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MINERVA CHIRURGICA

A Journal on Surgery


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Minerva Chirurgica 2018 Mar 28

DOI: 10.23736/S0026-4733.18.07649-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: risk factors for morbidity and postoperative outcome

Manuela ROBELLA , Marco VAIRA, Armando CINQUEGRANA, Alice BORSANO, Michele DE SIMONE

Unit of Surgical Oncology, Candiolo Cancer Institute, Candiolo, Turin, Italy


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BACKGROUND: Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) represents a treatment option for peritoneal surface malignancies. Even if it has been reported that this new approach improved survival of selected patients, it’s still associated with high morbidity and mortality rates.
METHODS: From October 1995 to December 2017, over 450 patients patients affected by peritoneal carcinomatosis (PC) underwent in our Institute to CRS associated with HIPEC. For this preliminary analysis we considered 300 patients presenting PC of different origin: pseudomyxoma peritonei (PMP, n = 98), epithelial ovarian cancer (EOC, n = 87), peritoneal mesothelioma (DMPM, n = 49) and colorectal cancer (CRC, n = 66). Postoperative morbidity and mortality were studied in order to identify possible risk factors.
RESULTS: The morbidity rate was 36.3% in all procedures (109/300). According to Dindo - Clavien Classification, 67 cases (22.3%) were associated with grade I-II complications and 35 cases(11.7%) with grade III-IV. Surgical and medical complication rates were 8.3% (25/300) and 11.3% (34/300), respectively. The mortality rate was 2.3%. Reoperation was needed in 28 patients (9.3%). The operative time, the number of anastomosis, of peritonectomy procedures, of visceral resections performed and the PCI value resulted the most statistically significant factors influencing postoperative morbidity and mortality.
CONCLUSIONS: The risks of perioperative morbidity and mortality after CRS and HIPEC are analogous to any other major gastrointestinal surgery. CRS and HIPEC should remain a treatment option for highly selected patients in whom a curative or life prolonging treatment is a pursuit and should be performed in high volume specialized institutions.


KEY WORDS: Carcinomatosis - Cytoreduction - Hyperthermia - Morbidity - HIPEC

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Publication History

Article first published online: March 28, 2018
Manuscript accepted: February 8, 2018
Manuscript received: January 29, 2018

Cite this article as

Robella M, Vaira M, Cinquegrana A, Borsano A, De Simone M. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: risk factors for morbidity and postoperative outcome. Minerva Chir 2018 Mar 28. DOI: 10.23736/S0026-4733.18.07649-6

Corresponding author e-mail

manuela.robella@hotmail.it