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Halkia E.,Peritoneal Surface Malignancy Unit | Gavriel S.,Peritoneal Surface Malignancy Unit | Spiliotis J.,Metaxa Cancer Hospital
Journal of B.U.ON. | Year: 2014

Peritoneal carcinomatosis (PC) is a condition that has been associated with poor outcomes and up until recently was considered a terminal condition. However, recent data suggest that cytoreductive surgery (CRS) and the administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective therapeutic approach. This paper is a review of the recent literature regarding this issue.

Spiliotis J.,Metaxa Cancer Hospital | Halkia E.,Metaxa Cancer Hospital | Halkia E.,Peritoneal Surface Malignancy Unit | Rogdakis A.,St Panteleimon Hospital OfNikaia | And 3 more authors.
Journal of B.U.ON. | Year: 2015

Purpose: The aim of this study was to explore the natural course of peritoneal carcinomatosis (PC) in patients who are not Jit to undergo cytoreductive (CRS) surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: Over an 8-year period (2006-2013) 320 patients were excluded from CRS and HIPEC at our center. Exclusion criteria were: (a) age >75 years; (b) ASA score 2 3; (c) extraperitoneal disease; (d) massive disease involvement of the small bowel; (e) disease involvement of the hepatic pedicle or the pancreas; (f) invasion of retroperitoneal space; (g) more than two stenoses of the small bowel. Another 130 patients underwent CRS and HIPEC. Results: In the HIPEC group (N=130), the mean overall survival was 26.2±11.7 months, while from the non- HIPEC group (N=320), 200 patients underwent palliative surgery, with a mean overall survival ofll.7±8.3 months. Only 120 patients received palliative chemotherapy with a mean overall survival of 7.2±4.3 months. Conclusion: Our study suggests that, in patients unfit to undergo CRS & HIPEC, an exploratory laparotomy and palliative surgery should be performed, offering a survival benefit and improved quality of life.

Spiliotis J.,Metaxa Cancer Institute | Halkia E.,Peritoneal Surface Malignancy Unit | de Bree E.,University of Crete
Current Oncology | Year: 2016

Peritoneal carcinomatosis (PTC) represents advanced malignant disease and has generally been associated with a grim prognosis. Peritoneal surface malignancy is often the major source of morbidity and mortality; it is of major concern in cancer management. Although PTC is categorized as metastatic disease, it represents a special disease pattern considered to be a locoregional disease limited to the abdominal cavity. The combination of cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) has successfully been used as locoregional treatment for selected patients with PTC from gastric, colorectal, and ovarian cancer; with mesothelioma; and with pseudomyxoma peritonei. In the prophylactic setting, HIPEC can also be used to prevent PTC in high-risk patients, and the first results of the “second-look” approach are promising. Patient selection—in which the risks of perioperative morbidity and mortality, which are analogous to those for any other major gastrointestinal surgery, are assessed—is of utmost importance. Those risks have to be weighed against the anticipated survival benefit, which depends mainly on tumour biology, extent of disease, and probability of achieving complete CRS. The present review discusses the principles of CRS and HIPEC, the most significant recent clinical data, and current perspectives concerning the application of this treatment modality in various malignancies. Ongoing trials and future directions are noted. It appears that the combination of CRS and HIPEC is an indispensable tool in the oncologist’s armamentarium. © 2016 Multimed Inc.

Halkia E.,Peritoneal Surface Malignancy Unit | Papantziala A.,Metaxa Cancer Hospital | Vassiliadou D.,Metaxa Cancer Hospital | Tsochrinis A.,Metaxa Cancer Hospital | And 3 more authors.
Journal of B.U.ON. | Year: 2014

Purpose: The aim of this study was to present a group of patients with <150 cm of small intestine after cytoreductive surgery (CRS)+hyperthermic intraperitoneal chemotherapy (HIPEC) and the special problems arising from this condition. Methods: From November 2005 to November 2013, 130 patients were treated for peritoneal carcinomatosis (PC) with CRS+HIPEC. Ten patients (7.7%) were left with a short bowel due to anatomical and surgical reasons. All these patients were subjected to ileostomy. Four patients (40%) were treated for ovarian carcinoma, 4 (40%) for colon and appendiceal carcinoma, 1 for peritoneal mesothelioma and 1 patient for primary peritoneal carcinoma. The completeness of cytoreduction (CC) score was CC-0 in 4 patients (40%), CC-1 in 3 (30%) and CC-2 in 3 (30%). Results: The mean length of the remaining small bowel was 105 cm (range 80-150). Mean hospitalization was 42 days vs 24 days in other patients with CRS+HIPEC (p<0.002). The daily ileostomy output increased between the 3rd to 4th week as a result of oral feeding and decreased at the 4th week due to somatostatin analogue administration and possible intestinal adaptation. The mean ileostomy output at 6 months was 810±100 ml vs 1590±210 ml the first month after CRS+HIPEC (p<0.001). The overall morbidity and mortality rate was the same as in patients without extensive resection. The impact of small bowel syndrome (SBS) on overall survival was very important, as the mean overall survival in the SBS group was 28.6 months vs 41 months in other CRS+HIPEC patients (p<0.001). Conclusions: SBS is sometimes inevitable in order to perform optimal cytoreduction. Special management is required for these patients, including special nutritional efforts and home total parenteral nutrition (TPN). Extensive small bowel resection may constitute a contraindication in the management of peritoneal carcinomatosis.

Spiliotis J.,Metaxa Cancer Hospital | Halkia E.,Metaxa Cancer Hospital | Halkia E.,Peritoneal Surface Malignancy Unit | Lianos E.,Metaxa Cancer Hospital | And 4 more authors.
Annals of Surgical Oncology | Year: 2015

Background: The current treatment of ovarian cancer consists of cytoreductive surgery (CRS) and systemic chemotherapy. The aim of this study was to examine if hyperthermic intraperitoneal chemotherapy (HIPEC) is an alternative modality to treat this category of patients along with a second attempt of surgical resection and second- or third-line systemic chemotherapy afterward. Methods: In an 8-year period (2006–2013), 120 women with advanced ovarian cancer (International Federation of Gynecology and Obstetrics [FIGO] IIIc and IV) who experienced disease recurrence after initial treatment with conservative or debulking surgery and systemic chemotherapy were randomized into two groups. Group A comprised 60 patients treated with CRS followed by HIPEC and then systemic chemotherapy. Group B comprised 60 patients treated with CRS only and systemic chemotherapy. Results: The mean survival for group A was 26.7 versus 13.4 months in group B (p < 0.006). Three-year survival was 75 % for group A versus 18 % for group B (p < 0.01). In the HIPEC group, the mean survival was not different between patients with platinum-resistant disease versus platinum-sensitive disease (26.6 vs. 26.8 months). On the other hand, in the non-HIPEC group, there was a statistically significant difference between platinum-sensitive versus platinum-resistant disease (15.2 vs. 10.2 months, p < 0.002). Complete cytoreduction was associated with longer survival. Patients with a peritoneal cancer index score of <15 appeared also to have longer survival. Conclusions: The use of HIPEC along with the extent of the disease and the extent of cytoreduction play an important role in the survival of patients with recurrence in an initially advanced ovarian cancer. © 2014, Society of Surgical Oncology.

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