Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e318265ad42
Original Contributions: Colorectal/Anal Neoplasia

Delayed Repeated Intraperitoneal Chemotherapy After Cytoreductive Surgery for Colorectal and Appendiceal Carcinomatosis

Fajardo, Alyssa D. M.D.1; Tan, Benjamin M.D.2; Reddy, Rishindra M.D.3; Fleshman, James M.D.2

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BACKGROUND: Delayed repeated intraperitoneal chemotherapy after cytoreductive surgery for carcinomatosis may be an alternative to intraoperative hyperthermic infusion.

OBJECTIVE: The aim of this study was to evaluate the safety and feasibility of delayed repeated intraperitoneal chemotherapy after cytoreduction of colorectal and appendiceal carcinomatosis and pseudomyxoma peritonei.

DESIGN: This study constitutes a retrospective case series.

SETTING: This study was conducted at a single institution.

PATIENTS: A total of 31 patients with peritoneal carcinomatosis (23) and pseudomyxoma peritonei (8) were included.

INTERVENTIONS: Cytoreduction was followed by placement of an adhesion barrier and intraperitoneal catheters. Peritoneal scintigraphy preceded biweekly intraperitoneal 5-fluorouracil and systemic combination chemotherapy with leucovorin, fluorouracil, and oxaliplatin (FOLFOX).

MAIN OUTCOME MEASURES: The primary outcomes measured are safety, feasibility, and short-term survival.

RESULTS: Cytoreduction to a score of 0 to 1 was possible in 25 patients (80%). Complications occurred in 16 patients (51.6%) and were confined to grades I to III. There were no deaths, and no digestive fistulae occurred. Port malfunction or complication resulted in removal in 5 patients (16.1%). Intraperitoneal chemotherapy was possible in 83.8% of patients; 55% completed the full course. Peritoneal scintigraphy demonstrated free diffusion of tracer in 18 patients (58%), 4 (12.9%) had diffusion in each gutter with limited communication, 5 (16.1%) had limited diffusion around each catheter without communication, and 2 (6.5%) had no diffusion on scintigraphy. Overall survival for peritoneal carcinomatosis was 44.5% at 3 years (95% CI = 23%–65%).

LIMITATIONS: The nonrandomized nature of this study and the early experience are limitations.

CONCLUSIONS: Delayed repeated intraperitoneal and systemic chemotherapy after cytoreduction is feasible and has acceptable morbidity rates. Delayed intraperitoneal chemotherapy is possible in 83% of patients.

© The ASCRS 2012


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