Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the Coliseum technique
Ad. Stephens et al., Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the Coliseum technique, ANN SURG O, 6(8), 1999, pp. 790-796
Background: Peritoneal carcinomatosis from gastrointestinal cancers is a fa
tal diagnosis without special combined surgical and chemotherapy interventi
ons. Guidelines for cytoreductive surgery and hyperthermic intraoperative i
ntraperitoneal chemotherapy (HIIC) by using the Coliseum technique have bee
n developed to treat patients with peritoneal carcinomatosis and other peri
toneal surface malignancies. The purpose of this study was to analyze the m
orbidity and mortality of patients undergoing cytoreductive surgery and HII
C by using mitomycin C.
Methods: Data were prospectively recorded on 183 patients who underwent 200
cytoreductive surgeries with HIIC between November 1994 and June 1998. Sev
enteen of the 183 patients returned for a second-look surgery plus HIIC. Al
l HIIC administrations occurred after cytoreduction and used continuous man
ual separation of intra-abdominal structures to optimize drug and heat dist
ribution. Origins of the tumors were as follows: appendix (150 patients), c
olon (20 patients), stomach (7 patients), pancreas (2 patients), small bowe
l (1 patient), rectum (1 patient), gallbladder (1 patient), and peritoneal
papillary serous carcinoma (1 patient). Morbidity was organized into 20 cat
egories that were graded 0 to IV by the National Cancer Institute's Common
Toxicity Criteria. In an attempt to identify patient characteristics that m
ay predispose to complications, each morbidity variable was analyzed for an
association with the 25 clinical variables recorded.
Results: Combined grade III/IV morbidity was 27.0%. Complications observed
included the following: peripancreatitis (6.0%), fistula (4.5%), postoperat
ive bleeding (4.5%), and hematological toxicity (4.0%). Morbidity was stati
stically linked with the following clinical variables: duration of surgery
(P < .0001), the number of peritonectomy procedures and resections (P < .00
01), and the number of suture lines (P = .0078). No HIIC variables were sta
tistically associated with the presence of grade III or grade IV morbidity.
Treatment-related mortality was 1.5%.
Conclusions: HIIC may be applied to select patients with peritoneal carcino
matosis from gastrointestinal malignancies with 27.0% major morbidity and 1
.5% treatment-related mortality. The frequency of complications was associa
ted with the extent of the surgical procedure and not with variables associ
ated with the delivery of heated intraoperative intraperitoneal chemotherap
y. The technique has shown an acceptable frequency of adverse events to be
tested in phase IH adjuvant trials.