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Perry Shen, MD; Edward A. Levine, MD; Jason Hall, MD; Doug Case, PhD; Greg Russell, MS; Ronald Fleming, PharmD; Richard McQuellon, PhD; Kim R. Geisinger, MD; Brian W. Loggie, MD

Arch Surg. 2003;138:26-33.

Hypothesis  Certain clinicopathologic factors predict improved survival after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis.

Design  Prospective clinical trial.

Setting  Surgical oncology service at a university academic hospital.

Patients  A population of 109 consecutive patients with peritoneal carcinomatosis treated between December 1991 and November 1997.

Intervention  All patients underwent resection of gross disease followed by 2-hour intraoperative perfusion of mitomycin C (20-40 mg) into the peritoneal cavity at a temperature of 40.5°C.

Main Outcome Measures  Clinicopathologic factors that independently predicted improved overall survival rates.

Results  Overall survival at 1 and 3 years was 61% and 33%, respectively. With median follow-up of 52 months, median overall survival was 16 months. Four factors were significant independent predictors of improved survival by multivariate analysis: nonadenocarcinoma histologic features (P = .001), the appendix as a primary site (P = .003), the absence of hepatic parenchymal metastases (P = .01), and complete resection of all gross disease (R1/0 resection) (P<.001). Patients with an R1/0 resection vs an incomplete resection of gross disease (R2 resection) had 3-year overall survival of 68% vs 21% (P<.001).

Conclusions  Patients with peritoneal carcinomatosis have a uniformly poor prognosis. However, in select patients, the natural history of this disease condition may be altered by using the multimodality approach of cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. These results require confirmation in prospective randomized studies.

From Wake Forest University Baptist Medical Center, Departments of General Surgery (Drs Shen, Levine, and Hall), Oncology (Drs Case and McQuellon and Mr Russell), and Pathology (Dr Geisinger), and Kucera Pharmaceutical Co (Dr Fleming), Winston-Salem, NC; and Creighton University Cancer Center, Omaha, Neb (Dr Loggie).

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