Implantación en Mallorca de un programa de Tratamiento multimodal de la Carcinomatosis Peritoneal mediante Quimioterapia Sistémica, Cirugía Citorreductora y Quimioterapia Intraperitoneal Hipertérmica (HIPEC)

Introduction: Research promoted since the early nineties by Sugarbaker et al in Washington, have demonstra- ted that many tumors of colorectal and appendiceal origen with peritoneal extension, may remain limited to the abdomen during relatively long periods before developing distant metastases. These findings have radically altered the consideration of peritoneal carcinomatosis from a systemic and almost terminal state, to a loco- regional disease, with possibility of surgical and oncological rescue, and thus, increasing the survival. The results of experimental studies of radical cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy, have demonstrated better results in terms of long-term survival and quality of life than con- ventional treatments. The rationale for the current treatment of peritoneal carcinomatosis is organized around a multimodal treat- ment with three courses of action: 1. Preoperative intravenous induction chemotherapy, 2. Cytoreductive sur- gery and peritonectomy, and 3. Hyperthermic intraperitoneal chemotherapy (HIPEC). The scientific basis of this multimodal treatment is based on the synergism between the hyperthermia and several cytostatic agents (mitomycin-C, cisplatin, oxaliplatin, etc.), the direct heat cytotoxicity on tumor cells, and the pharmacokine- tic advantages of chemotherapy administered intraperitoneally. Methodology: Program Objectives were the following: 1. Development of Multimodal surgical and oncologic treatment protocol; 2. Continuing education of the multidisciplinary group; 3. Ongoing training in the hyper- thermic intraperitoneal perfusion chemotherapy; 4. Application of a Work Safety Protocol; 5. Definition of indicators; 6. Design of database for exploitation of results; 7. Monitoring of morbidity and mortality, and 8. Monitoring and analysis of survival. Clinical evaluation and preoperative tumor extension study. 1. Clinical Indications. Types of tumors; 2. Patient selection. Inclusion and exclusion criteria; 3. Preoperative Evaluation Oncology; 4. Preoperative radiological evaluation; 5. Clinical pathway algorithm; 6. Patients follow-up, and 7. Laboral safety. Results: Five years ago, we started cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in the Hospital Son Llàtzer. 46 patients were operated (40 women and 6 men) with a mean age of 58.3 years (47-73 years). Of these 46 patients, 30 were patients with ovarian can-