Elie Chouillard. Paris West Medical Center
Purpose: Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment for selected patients with peritoneal carcinomatosis (PC). Usually, HIPEC is performed concomitantly with CRS for peritoneal (PC) or more occasionally as an adjuvant treatment after gastric resection for cancer. In this report, we describe the long-term results of our experience with staged adjuvant laparoscopic HIPEC after complete resection in patients with advanced colorectal or gastric cancer.
Methods: Between January 2005 and December 2010, 75 patients underwent resection for advanced colorectal (48 patients) or gastric cancer (27 patients) followed by staged laparoscopic HIPEC. Indications included patients with obstruction, perforation, T4, N2, or positive peritoneal cytology. Laparoscopic HIPEC was performed 8 to 13 days after primary surgery. The homogeneity of the hyperthermia across the abdominal cavity was electronically maintained throughout the procedure by input and output flow regulation. Operative technique, complications, as well as long-term follow-up findings were assessed.
Results: Mean intra-peritoneal temperature was 41.9° C. One conversion to laparotomy was required in 3 patients (4 %). No major operative incident was encountered. Two patients died in the 30-day postoperative period (2.7 %). The mean hospital stay was 12 days (range, 9-23). Fifteen patients developed complications (20 %). Three patients were reoperated (4 %).
Mean follow-up was 74.5 months (range, 66-136). Thirty-Eight patients died including 20 of cancer related causes (distant metastases). Fifty-one patients (68 %) had some form of second look laparoscopy or laparotomy and 12 patients had autopsy (16 %). All patients had follow-up Positron Emission Tomography (PET) scans regularly. Only, 4 patients (5.5 %) developed PC.
Conclusion: Staged laparoscopic adjuvant HIPEC after open or laparoscopic resection in selected patients with colorectal or gastric cancer is safe and feasible. After more than 5-year follow-up, the risk of developing PC seems to be significantly decreased.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91182
Program Number: ETP838
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster