Hyperthermic intraperitoneal chemotherapy

In summary, tumor resection coupled with hyperthermic chemotherapy administration can be an effective intervention in cancer treatment. The hyperthermia itself is an important variable because tumor cell death occurs at lower temperatures than that seen in normal tissue.^2,24,25 The literature overwhelmingly supports the conclusion that CHPP affords an improved 5-year overall survival rate across various malignancies. For patients with pseudomyxoma peritonei, Deraco et al observed a 5-year overall survival rate of 97%.⁴ Patients with ovarian cancer showed a 5-year survival rate of 63.4% versus 52.8% in the control group, in a study by Ryu et al.²⁶ In a study by Shen et al²⁷ on a colorectal cancer population, one third of patients with complete resection of gross disease had 5-year overall survival. Although this is not as impressive as the survival seen for patients with pseudomyxoma peritonei and ovarian cancer, it is a much better outcome than the 6-month survival duration in a similar population undergoing standard treatment. McQuellon and his group²⁸ evaluated the functional status and quality of life of patients, as opposed to their 5-year survival status. Most patients showed a return to baseline, or an improvement above the baseline level, in functional status by 3 months after surgery. Interestingly, a subset of patients with ascites showed an improvement earlier in their recovery course and a resulting quality of life even higher than that experienced preoperatively. Undoubtedly, CHPP is an invaluable therapeutic option. Patient selection requires an evaluation of many facets: the extent of the disease, histologic differentiation, comorbidities, and other variables. Once elected, CHPP, perhaps more than any other intraoperative procedure, requires a team approach.