Peritonectomía radical y quimioterapia intraperitoneal : cinco años de experiencia en la Fundación Santa Fe de Bogotá (ONCOLGroup - estudio ATIA).

Peritoneal cytoreductive surgery and intraperitoneal chemotherapy : five years of experience at the Fundación Santa Fe de Bogotá (ONCOLGroup - ATIA study).

Contenido principal del artículo

Jorge Miguel Otero
Fernando Arias
Eduardo Londoño
Martha Mora
Henry Becerra
Natalia Cortés
Ómar Salamanca
Carlos Guerrero
Hernán Carranza
Carlos Vargas
Laura Bernal
Andrés Felipe Cardona

Resumen

Objetivo: Evaluar varios desenlaces tempranos en una cohorte de pacientes con neoplasias del peritoneo tratados con peritonectomía radical seguida de quimioterapia hipertérmica intraperitoneal (hyperthermic intraperitoneal chemotherapy, HIPEC). Métodos: Se incluyeron 48 pacientes tratados consecutivamente con peritonectomía radical más HIPEC, entre noviembre de 2007 y junio de 2012; 34 pacientes (70,8%) presentaron tumores de origen apendicular, 6 (12,5%) fueron primarios del peritoneo, 3 (6,3%) de ovario, 3 (6,3%) de colon, 1 carcinosarcoma (2,1%) y 1 (2,1%) angiosarcoma. La edad promedio fue 51 años (±13,1) y la mediana de seguimiento 30 meses (r, 1-46). Se valoraron diversos datos demográficos, la histología, el índice de carcinomatosis peritoneal (PCI), las características de los procedimientos quirúrgicos y varios desenlaces, como la supervivencia libre de recaída (SLR) y la global (SG). También, se determinó la morbilidad y mortalidad a corto plazo. Resultados: En 34 pacientes se logró realizar citorreducción completa (71%). El PCI promedio fue 18 (<_x0031_0: _x0032_7_x002c_2_x0025_ y>10: 70,8%) y la mediana para el tiempo quirúrgico, la estancia en UCI, la duración del soporte nutricional y el tiempo de estancia hospitalaria fueron 14,1 horas (±3,2), 9,3 días (±7), 12,8 días (±9,6) y 29,5 días (±18,6), respectivamente. Las complicaciones más frecuentes fueron eventos tromboembólicos (31%), bacteremia relacionada con catéter (23%), las fístulas (17%), la nefrotoxicidad (17%) y la fuga biliar (8,3%). Dos pacientes (4,2%) fallecieron por complicaciones asociadas al procedimiento. Dieciséis pacientes (33%) tuvieron recaída con una mediana de SLR de 20 meses (IC95%, 11,3-28,4). Conclusiones: La cirugía citorreductiva más HIPEC en pacientes bien seleccionados que presentan neoplasias que afectan el peritoneo es un procedimiento que se puede realizar en Colombia con un adecuado perfil de seguridad y eficacia. La mortalidad fue similar a lo reportado en la literatura mundial.

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Detalles del artículo

Biografía del autor/a (VER)

Jorge Miguel Otero, Fundación Santa Fe de Bogotá

Grupo Oncología Clínica y Traslacional, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia). Sección Enfermedades del Peritoneo, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Fernando Arias, Fundación Santa Fe de Bogotá

Sección Enfermedades del Peritoneo, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Eduardo Londoño, Fundación Santa Fe de Bogotá

Sección Enfermedades del Peritoneo, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Martha Mora, Fundación Santa Fe de Bogotá

Sección Enfermedades del Peritoneo, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Henry Becerra, Fundación Santa Fe de Bogotá

Grupo Oncología Clínica y Traslacional, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia)

Natalia Cortés, Fundación Santa Fe de Bogotá

Departamento de Cirugía, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Ómar Salamanca, Fundación Santa Fe de Bogotá

Sección Enfermedades del Peritoneo, Fundación Santa Fe de Bogotá (Bogotá, Colombia). Departamento de Medicina Interna, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Carlos Guerrero, Fundación Santa Fe de Bogotá

Sección Enfermedades del Peritoneo, Fundación Santa Fe de Bogotá (Bogotá, Colombia). Departamento de Anestesiología, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Hernán Carranza, Fundación Santa Fe de Bogotá ; Fundación para la Investigación Clínica y Molecular Aplicada del Cáncer (FICMAC)

Grupo Oncología Clínica y Traslacional, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia). Fundación para la Investigación Clínica y Molecular Aplicada del Cáncer – FICMAC (Bogotá, Colombia).

Carlos Vargas, Fundación Santa Fe de Bogotá ; Fundación para la Investigación Clínica y Molecular Aplicada del Cáncer (FICMAC)

Grupo Oncología Clínica y Traslacional, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia). Fundación para la Investigación Clínica y Molecular Aplicada del Cáncer – FICMAC (Bogotá, Colombia).

Laura Bernal, Fundación Santa Fe de Bogotá

Grupo Oncología Clínica y Traslacional, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia)

Andrés Felipe Cardona, Fundación Santa Fe de Bogotá

Grupo Oncología Clínica y Traslacional, Instituto de Oncología, Fundación Santa Fe de Bogotá (Bogotá, Colombia). Sección Enfermedades del Peritoneo, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

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