الفهرس 
ReviewOnly 14 pages are availabe for public view
 |  | from | 109 |  |  |
| | | from | 109 | | |
Abstract
Cytoreductive Surgery (CRS) defined as removal of macroscopic abdominal and peritoneal disease, combined with hyperthermic perioperative chemotherapy (HIPEC) is the treatment indicated for pseudomyxoma peritonei (PMP) and appendiceal neoplasms with peritoneal metastases. CRS and HIPEC should now be considered as the standard of care for selected patients with peritoneal mesothelioma, ovarian and moderate to small volume peritoneal metastases secondary to colorectal cancer. CRS and HIPEC should be avoided in patients who are unlikely to undergo a complete or near-complete resection, or due to comorbidities are unlikely to achieve a full recovery. Our experience after CRS and HIPEC concluded that its risk of complications appeared to be acceptable with statistically significance correlation between occurrence of major morbidity and DM, high preoperative ESR, high preoperative CRP >1.4, high preoperative LDH, high preoperative NLR > 7 and high PCI ≥ 15. We choose IP chemotherapy type according to origin of primary tumor pathology ( histology driven ), we used fluorouracil with concomitant Iv calcium folinate in PMP in contrast to established protocols used oxaliplatin or mitomycin in PMP, we add irinotecan to cisplatin in refractory ovarian cancer with acceptable tolerability and better results, oxaliplatin with or without irinotecan and concomitant IV fluorouracil and calcium folinate in CRC and cisplatin in mesothelioma and adding concomitant iv gemcitabine. In our study, almost all patients of PMP, mesothelioma and CRC we used bidirectional chemotherapy with intraperitoneal chemotherapy combined with Iv chemotherapy which was feasible and acceptable tolerability. Our study demonstrated statistically significance correlation between PFS and presence of ascites, high preoperative NLR and high PCI. Our study demonstrated correlation between OS and presence of ascites, high preoperative NLR and high PCI, this feasible non costy prognostic and predictive markers producing an intentionally highly selected patient population Our study demonstrated that OS and PFS was highly dependent on the underlying primary disease and origin of primary tumor as we found better result with PMP and worest with CRC, while CRC cases was of low number and with refractory on more than one line of chemotherapy so we need further studies to demonstrate benefit of HIPEC for CRC patients. In conclusion, since we started our program in 2014 at our center, we have been able to confirm the feasibility of CRS + HIPEC for the PSM of different tumor entities. Every patient who is a potential candidate for CRS and HIPEC should be discussed in a multidisciplinary team has enjoyed an intense collaboration of different specialties and our definition of rigorous inclusion and exclusion criteria for patient selection. With acceptable morbidity rates that can be explained by the complexity of the procedure and an acceptable 30-day mortality, we were able to confirm the safety of this procedure in our center.