Treatment of liver metastases with moderate peritoneal carcinomatosis by hepatectomy and cytoreductive surgery followed by immediate post-operative intraperitoneal chemotherapy: Feasibility and preliminary results

BACKGROUND/AIMS: Peritoneal carcinomatosis (PC) discovered during hepatecto my is usually a contraindication to resection. A potentially efficient trea tment of PC is the resection of the macroscopic disease and the treatment o f the residual microscopic disease with immediate postoperative intraperito neal chemotherapy (IPIC) (before the entrapment of cancer cells inside the fibrin deposit which rapidly cover the injured tissues). Feasibility and su rvival results of this treatment, combined with major hepatectomy, have nev er been evaluated. The purpose of this study is to report tolerance and pre liminary results in patients with liver metastases synchronous to moderate PC, treated with hepatectomy, complete cytoreductive surgery, and IPIC. METHODOLOGY: Twelve patients with liver metastases and moderate PC from mis cellaneous origins, underwent: 1) hepatectomy (9 of them were major hepatec tomies); 2) complete cytoreductive surgery of the PC resecting between 20 a nd 150 nodules; and, 3) IPIC, for 5 days, according to histology. RESULTS: There was no mortality. Morbidity was mainly due to four transient biliary leakages (33%) and there was no systemic complication due to the c hemotherapy. After a median follow-up of 14.4 months, there was no detectab le recurrence of the PC. Preliminary results concerning survival are promis ing with 7 patients without recurrent disease. CONCLUSIONS: When a minimal or moderate PC is discovered during laparotomy for liver resection of metastases, the combination of hepatectomy with comp lete cytoreductive surgery of the peritoneal disease, followed with IPIC is logical and feasible. This aggressive treatment is well tolerated although the frequency of biliary leakage seems to be higher than that after standa rd hepatectomy. No recurrence of the peritoneal disease was detected and su rvival results are very promising.