Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy (Hipec) In Children: Our First Three Cases.

Aim of the study Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an innovative technique for peritoneal sarcomatosis in children, a condition associated with very poor outcomes. We report the characteristics, outcome and complications of the first three patients treated with CRS and HIPEC in our center. Case description During the last five years, 4 children were considered eligible to CRS and HIPEC. These children were affected by desmoplastic small round cell tumor (DSRCT - n =2), abdominal rhabdomyosarcoma (n=1) and pelvic angiosarcoma (n=1). Two patients presented a controlled extra-abdominal disease. In one case of DSRCT, CRS and HIPEC were not performed as the disease was considered to be too extended at the moment of surgery. In the other cases, HIPEC was performed using closed technique, with cisplatin (in the case of DSRCT) or cisplatin and doxorubicin (in the other two cases) at 41°C. Peritoneal Cancer index ranged from 9 (abdominal rhabdomyosarcoma) to 28 (pelvic angiosarcoma). In all cases, a complete cytoreduction was obtained. No major complications were observed at 30 days. All patients received radiotherapy after the procedure. Two patients died respectively 7 and 32 months after the procedure; the last one suffered from a severe enteroparesis. One patient (affected by abdominal rhabdomyosarcoma) is still alive 17 months after the procedure, but suffers from a severe enteroparesis. Conclusions CRS and HIPEC can be performed safely and can conduct to a survival gain in patients with sarcomatosis. Nevertheless, severe complications can be observed even months after the procedure.