ročník 11,2003 č.4

The Czech experience with peritonectomy and peroperative hyperthermic chemotherapy in the treatment of abdominal malignancy

Antoš, F., Šerclová, Z., Gilbert., Z., Vitek, P., Skála, M., Hrotková, H.

Department of Surgery
Institute for Postgraduate Medical Education
University Hospital Prague
The lst. Medical School, Charles University

The spread of the tumor cells on the peritoneal surfaces is usually considered as a sign of inoperability of the neoplastic process.The peritonectomy together with the perioperative hyperthermic cytostatic lavage as described by Sugarbaker gives the hope for better results in the treatment of primary or secondary malignancy.
In the Surgical Department of the University Hospital Bulovka there were operated on for the peritoneal dissemination of malignant tumors altogether 32 patients between the years 1999 and 2003.Sixteen men (50 %) with the mean age of 49,8 years (range 25-73 years ) and 16 females (50% ) with the mean age of 60,9 years ( range 42-75 years ) were indicated for the agressive cytoreduction, total or limited peritonectomy and peroperative hyperthermic chemoperfusion for the diagnoses - pseudomyxoma peritonei, mesothelioma,colorectal cancer,gynecologic cancer,urologic cancer. All of the patients but two had been previously surgically treated elsewhere: debulking, appendicectomy, partial colectomy, ovarectomy, cystectomy and 24 patients (85% ) had received systemic chemotherapy.Because of to our initial observation, besides of the main group of patients who received the complete treatment there was a group of 8 patients with completely inoperable condition who after laparotomy received only the hyperthermic chemoperfusion without any cytoreduction in order to influence at least the present ascites.
The overall morbidity was high as 85,7%. The perioperative lethality ( 30 days ) was 12,5 % ( 4 patients ) mainly because of cardiopulmonary problems. The in-hospital lethality was 21,9 % ( 7 patients ) mainly because of urological complications. In order to evaluate the long-term results ( 3 months-4.5 years ) the group of patients was divided according to the peroperative cytoreduction radicality to the regular group of 22 patients where cytoreduction was complete and the group of 10 patients where the completion of cytoreduction was not achieved mainly because of advanced recurrent disease ( supporting measure group ) . The results of both groups will be presented. All 6 patients in the only chemoperfusion group died within 7 months from the operations but none of them developed ascites again. The average hospital stay was 31.3 days.
According to increasing numbers of both experimental and clinical evidence the therapeutic and prophylactic use of peritonectomy and peroperative hyperthermic chemoperfusion in patients without systemic malignant disease seems to be justified. Although the morbidity rate is high the lethality rate is acceptable and procedure is relatively safe for patients. The proper selection of patients for this exacting and many hours lasting operations is necessary. There is still a need for well structured randomized trials in order do establish the role of this promising technique.

This study has been supported by the grant of Ministry of Health- IGA MZCR- ND-6807-3.

Address for correspondence:

Professor František Antoš, MD, PhD.
Department of Surgery
University Hospital Prague - Bulovka