Hyperthermic IntraPeritoneal

Chemotherapy
-HIPEC-

Rusie Daniel,
Medic Rezident Chirurgie Generala
 Carcinomatoza Peritoneala
Frecventa in tumorile gastrointestinale
Considerata multa vreme stadiu terminal
Prognostic foarte prost - supravietuire <6 luni
Tratament paliativ
 HIPEC

Citoreductie

Chimioterapie Hipertermie
intraperitoneala
 Indicatii
Pseudomixom peritoneal
Mezoteliom peritoneal
Adenocarcinom apendicular
Cancer colorectal
Cancer ovarian*
Cancer gastric*
 Rata de supravietuire la 5 ani (1)

Pseudomixom peritoneal - 80%

Mezoteliom peritoneal - 50%
Adenocarcinom apendicular - 49%
Cancer colorectal - 50% (PCI <10)
Cancer ovarian*
Cancer gastric* - 23% (PCI <10)
 Contraindicatii:
Tumori:
-Mamare
-Pancreatice
-Hepatice
-Biliare
 Contraindicatii:
Majore:
Varsta >65 ani
Comorbiditati cardio-pulmonare
Insuficienta renala
 Contraindicatii:
Minore:
Obezitate morbida (IMC >40)
Status nutritional prost
Obstructie intestinala
 Contraindicatii:
Absolute
Metastaze extra abdominale
Afectarea masiva a ggl retroperitoneali
Metastaze hepatice*
(cu exceptia CRC - acceptabil 1-3 metastaze hepatice
rezecabile)
Tumora primara nerezecabila.
 Factori prognostici
1) Gradul de citoreductie (Completeness of
Cytoreduction)
2) Peritoneal Cancer Index (PCI)
 Completeness of Cytoreduction (CCR)
CCR 0 - fara tumori reziduale vizibile
CCR 1 - noduli tumorali < 2.5mm
CCR 2 - noduli tumorali 2.5 mm - 2.5 cm
CCR 3 - noduli tumorali >2.5 cm
Peritoneal Cancer Index (PCI)
 Peritoneal Cancer Index (PCI)
Estimeaza probabilitatea citoreductiei complete
PCI <20 - HIPEC
Cancer colo rectal - PCI <16
Cancer gastric - PCI <10 - <15
Pseudomixom peritoneal >20*
 Avantajele HIPEC
Concentratii intraperitoneale mari - concentratii
plasmatice mici
Hipertermia - distruge fizic celulele maligne
- Potenteaza efectul
citotoxic al chimioterapicului
Chimioterapice
 Tipuri HIPEC
Deschis “Coloseum”
Semi-deschis
Inchis
Laparoscopic
Tipuri HIPEC
Tipuri HIPEC
Tipuri HIPEC
Tipuri HIPEC
Tipuri HIPEC
Tipuri HIPEC
1) Morris DL. Peritonectomy HIPEC—contemporary results, indications. Chinese Journal of Cancer Research.
2013;25(4):373-374. doi:10.3978/j.issn.1000-9604.2013.07.03.
2) Cotte E, Passot G, Gilly F-N, Glehen O. Selection of patients and staging of peritoneal surface malignancies. World
Journal of Gastrointestinal Oncology. 2010;2(1):31-35. doi:10.4251/wjgo.v2.i1.31.
3) González-Moreno S, González-Bayón LA, Ortega-Pérez G. Hyperthermic intraperitoneal chemotherapy: Rationale
and technique. World Journal of Gastrointestinal Oncology. 2010;2(2):68-75. doi:10.4251/wjgo.v2.i2.68.
4) E. Halkia, A. Tsochrinis, D. T. Vassiliadou, et al., “Peritoneal Carcinomatosis: Intraoperative Parameters in Open
(Coliseum) versus Closed Abdomen Hipec,” International Journal of Surgical Oncology, vol. 2015, Article ID 610597,
6 pages, 2015. doi:10.1155/2015/610597
5) Klaver CEL, Musters GD, Bemelman WA, et al. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in
patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial. BMC
Cancer. 2015;15:428. doi:10.1186/s12885-015-1430-7.