Gastrointestinal system (stomach, colon and peritoneum) and gynecological (ovarian) cancers may recur in the abdomen at the time of diagnosis or during the postoperative follow-up period. We call widespread intra-abdominal spread peritoneal carcinomatosis. Recurrence of cancer in the same organ, lymph node or intra-abdominal (peritoneum) reduces life expectancy.
At the time of diagnosis, we encounter advanced stage-stage 4 disease in 15% of patients with colon cancer and 5-30% of patients with stomach cancer. The average life expectancy of these patients is 6 months (1,2). After successful cytoreductive surgery and HIPEC, this period may exceed 11 months. While the life expectancy of ovarian cancer is 12-25 months with chemotherapy alone in common disease; Life expectancy can increase up to 22-64 months after cytoreductive surgery and HIPEC.
Today, in cases of recurrent cancer in the abdomen, we apply hot chemotherapy (hyperthermic intraperitoneal chemotherapy - HIPEC) into the abdomen after removing the cancerous tissues (cytoreductive surgery). In cytoreductive surgery, tissues and peritoneal surfaces with cancer spread are removed. The aim is to clear visible tumor areas. After the tumor foci are cleared, it is planned to treat cancerous areas at the microscopic-cellular level with chemotherapy drugs that have fewer side effects on the body.
The effectiveness of intra-abdominal chemotherapy drugs has been shown to be more effective than standard chemotherapy administered intravenously (3). Administering chemotherapy drugs into the abdomen with fluids with increased temperature (hyperthermia) increases blood flow in the peritoneum and can directly kill cancerous cells (cytotoxicity) (4). Cisplatin, mitomycin C, paclitaxel, liposomal doxorubicin, oxaliplatin, carboplatin, docetaxel and irinotecan can be used as chemotherapy drugs. Hyperthermia-temperature is applied at 40-450. After treatment, the life expectancy of patients increases, and some patients can be completely cured (5).
The operation time is long, more tissue needs to be removed, and we may see more problems in the postoperative period. The most common problems are intra-abdominal bleeding, anastomotic leaks, respiratory system problems and a higher risk of death. Generally cytoreductive General morbidity after surgery and HIPEC has been reported as 12-56% and perioperative mortality as 0-12% (6). Additionally, toxicity may develop in kidney and blood cells due to hot chemotherapy.
Determining patients suitable for HIPEC and cytoreductive surgery is done with a multidisciplinary approach. Patients with good performance should be evaluated by general surgery, medical and radiation oncology, and patients who will benefit from this treatment should be identified. It should be noted that not every patient is suitable for this treatment. The more widespread the cancerous cells are (tumor grade, lymph node involvement, lymphatic/venous invasion, signet ring cell histology), the more negatively affected the treatment success is.
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