MORBIDITY AND MORTALITY OF CYTOREDUCTIVE SURGERY AND INTRAPERITONEAL CHEMOTHERAPY

Background. Peritoneal carcinomatosis has been regarded as a uniformly lethal clinical entity. Recently, dose-intensive treatments combining cytoreductive surgery and intraperitoneal chemotherapy have resulted in long-term survival in selected patients. Methods. This article repo rts the morbidity and mortality associated with this new treatment str ategy in 45 consecutive treatments of 43 patients with peritoneal carc inomatosis treated during an 18-month interval. Results. The duration of median postoperative ileus was 21 days, and increased age of the pa tient and extent of cytoreduction caused an increased incidence of ile us. Twenty-one complications occurred in 17 patients (37.7%). Complica tions related to enteric function included fistula (n = 4), bile leak (n = 1), pancreatitis (n = 1), and anastomotic disruption (n = 1). The re were two early and two late episodes of postoperative bleeding requ iring reoperation. Six patients had pneumonia and one had deep vein th rombosis. There were no deaths. Six of the seven complications related to enteric function occurred in patients who had undergone induction intraperitoneal chemotherapy before cytoreductive surgery plus early p ostoperative intraperitoneal chemotherapy. Conclusions. As a result of these findings, induction intraperitoneal chemotherapy is only recomm ended for patients with low-volume intraabdominal cancer. In most pati ents surgical removal of peritoneal carcinomatosis before intraperiton eal chemotherapy is recommended. Because of the significant morbidity related to treatment of peritoneal carcinomatosis, careful patient sel ection and favorable long-term results of treatment are required.