61 - Freie Mitteilung
HPB II & general oncology
16. Mai 2019, 13:45 - 15:15, Bellavista 5, 6. OG
Implementation of a peritoneal carcinomatosis program in a Swiss tertiary care hospital
P. Müller, C. Soll, S. Schacher, A. Müller, F. Grieder, S. Breitenstein, M. Adamina, Presenter: P. Müller (Winterthur)
Peritoneal carcinomatosis cannot be cured even by the most aggressive systemic therapy, whereas peritoneal progression causes a steep decrease in quality of life. Cytoreductive surgery with intraoperative chemotherapy (CRS HIPEC) offers a small but proven chance for cure. When carcinomatosis is non resectable, pressurized intraperitoneal aerosol chemotherapy (PIPAC) confers effective peritoneal palliation. The present work reports the implementation of a peritoneal carcinomatosis program at a Swiss tertiary care hospital.
Patients were referred from a catchment area of 500’000 and discussed at the interdisciplinary tumor board. When a curative treatment was intended, surgery started with laparoscopy and progressed to laparotomy and CRS HIPEC when complete cytoreduction was achievable and the peritoneal cancer index (PCI) reasonable. When a palliative context was recognized, patients were offered laparoscopic PIPAC in combination with a systemic therapy. All patients were included in an approved, prospective clinical database. Results are expressed in median and interquartile range (IQR).
76 procedures were performed from July 2015 to December 2018, including 40 CRS HIPEC in 39 patients (16 men : 23 women) and 37 PIPAC in 15 patients (5 men : 10 women) of age 60 (IQR 50-71) and PCI 6.5 (IQR 4-11). Patients were operated for colorectal (n=17), pseudomyxoma/appendiceal neoplasia (n=14), ovarian (n=4), mesothelioma (n=3), and gastric cancers (n=1). Overall, surgery lasted 546 minutes (435-737) for CRS HIPEC and 109 minutes (92-128) for PIPAC, while length of stay was 12 days (8-15) for CRS HIPEC and 1.5 (1-2) for PIPAC patients. Major complications (III-IVa) occurred in 10 CRS HIPEC (25%) patients and mortality was nil. Of 62 anastomosis performed, 2 leaked (3.2%). Yet, 30-day mortality in PIPAC patients amounted to 5.4%. Last, laparoscopic CRS HIPEC was initiated 2017 and 7 selected patients were operated with a PCI of 3 (IQR 2-4.5) and surgery time of 430 minutes (IQR 386-440) as opposed to 630 minutes (IQR 486-740) for open CRS HIPEC. Major morbidity was nil and length of stay was significantly shorter (7 days, IQR 6.5-8, p=0.02).
Implementation of a contemporary carcinosis program of CRS HIPEC and PIPAC is feasible at the cost of long operative times. A reasonable morbidity and mortality could be achieved, pending on careful interdisciplinary patient selection.