Peritoneal carcinomatosis treated by cytoreduction surgery and intraperitoneal hyperthermic perfusion.

Study aim: The aim of this prospective non-randomized trial was to report a series of intraperitoneal carcinomatosis due to miscellaneous causes, trea ted by intraperitoneal hyperthermic perfusion (IPHP) and cytoreductive surg ery. Patients and method: From January 1995 to May 1999, 35 patients were treate d by IPHP and 26 of them underwent maximal cytoreductive surgery. IPHP was performed for 60 minutes at an intraperitoneal temperature of 42 degrees C with Mitomycin C (10 mg/L) or cisplatinum (12 mg/L) at a flow rate of 0.9 L /min. Results: There was one (2.8%) postoperative death due to respiratory compli cations on day 16. Three patients (8.5%) were admitted to the intensive car e unit. A high morbidity rate (54%) was observed with intra-abdominal compl ications in 28.5% of patients, requiring reoperation in three patients. In patients with stages 1 and 2 peritoneal carcinomatosis (granulations les s than 5 mm), the 12- and 24-month survival rates were 63.1% and 31.5%, res pectively. In patients with advanced stage 3 (diffuse malignant nodules les s than 2 cm) and stage 4 carcinomatosis (malignant nodules larger than 2 cm ), the 12- and 24-month survival rates were 31.2% and 12%, respectively. Si x patients survived for more than 30 months. Conclusion: IPHP appears to be an effective treatment for peritoneal carcin omatosis. IPHP combined with cytoreductive surgery is aggressive with a hig h morbidity rate. Rigorous patient selection is necessary. IPHP is still un der evaluation. Prospective randomized trials with identical IPHP protocols are required. (C) 2000 Editions scientifiques et medicales Elsevier SAS.