEC. The mean duration of surgery was 12 h including HIPEC. Continuous monitoring of hepatic and renal functions and hydroelectrolytic balance was performed in the postoperative period. RESULTS: Twenty-four patients presented with postoperative complications: surgical morbidity was observed in 16 patients and 6 patients were re-operated. All complications were successfully treated and no postoperative deaths were observed. Risk factors for postoperative morbidity were considered to be gender, age, body surface, duration of surgery, Peritoneal Cancer Index (PCI) and tumor residual value (CC score). No statistically significant correlation was found during the multivariate analysis: only the CC score was statistically significant. The OS in our experience was 81.8%, with a DFS of 80% at 5 years and of 70% at 10 years. CONCLUSION: In our experience, even if HIPEC combined with cytoreductive surgery involves a high risk of morbidity, postoperative complications can be resolved favorably in most cases with correct patient selection and adequate postoperative care, thus minimizing mortality. The association of CCR and HIPEC can be considered as the standard treatment for PMP. The OS and DFS results confirm the validity of this combined approach for the treatment of this rare neoplasm. The impact of preoperative chemotherapy on OS, in our opinion, is due to a major aggressiveness of tumors in treated patients. |
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Authors:
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Tommaso Cioppa; Marco Vaira; Camilla Bing; Silvia D'Amico; Alessandro Bruscino; Michele De Simone |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: World journal of gastroenterology : WJG Volume: 14 ISSN: 1007-9327 ISO Abbreviation: World J. Gastroenterol. Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-12-05 Completed Date: 2009-04-09 Revised Date: 2010-09-22 |
Medline Journal Info:
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Nlm Unique ID: 100883448 Medline TA: World J Gastroenterol Country: China |
Other Details:
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Languages: eng Pagination: 6817-23 Citation Subset: IM |
Affiliation:
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Department of General and Oncological Surgery, San Giuseppe Hospital, viale Boccaccio, 50053 Empoli, Florence, Italy. cioppat@tin.it |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Carcinoma / mortality, pathology, surgery, therapy* Chemotherapy, Adjuvant Chemotherapy, Cancer, Regional Perfusion* Disease-Free Survival Female Humans Hyperthermia, Induced* Kaplan-Meiers Estimate Male Middle Aged Neoplasm Staging Peritoneal Neoplasms / mortality, pathology, surgery, therapy* Postoperative Complications / etiology Proportional Hazards Models Pseudomyxoma Peritonei / mortality, pathology, surgery, therapy* Reoperation Risk Assessment Time Factors Treatment Outcome |
| Comments/Corrections | |
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