CRS + HIPEC in Recurrent Ovarian Cancer

Case Record: CRS+HIPEC for recurrent Epithelial Ovarian Cancer (EOC). Clinical History. Patient #1: · Patient diagnosed with recurrent EOC (sensitive to platinum). Histology: mucinous tumor. Endocervical type · Clinical, biochemical, and radiological response. · Cytoreductive Radical Surgery plus Heated Intraperitoneal Chemotherapy (CRS + HIPEC) is proposed Other History: The radiological study was given at the diagnosis of the recurrence and the neoadjuvant CT treatment was finished Technique Description 1) Xiphopubic approach to the abdomen 2) Rigorous exploration of all abdominal-pelvic regions 3) Confirmation of the technical possibilities of complete cytoreduction with absence of visible tumor residue (CC-O) 4) Strategic design of the CRS by unifying all the peritonectomy procedures described by Sugarbaker in two surgical steps 5) Confirmation of the CC-O 6) Administration of the HIPEC in the open mode (Colosseum) Procedure Steps 1) Parietal peritonectomy, pelvic peritonectomy with rectosigmoid resection 2) Residual greater omentectomy, and splenectomy 3) Subphrenic right peritonectomy and lesser omentectomy 4) Digestive reconstruction. Colo-rectal anastomosis without stoma 5) "Colosseum" HIPEC: preparation and administration. Preparation and administration of chemotherapy for 60 min at 42.5ºC Learning Points · Role of CRS + HIPEC in recurrent EOC ovarian cancer · Use of Peritonectomy Procedures associated with visceral resection (Sugarbaker) to achieve complete CRS (macroscopic absence of tumor CC-O) · Technical modifications to the original peritonectomy procedures · Pelvic peritonectomy and rectosigmoid colon resection · Greater (residual) omentectomy and splenectomy · Left subphrenic peritonectomy · Lesser omentectomy and cholecystectomy with stripping of the hepatoduodenal ligament · Complete right subphrenic peritonectomy · “True” end to end colorectal mechanical reinforced anastomosis · Preparation and administration of the HIPEC in its “open” or coliseum modality · Personal series results. 146 patients treated for recurrent EOC over 1.240 CRS+HIPEC · Conclusions

Case Record

CRS+HIPEC for recurrent Epithelial Ovarian Cancer (EOC)

Clinical History

Patient #1

· Patient diagnosed with recurrent EOC (sensitive to platinum). Histology: mucinous tumor. Endocervical type
· Clinical, biochemical, and radiological response.
· Cytoreductive Radical Surgery plus Heated Intraperitoneal Chemotherapy (CRS + HIPEC) is proposed

Other History:

The radiological study was given at the diagnosis of the recurrence and the neoadjuvant CT treatment was finished

Technique Description

1) Xiphopubic approach to the abdomen
2) Rigorous exploration of all abdominal-pelvic regions
3) Confirmation of the technical possibilities of complete cytoreduction with absence of visible tumor residue (CC-O)
4) Strategic design of the CRS by unifying all the peritonectomy procedures described by Sugarbaker in two surgical steps
5) Confirmation of the CC-O
6) Administration of the HIPEC in the open mode (Colosseum)

Procedure Steps

1) Parietal peritonectomy, pelvic peritonectomy with rectosigmoid resection
2) Residual greater omentectomy, and splenectomy
3) Subphrenic right peritonectomy and lesser omentectomy
4) Digestive reconstruction. Colo-rectal anastomosis without stoma
5) "Colosseum" HIPEC: preparation and administration. Preparation and administration of chemotherapy for 60 min at 42.5ºC

Learning Points

· Role of CRS + HIPEC in recurrent EOC ovarian cancer
· Use of Peritonectomy Procedures associated with visceral resection (Sugarbaker) to achieve complete CRS (macroscopic absence of tumor CC-O)
· Technical modifications to the original peritonectomy procedures
· Pelvic peritonectomy and rectosigmoid colon resection
· Greater (residual) omentectomy and splenectomy
· Left subphrenic peritonectomy
· Lesser omentectomy and cholecystectomy with stripping of the hepatoduodenal ligament
· Complete right subphrenic peritonectomy
· “True” end to end colorectal mechanical reinforced anastomosis
· Preparation and administration of the HIPEC in its “open” or coliseum modality
· Personal series results. 146 patients treated for recurrent EOC over 1.240 CRS+HIPEC
· Conclusions