Preliminary Experience and Morbidity Analysis of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/Hipec) from a Tertiary Cancer Center in India

Abstract

Background: Peritoneal carcinomatosis (PC) can arise directly from peritoneum (primary) or from regional spread of gastrointestinal and gynecological malignancies. It is often considered a terminal event. CRS/HIPEC procedure provides encouraging outcomes in select sub-set of patients with PC. In this study we present our initial experience of this combined procedure from a tertiary cancer care center in India. Materials and Methods: Between January 2014 to January 2015, 13 patients underwent CRS + HIPEC procedure at our center. Preoperative assessment for cytoreduction was done using contrast CT-scan of the abdomen and staging laparoscopy. All procedures were performed by the same surgical team. After cytoreduction, HIPEC was performed by closed method. Results: Median patient age was 52 and median PCI was 13.5 (5-21). Ovarian cancers were commonest origin of PC in our series. All patients had a complete cytoreduction with a median operative time of 8.3 hours. Postoperative ileus was the commonest adverse event. In the immediate postoperative period, major complications were observed in 23% (3/13) of our patients (1. intra-abdominal abscess 2. Septicemia and liver function derangement 3. Bowel obstruction which required a reoperation. Median hospital stay was 12 days (range 9-45 days) and there was no perioperative mortality. Conclusion: Our initial results indicate that CRS + HIPEC procedure can be performed with acceptable morbidity and no mortality. Appropriate case selection by a multi-disciplinary team is vital to achieve complete cytoreduction and optimize outcomes.

Keywords

• carcinomatosis
• colorectal neoplasm
• ovarian neoplasm
• regional chemoperfusion