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Surgery Combined With Peritonectomy Procedures and Intraperitoneal Chemohyperthermia in Abdominal Cancers With Peritoneal Carcinomatosis: A Phase II Study

O. Glehen, F. Mithieux, D. Osinsky, A.C. Beaujard, G. Freyer, Ph. Guertsch, Y. Francois, P. Peyrat, G. Panteix, J. Vignal, F.N. Gilly

From the Surgical Department, Anesthesiology and Intensive Care Unit, Medical Oncology Department, Centre Hospitalo-Universitaire Lyon Sud, Pierre Bénite; Université Lyon, Faculté Lyon Sud, Oullins, France; Surgical Department, Bellinzona University Hospital, Switzerland.

Address reprint requests to F.N. Gilly, Surgical Department, Centre Hospitalo Universitaire Lyon Sud, 69495 Pierre Bénite Cedex, France; email: francogi{at}lyon-sud.univ-lyon1.fr.

Purpose: To evaluate the tolerance of peritonectomy procedures (PP) combined with intraperitoneal chemohyperthermia (IPCH) in patients with peritoneal carcinomatosis (PC), a phase II study was carried out from January 1998 to September 2001.

Patients and Methods: Fifty-six patients (35 females, mean age 49.3) were included for PC from colorectal cancer (26 patients), ovarian cancer (seven patients), gastric cancer (six patients), peritoneal mesothelioma (five patients), pseudomyxoma peritonei (seven patients), and miscellaneous reasons (five patients). Surgeries were performed mainly on advanced patients (40 patients stages 3 and 4 and 16 patients stages 2 and 1) and were synchronous in 36 patients. All patients underwent surgical resection of their primary tumor with PP and IPCH (with mitomycin C, cisplatinum, or both) with a closed sterile circuit and inflow temperatures ranging from 46° to 48°C. Three patients were included twice.

Results: A macroscopic complete resection was performed in 27 cases. The mortality and morbidity rates were one of 56 and 16 of 56, respectively. The 2-year survival rate was 79.0% for patients with macroscopic complete resection and 44.7% for patients without macroscopic complete resection (P = .001). For the patients included twice, two are alive without evidence of disease, 54 and 47 months after the first procedure.

Conclusion: IPCH and PP are able to achieve unexpected long-term survival in patients with bulky PC. However, one must be careful when selecting the patients for such an aggressive treatment, as morbidity rate remains high even for an experienced team.

This study was financed by a grant from the French National League Against Cancer.

Related Correspondence

• Peritoneal Carcinomatosis: What Can We Do About It?
  Perry Shen, Edward A. Levine, and Brian W. Loggie
  JCO 2004 22: 202 [Full Text]

Related Reply

• In Reply:
  Olivier Glehen and François Noël Gilly
  JCO 2004 22: 203 [Full Text]

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