Initiation of a Hyperthermic Intraperitoneal Chemotherapy Program at Aurora Health Care
Background: The use of hyperthermic intraperitoneal chemotherapy (HIPEC) along with radical debulking has been the standard treatment for peritoneal-based malignancies, including appendiceal cancer (APPX), primary peritoneal cancer (PPC), peritoneal mesothelioma, and peritoneal spread from colorectal (CRC), gastric (GA), and gynecologic malignancies. At Aurora Health Care, a HIPEC program was initiated by our multidisciplinary gastrointestinal cancer group.
Purpose: To review the initiation and implementation of a HIPEC program started at Aurora.
Methods: Our protocol involves preoperative computed tomography scan, colonoscopy, upper endoscopy, and presentation at a multidisciplinary meeting. All patients received preoperative chemotherapy. All patients had diagnostic laparoscopy to determine resectability prior to debulking (same day). Laparotomy with complete debulking and resection of visually involved tissue was then performed. After temporary abdominal wall closure, HIPEC was performed for 90 minutes, chemotherapy was flushed and drained, and anastomoses were created. Patients were kept on chemotherapy precautions in the intensive care unit for a minimum of 48 hours.
Results: From October 2016 to June 2017, a total of 12 patients 28–76 years of age were referred for HIPEC; 10 patients had HIPEC (90 minutes at 42°C) utilizing mitomycin C (30 mg at time 0 and 10 mg at 60 minutes) after complete debulking of their tumor. Diagnoses included APPX (4), PPC (2), ovarian cancer (2) and CRC (2). Two patients did not undergo HIPEC due to extensive disease (GA and APPX). Of the 10 patients who had HIPEC, 9 had prior surgeries (mean: 1.8, range: 1–4). Peritoneal carcinomatosis index score ranged from 4 to 19. Resections included colon (7), spleen (3), diaphragm (3), small bowel (2), liver (2), stomach (1), gall bladder (1), pancreas (1), abdominal wall (1) and ovary (1). No patients had anastomotic leakage. Length of stay ranged from 7 to 54 days (mean: 15.8, median: 10). All patients had complete debulking; 3 received postoperative chemotherapy and 2 (APPX and CRC) have recurred. Postoperative complications have included prolonged ileus, recurrent small bowel obstruction, and intraabdominal collections and abscesses. There were no mortalities.
Conclusion: Cytoreduction and HIPEC are feasible in a large community-based health system. Our results were favorable and, after our initial evaluation, we plan to continue our program and move forward with an institutional review board-approved study looking at tissue and blood levels of mitomycin C prior to, during, and after HIPEC.