Strategies to reduce perioperative morbidity in cytoreductive surgery

Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (HIPEC) is an aggressive treatment for patients with peritoneal malignancies. While promising, this therapeutic regimen has been associated with significant morbidity, long hospital stay and an increased risk for perioperative mortality. The purpose of this study was to evaluate the possibility to reduce morbidity by use of strategy aiming to reduce inflammatory response associated with cytoreductive surgery plus HIPEC.

241 consecutive patients underwent cytoreductive surgery plus HIPEC during the period of 4 years (1/03-12/06). All patients were managed through multivisceral resection followed by HIPEC using an open technique. Peritonectomy was performed with the goal of total eradication of all visible tumor formations.

276 procedures were performed in 241 patients with 27 re-resections and 4 re-re-resections. Male/female ratio was 134/142. Mean age was 49 years (range 26-82). Optimal cytoreduction defined as CC-0 and CC-1 resection could be reached in 230 cases (83.3%). Complication rate (Feldman scale grade 3/4) and 30-day mortality rate were as follows: 2003: 26.5%, 2% 2004: 20%, 0% 2005: 14%, 1% 2006: 10%, 0%.

The results of this study demonstrate the possibility to reduce the perioperative risk of cytoreductive surgery plus IPHC. The described strategy aiming the reduction of inflammatory response was able to reach a morbidity level which stands in line with other major oncologic operations.