Peritoneal carcinomatosis of colorectal origin is considered stage IV metastatic disease and is sometimes the only site of distant spread (1). It was once considered a terminal condition with a six-month median survival (2). Since 1980, the concept of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has evolved into at least a reasonable if not a standard treatment for
Inhibitors,research,lifescience,medical such aggressive disease (3),(4). Peritonectomy associated with organ resections was thoroughly described by Sugarbaker to achieve complete macroscopic cytoreduction (5). The addition of HIPEC helps treat residual microscopic disease by providing a high concentration of cytotoxic agents with minimal systemic absorption (6). Hyperthermia potentiates the cytotoxic effects of chemotherapy (7). Mitomycin C (MMC) and oxaliplatin are the most commonly used drugs for non-ovarian malignant peritoneal carcinomatosis (8). The last consensus meeting in Milan addressed adverse effects Inhibitors,research,lifescience,medical in CRS + HIPEC agreeing to use National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE V3) standard criteria to grade the complications (9). This extensive procedure comes at a high price of grade III/IV (10) morbidity
(12-52%) and early mortality (0.9-5.8%) (11). The main complications with these approaches Inhibitors,research,lifescience,medical are infectious, renal, Inhibitors,research,lifescience,medical thrombotic and hematologic (12). They are related to the extent of the cytoreduction but also to the local and systemic toxicity of the intra peritoneal chemotherapy. In this issue, Becher and al. analyzed 195 patients undergoing CRS and HIPEC for carcinomatosis, mainly of appendiceal and colon origin. They compared patients
Inhibitors,research,lifescience,medical requiring splenectomy to those who did not with the focus of this report on hematotoxicity. The authors are to be congratulated for the complete laboratory and toxicity data, which are often missing or incomplete in the literature. The number of patients studied is significant, highlighting the familiarity and experience with the procedure at the Wake Forest University School of Medicine, Winston-Salem. Three important points can be gleamed from this study. The splenectomy group required those more red blood cells transfusions, had a longer hospital stay and they also had a lower incidence of white blood cell toxicity. There was no CP-868596 supplier significant difference in platelet or plasma requirements. These findings can be explained by the fact that patients requiring splenectomy had a more important tumor burden and thus required a more extensive surgery. The white blood cell nadir post HIPEC was statistically higher in the splenectomy group. Hence, granulocyte colony stimulating factor (G-CSF; filigrastim) was needed in only 29% of the splenectomy group compared to 43% of non-splenectomy patients (P=0.043) following their protocol for its use (13).