Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from ovarian cancer

World Journal of Surgical Oncology

Hans Juergen Schlitt²  Martin Loss²  Marc-Hendrik Dahlke²  Pompiliu Piso¹ 

[1] Department for Visceral and Transplant Surgery, Medical School of Hannover, 30623 Hannover, Germany;Department for Surgery, University of Regensburg, 93053 Regensburg, Germany

关键词: intraperitoneal chemotherapy;    cytoreductive surgery;    ovarian cancer;    peritoneal carcinomatosis;   

Others  :  1207470
DOI  :  10.1186/1477-7819-2-21

 received in 2004-04-24, accepted in 2004-06-28,  发布年份 2004

【 摘 要 】

Background

In selected patients with peritoneal carcinomatosis from ovarian cancer prognosis can be improved by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

Between September 1995 and February 1999, 19 patients (mean age 52 years, range 30–72 years) with peritoneal carcinomatosis from primary or recurrent epithelial ovarian carcinoma were operated with the aim of complete macroscopical cytoreduction. Surgery was followed by intraoperative HIPEC. The data was analyzed retrospectively.

Results

Eleven patients had recurrent and 8 primary ovarian cancer. The median progression free interval was 18 months (range 6–36 months). Macroscopically complete cytoreduction was achieved in 9 patients. Cisplatin (n = 16) or mitoxantrone (n = 3) were used for the intraoperative chemotherapy. The median intraabdominal inflow temperature was 41.5°C. Complications occurred in seven patients. Most frequent complications were anastomotic leakage (2/19) and intraabdominal abscess formation (2/19). One patient died postoperatively. The mean (± SD) overall survival time was 33(± 6) months with a 5-year survival rate of 15%. The survival was found to be influenced by the completeness of cytoreduction (44 ± 11 vs. 25 ± 6 months, p = 0.40), tumor volume (54 ± 10 versus 16 ± 4, p = 0.002) and presence of lymph node (38 ± 8 vs. 20 ± 8 months, p= 0.2) or liver metastases (51 ± 9 vs. 21 ± 6 months, p = 0.06).

Conclusions

Cytoreductive surgery combined with HIPEC is feasible and is associated with a reasonable morbidity and mortality. Complete cytoreduction may improve survival in select group of patients with low tumor volume and no organ metastases.

【 授权许可】

   
2004 Piso et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bonnefoi H, A'Hern RP, Fisher C, Macfarlane V, Barton D, Blake P, Shepherd JH, Gore ME: Natural history of stage IV epithelial ovarian cancer. J Clin Oncol 1999, 17:767-775.
• [2]Yancik R: Ovarian cancer. Age contrasts in incidence, histology, disease stage at diagnosis, and mortality. Cancer 1993, 71:517-523.
• [3]Abu-Rustum NR, Chi DS, Curtin JP: Epithelial ovarian cancer. Curr Probl Surg 1999, 36:7-53.
• [4]Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ: Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002, 5:1248-1259.
• [5]Kecmanovic DM, Pavlov MJ, Kovacevic PA, Ceranic MS, Stamenkovic AB: Cytoreductive surgery for ovarian cancer. Eur J Surg Oncol 2003, 29:315-320.
• [6]Deraco M, Rossi CR, Pennacchioli E, Guadagni S, Somers DC, Santoro N, Raspagliesi F, Kusamura S, Vaglini M: Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion in the treatment of recurrent epithelial ovarian cancer: a phase II clinical study. Tumori 2001, 87:120-126.
• [7]Look M, Chang D, Sugarbaker PH: Long-term results of cytoreductive surgery for advanced and recurrent epithelial ovarian cancers and papillary serous carcinoma of the peritoneum. Int J Gynecol Cancer 2003, 13:764-770.
• [8]Los G, Smals OA, van Vugt MJ, van der Vlist M, den Engelse L, McVie JG, Pinedo HM: A rationale for carboplatin treatment and abdominal hyperthermia in cancers restricted to the peritoneal cavity. Cancer Res 1992, 52:1252-1258.
• [9]Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, Zoetmulder FA: Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003, 21:3737-3743.
• [10]Sugarbaker PH, Chang D: Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 2000, 6:727-731.
• [11]Piso P, Bektas H, Werner U, Schlitt HJ, Kubicka S, Bornscheuer A, Manns M, Klempnauer J: Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. Eur J Surg Oncol 2001, 27:286-290.
• [12]McQuellon RP, Loggie BW, Lehman AB, Russell GB, Fleming RA, Shen P, Levine EA: Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol 2003, 10:155-162.
• [13]Sugarbaker PH: Complete parietal and visceral peritonectomy of the pelvis for advanced primary and recurrent ovarian cancer. In Peritoneal carcinomatosis: drugs and diseases. Edited by Sugarbaker P. Boston, Kluwer Academic Publishers; 1996:75-86.
• [14]Sugarbaker PH: Peritonectomy procedures. Ann Surg 1995, 221:29-42.
• [15]Sugarbaker PH: Management of peritoneal-surface malignancy: the surgeons role. Langenbecks Arch Surg 1999, 384:576-587.
• [16]Van der Burg MF: Advanced ovarian cancer. Curr Treat Options Oncol 2001, 2:109-118.
• [17]Zang RY, Zhang ZY, Cai SM, Li ZT, Chen J, Tang MQ, Liu Q: Effect of cytoreductive surgery on survival of patient with recurrent epithelial ovarian cancer. J Surg Oncol 2000, 75:24-30.
• [18]Janicke F, Holscher M, Kuhn W, von Hugo R, Pache L, Siewert JR, Graeff H: Radical surgical procedure improves survival time in patients with recurrent ovarian cancer. Cancer 1992, 70:2129-2136.
• [19]Alberts DS, Liu PY, Hannigan EV, O'Toole R, Williams SD, Young JA, Franklin EW, Clarke-Pearson DL, Malviya VK, DuBeshter B: Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophospahmide for stage III ovarian cancer. N Engl J Med 1996, 335:1950-1955.
• [20]Link KH, Roitman M, Holtappels M, Runnebaum I, Urbanzyk H, Leder G, Staib L: Intraperitoneal chemotherapy with mitoxantrone in malignant ascites. Surg Oncol Clin N Am 2003, 12:865-872.
• [21]Scarabelli C, Gallo A, Carbone A: Secondary cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol 2001, 83:504-512.
• [22]Stephens AD, Alderman R, Chang D, Edwards GD, Esquivel J, Sebbag G, Steves MA, Sugarbaker PH: Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative chemotherapy using the Coliseum technique. Ann Surg Oncol 2000, 6:790-796.
• [23]Elias D, Blot F, El Otmany A, Antoun S, Lasser P, Boige V, Rougier P, Ducreux M: Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 2001, 92:71-76.
• [24]Salom E, Almeida Z, Mirhashemi R: Management of recurrent ovarian cancer: evidence-based decisions. Curr Opin Oncol 2002, 14:519-527.
• [25]Tentes AA, Tripsiannis G, Markakidis SK, Karanikiotis CN, Tzegas G, Georgiadis G, Avgidou K: Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer. Eur J Surg Oncol 2003, 29:69-73.