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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

doi: 10.1097/DCR.0b013e318265ad42
Original Contributions: Colorectal/Anal Neoplasia

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.

1Indiana University School of Medicine, Department of Surgery, Indianapolis, Indiana

2Washington University School of Medicine, Department of Surgery, Section of Colon and Rectal Surgery, St Louis, Missouri

3University of Washington School of Medicine, Department of Cardiovascular Surgery, Seattle, Washington

Funding/Support: This work was supported by a grant from Siteman Cancer Center and Washington University Institute of Minimally Invasive Surgery.

Financial Disclosures: Dr Fleshman is a consultant for Genzyme Biosurgery and Ethicon and has done research for Ethicon and LifeCell. Drs Fajardo, Tan, and Reddy have reported no disclosures.

Poster presentation at the meeting of the Society of Surgical Oncology, Phoenix, AZ, March 5 to 8, 2009.

Correspondence: James W. Fleshman, M.D., Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8109, St. Louis, MO 63110. E-mail:

© The ASCRS 2012