The Use of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Pediatric Peritoneal Metastasis

The management of pediatric peritoneal metastasis and the possible role of logo regional treatment using cytoreductive surgeryand Hyperthermic Intraperitoneal Chemotherapy (HIPEC). A retrospective review of the last two decades from the sameperitoneal surface malignancy center.Objective: Pediatric peritoneal metastasis.Background: Peritoneal malignancies in children are rare, but associated with poor outcome. The CRS and HIPEC have beenapplied to pediatric population in recent years. The role of this treatment remains controversial due to the rarity of the diseaseand the limited of the cases.Method: A retrospective analysis from 2003 to 2023 identified 16 children with PM who underwent CRS and HIPEC from ourgroup.Results: The median age of the children was 14 year (range 8-16,4). The histological types included Desmoid tumors (5),Wilms tumors (5), rhabdomyosarcoma (2) and other (4). The median peritoneal cancer index was 10.2 (range 6-28). There is 1postoperative death.The median PCI 10.2 (range 6-28). The median operation time was 6h (range 4-10). There is one postoperative death 1/16(6.25%) due to massive pulmonary embolism in a colon cancer patient.All patients routinely received a Levine tube (gastric tube) following CRS and HIPEC, which was removed between the 4th and8th postoperative day. No evidence of renal failure or other metabolic complications. The major complications according to the Clavien-Dindo were 3/16 (18.8%).Postoperatively patients received chemotherapy (n=13) and radiotherapy (n=8) according to the different received molecular targeted therapy. From the 14 patients 8 relapsed after CRS + HIPEC, tree of them in peritoneal cavity and five in Liver/or Lungs.The mean time of relapse disease is 2 years after CRS plus HIPEC.Conclusion: CRS+HIPEC are safe and feasible in children with good selection of the cases.