Looking into HIPEC

[Shana]

Just sending you hope and prayers and wishing that you will find the right path to wellness and NED.

We are all in this together and I am so grateful for everyone who shares their knowledge with us.

((( Hugs )))

[StDrogo]

I believe the benefits of CRS/HIPEC in CRC are both under- and overstated. They are understated inasfar as a very select subset of "ideal" patients (e.g., Skifletch, jenhopesprayd, rheaeliza, and possibly my wife) stand to benefit enormously, even curatively, from the procedure. The peritoneal carcinomatosis index is the main determining factor in CRC (with PMP and mucinous appendiceal neoplasms, only post-CRS PCI is especially relevant). Basically, those with a PCI less than 6 are potentially curable—and the experiences on this board, apart from Julie Yip Williams's case, bear that out. Someone with a PCI of 0 appears to benefit the most, though it's quite rare right now for such a person to be referred for HIPEC by medical oncologists. When the PCI is between 7 and 13 (my wife's center has a threshold of 10 before terminating the operation, but many centers in America use 19), the intervention is likely palliative, but it is still more likely to extend OS to a couple of years, rather than months. Above 13, however, and the body's inflammatory response to such an extreme surgical intervention is likely to generate an even more favorable tumor microenvironment and hasten demise. The difficulty is that it's hard to determine PCI preoperatively (even with laparoscopic investigation, since 4 regions in the small bowel are calculated in the PCI that are difficult to reliably assess laparoscopically), which leads many surgeons to push the envelope once the patient is already open.

The benefits are also overstated since too little emphasis is placed on the ideal method of perfusion in the HIPEC portion of the procedure. If I'm not mistaken, Sugarbaker uses an open coliseum technique (which has an advantage over the closed technique in achieving good cytotoxic exposure by allowing the surgeon to manually release intraoperative fibrinous adhesions). The weakness, however, is that hyperthermic equilibrium can never really reliably be achieved throughout the abdomen in an open surgical field, and never to the anterior abdominal wall. For more extensive disease, I suspect that Marco Lotti of Bergamo's laparoscopic-enhanced closed technique is the best of both worlds, but I'm not aware of any surgeons in the U.S. who practice it.

Frankly, I'm cautious about saying that you are likely to significantly benefit from the procedure at the present time, but it's certainly possible that a more ideal perfusion agent than oxaliplatin or mitomycin C will be discovered and/or your existing mets will continue to respond to systemic chemo until such a time as you are a candidate for the procedure.

[bitchslapped]

Link to a thread on Colon Talk discussing HIPEC I happened to run across . Looks like Skifletch had Dr. Skitzki, associate of Dr. Kane:
http://coloncancersupport.colonclub.com ... hp?t=16554