ANALYSIS OF MORBIDITY AND MORTALITY IN 60 PATIENTS WITH PERITONEAL CARCINOMATOSIS TREATED BY CYTOREDUCTIVE SURGERY AND HEATED INTRAOPERATIVE INTRAPERITONEAL CHEMOTHERAPY

BACKGROUND. Peritoneal carcinoma has been regarded as a uniformly leth al clinical entity. A treatment plan combining cytoreductive surgery a nd heated intraoperative intraperitoneal chemotherapy (HIIC) was devis ed and tested to treat such patients. The purpose of this study was to evaluate the morbidity and mortality associated with this treatment a pproach. METHODS. Sixty patients with peritoneal carcinomatosis from a denocarcinoma of the colon or appendix were included in the study. Ext ensive cytoreductive surgery was combined with heated intraperitoneal mitomycin in an intraoperative lavage technique followed by one cycle of early postoperative intraperitoneal 5-fluorouracil. Eleven clinical variables were selected and statistically correlated with morbidity a nd mortality. RESULTS. Twenty-five complications occurred in 21 patien ts (morbidity = 35%). Morbidity related to gastrointestinal function i ncluded anastomotic leak (n = 6), bowel perforations (n = 5), bile lea k (n = 3), and pancreatitis (n = 2). Four patients presented with seve re hematologic toxicity (Grade 3 or 4). There were three cases of post operative bleeding, one case of abdominal wound dehiscence, and one ca se of pulmonary embolism. Morbidity was significantly associated with three clinical factors: male sex, high intraabdominal temperature duri ng HICC, and duration of the surgical procedure. Enteral complications (bowel fistula and anastomotic leak) occurred in patients with a sign ificantly higher number of peritonectomy procedures and a significantl y longer operation. Three patients died within 8 weeks after the proce dure (mortality = 5%). Mortality was significantly associated with age and intraabdominal temperature. CONCLUSIONS. Cytoreductive surgery co mbined with HICC is associated with a 35% morbidity rate and a 5% mort ality rate. Extensive surgery (duration and number of peritonectomy pr ocedures) and high intraabdominal temperature represent the major risk factors for postoperative morbidity and mortality of patients treated with this new therapeutic approach. (C) 1996 American Cancer Society.