Article: article from journal or magazin.
Results of systematic second-look surgery plus HIPEC in asymptomatic patients presenting a high risk of developing colorectal peritoneal carcinomatosis
1528-1140 (Electronic)0003-4932 (Linking)
Elias, DHonore, CDumont, FDucreux, MBoige, VMalka, DBurtin, PDromain, CGoere, Deng2011/06/29 06:00Ann Surg. 2011 Aug;254(2):289-93. doi: 10.1097/SLA.0b013e31822638f6.
PURPOSE: To analyze the impact of systematic second-look surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) performed 1 year after resection of the primary tumor in asymptomatic patients at high risk of developing peritoneal carcinomatosis (PC). PATIENTS AND METHODS: From 1999 to 2009, 41 patients without any sign of recurrence on imaging studies underwent second-look surgery aimed at treating limited PC earlier and more easily. They were selected based on 3 primary tumor-associated criteria: resected minimal synchronous macroscopic PC (n = 25), synchronous ovarian metastases (n = 8), and perforation (n = 8). RESULTS: PC was found and treated with complete surgery plus HIPEC in 23 of the 41 (56%) patients. The other patients underwent complete abdominal exploration plus systematic HIPEC. Median follow-up was 30 (9-109) months. One patient died postoperatively at day 69. Grade 3-4 morbidity was low (9.7%). The 5-year overall survival rate was 90% and the 5-year disease-free survival rate was 44%. Peritoneal recurrences occurred in 7 patients (17%), 6 of whom had macroscopic PC discovered during the second-look (26%), and one patient had no macroscopic PC (6%). In the univariate analysis, the presence of PC at second-look surgery was a significant risk factor for recurrence (P = 0.006). CONCLUSION: Selection criteria for high-risk patients appear to be accurate. In these patients, the second-look strategy treated peritoneal carcinomatosis preventively or at an early stage, yielding promising results. This study has allowed us to design a multicentric randomized trial (comparing the second-look + HIPEC approach versus standard follow-up alone), which is beginning.
Adult, Chemotherapy, Cancer, Regional Perfusion/*methods, Colorectal Neoplasms/*drug therapy/mortality/pathology/*surgery, Disease-Free Survival, Female, Follow-Up Studies, Humans, Hyperthermia, Induced/*methods, Male, Middle Aged, Neoplasm Seeding, Neoplasm Staging, Peritoneal Neoplasms/drug therapy/mortality/*secondary/*surgery, Prospective Studies, Risk Factors, *Second-Look Surgery
Last modification date