Closed hyperthermic intraperitoneal chemotherapy with CO recirculation system compared with the open Coliseum technique in peritoneal malignity treatment.
Eduardo Diaz, Isabel Fabra, Emilio Vicente, Yolanda Quijano, Hipolito Duran, Luis Malave, Pablo Ruiz, Giulia Costantini, Valentina Nola, Riccardo Caruso, Valentina Ferri
Author Information
Eduardo Diaz: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain.
Isabel Fabra: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain.
Emilio Vicente: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain.
Yolanda Quijano: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain.
Hipolito Duran: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain.
Luis Malave: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain.
Pablo Ruiz: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain.
Giulia Costantini: Università degli Studi di Pavia, General Surgery, Italy.
Valentina Nola: Università degli Studi di Pavia, General Surgery, Italy.
Riccardo Caruso: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain.
Valentina Ferri: Hospital Universitario Madrid Sanchinarro, General Surgery, Spain. Electronic address: valenpeglio@gmail.com.
BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis can be performed in two ways: first, the standard open abdominal technique (Open HIPEC); or second, the closed technique. In recent years, a new technique has been introduced to perform closed HIPEC; the Peritoneal Recirculation System (PRS-1.0 Combat) with CO recirculation technology (PRS Closed HIPEC). The objective of this study is to present our experience with the PRS Closed HIPEC by comparing the intraoperative, postoperative and oncological results with the standard Open HIPEC technique (the Coliseum technique). METHODS: Data on patients undergoing CRS and HIPEC at the Sanchinarro University Hospital, Madrid from October 2012 to June 2021 were collected in a prospective database. The inclusion criteria were patients with primary or recurrent peritoneal metastases in gastrointestinal malignancies or ovarian cancer. The presence of an unresectable peritoneal carcinomatosis, the coexistence of another oncological disease, unresectable and distant metastases were the exclusion criteria. RESULTS: From October 2014 to June 2021, 84 patients underwent CRS and HIPEC at the Sanchinarro University Hospital, Madrid with curative intent. Since the introduction of the PRS Closed HIPEC technique in 2016, 65 patients have been treated. Before the introduction of PRS Closed HIPEC, 19 cases were performed using the Coliseum technique (the Open HIPEC group). The intraoperative results were similar in the two groups. Complete cytoreduction was achieved in all cases in the Open HIPEC group and in 98% in the PRS Closed HIPEC group. The rate of major complications was similar between the groups. Median Overall Survival (OS) resulted better in the Closed HIPEC group (67 months) with respecto to the Open group (43 months) (p < 0,001). Median Disease-Free Survival (DFS) was 15 months in the Open HIPEC group and 40 months in the PRS Closed HIPEC group (p < 0.001). CONCLUSION: The Peritoneal Recirculation System with CO recirculation technology (PRS Closed HIPEC) is a reproducible and safe technique and may represent a valid alternative for the administration of HIPEC.
