Resectable Pancreatic Cancer With Peritoneal Metastases: Is Cytoreduction Combined With Hipec Effective and When?

Purpose: The purpose of the study is the presentation of the experience of one surgical team in patients with pancreatic cancer and peritoneal metastases treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and a review of the literature. Patients-Methods: The data of patients with pancreatic cancer and peritoneal metastases who underwent treatment with CRS plus HIPEC were analyzed. Clinical and histopathologic variables were correlated to survival, recurrence, and morbidity. Results: In 10 patients (6 men and 4 women), with a mean age of 54.5+12.2 (28-72) years, 13 cytoreductions and HIPEC were undertaken for pancreatic cancer and peritoneal carcinomatosis. Complications were recorded in 8 patients, and 2 patients died in the perioperative period. The 1- and 3-year overall survival rates were 76% and 18%, respectively, and the median survival was 28 months. The completeness of cytoreduction and the performance status were related to survival (p<0.05). The recurrence rate was 69.2%. The gender and the presence of ascites were related to recurrence (p<0.05). Ascites has been identified as a possible prognostic indicator of recurrence (p=0.027). Conclusion: There is evidence that CRS with HIPEC can increase survival in selected patients with pancreatic cancer and peritoneal metastases. Future studies are needed to identify the group of patients that will benefit from this treatment.