Koray Topgül1, Mehmet Bilge Çetinkaya2, N. Çiğdem Arslan3, Mustafa Kemal Gül4, Murat Çan5, Mahmut Fikret Gürsel5, Dilek Erdem4, Zafer Malazgirt5

1Department of General Surgery, İstanbul Kemerburgaz University Faculty of Medicine, İstanbul, Turkey
2Department of Gynecology and Obstetrics, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
3Clinic of General Surgery, Tatvan State Hospital, Bitlis, Turkey
4Clinic of Medical Oncology, Medical Park Samsun Hospital, Samsun, Turkey
5Clinic of General Surgery, Medical Park Samsun Hospital, Samsun, Turkey


Objective: The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature.
Material and Methods: Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed.
Results: The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence.
Conclusion: Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.

Keywords: Peritoneal carcinomatosis, cytoreductive surgery, hipec


Ethics Committee Approval

Since it is a retrospective study, we did not apply for ethical committee approval and obtained our data from patients’ files.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - K.T.; Design - K.T., N.Ç.A.; Supervision - K.T., M.B.Ç, M.K.G., Z.M.; Materials - N.Ç.A., M.Ç.; Data Collection and/or Processing - M.K.G., M.Ç., M.F.G.; Analysis and/or Interpretation - K.T., N.Ç.A., M.K.G., Z.M.; Literature Review - K.T., N.Ç.A., D.E.; Writer - K.T.; Critical Review - K.T., Z.M., M.B.Ç., N.Ç.A.; Other - D.E., M.F.G.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study has received no financial support.