1. Gazi ABDULHAY, Sebile GÜLER ÇEKİÇ
Outcomes of new technique in implanting intraperitoneal ports for intraperitoneal chemotherapy
Gazi ABDULHAY, Sebile GÜLER ÇEKİÇ

2. Intraperitoneal Chemotherapy
Intraperitoneal (IP) chemotherapy, proposed in the 1970’s, provides an easy access to the peritoneal cavity for delivering chemotherapy in which drug interferes with the tumoral surfaces rapidly and remains longer.
In 2006, the National Cancer Institute (NCI) advised the IP/IV chemotherapy to be used in selected patients based on the GOG study 172
In the GOG 172 study, it was demonstrated that a 16 month improvement in median overall survival although only 42% of the patients completed the intended six cycles

3. Materials and Method
Leigh Valley Women’s Cancer Center from January 2005 to May 2016
Evaluated for:
demographic and surgicopathologic characteristics including extend of surgical procedure at the time of cytoreductive surgery,
timing of catheter placement,
findings during laparoscopic port placement operations,
complications associated with catheter placement,
side effects of chemotherapy,
timing of port removal

4. Survival was calculated from the first cytoreductive surgery to the last visit.
For the patients with recurrence it was calculated from the last cytoreductive operation before placement
Main target of this technique was to finish 6 cycles of IPCT

5. Results 72 patients The average age of the patients were 58.11 ± 1.167
One patient changed the institution
One had peritoneovaginal fistula after the cytoreductive operation
One refused to have IPCT
The average age of the patients were ± 1.167
Body Mass Index (BMI) was ± 0.82

6. Age
N (%)
18-54
27 (37.50)
55-64
28 (38.89)
>65
17 (23.60)
Median (range)
 58 (39-80)
Body Mass Index
<20
2 (2.80)
20-24,9
18 (25.00)
25-29,9
30-34,9
17 (23.61)
>35

7. Malign Mixed Mesenchimal Tumor Others 2(2.8)
Primary Site
N(%)
Ovarian
54 (75)
Peritoneal
7 (9.8)
Endometrial
6 (8.3)
Synchronous
5 (7.0)
Stage II
1 (1.4)
IIIA
4 (5.6)
IIIB
5 (6.9)
IIIC
46 (63.9) IV
15 (20.8)
Histology
Serous
45 (62.5)
Endometrioid
13 (18.1)
Mucinous
Clear cell
3 (4.2)
Malign Mixed Mesenchimal Tumor
Others
2(2.8)

8. Grade
N(%)
I and II
18 (25)
III
54 (75)
Residual
None
64 (88.9)
Yes 
8 (11.1)
Neoadjuvant chemotherapy No
54 (75.0)
Yes
18 (25.0)
Secondary
57 (79.2)
15 (20.8)

9. Lymph node positivity No 24
Yes  39
Surgical Procedures
Hysterectomy and ooferectomy
59 (81.9)
Omentectomy, peritonectomy
66 (91.7)
Appendectomy
56 (77.8)
Bowel resection
20 (27.8)
Lymph node resection
62 (86.1)
Spleenectomy, hepatic nodul or partial bladder resection 
14 (19.4)
Genetic background
(n=48)
Negative
38 (79.17)
BRCA 1 positive
6 (12.5)
BRCA 2 positive
2 (4.16)
Mutation of unknown significance

10. Implant placement
Laparotomy 
11 (15.28)
Laparoscopy 
61 (84.72)
New tumoral implants during LS
None 
50 (81.97)
Yes
11 (18.03)
Optimal cytoreduction during LS
No 
2 (3.28)
59 (96.72)
Adhesions
None
22 (36.07)
Upper abdomen
23 (37.7)
Lower abdomen
5 (8.20)
Both

11. Average survival (months)
Number of cycles
Number of patients (%)
Average survival (months)
2 (2.86)
22.00±3.00 1
7 (9.86)
17.71±8.66 2
46.86±17.08 3
3 (4.23)
63.33±33.92 4
41.50±28.50 5
57.67±20.19 6
13 (18.31)
45.00±8.25 7
5 (7.04)
69.80±14.81 8
29 (40.84)
63.90±5.87
66%

12. Survival

13. Side effects of intraperitoneal chemotherapy and reasons for discontinuation
Reason for change/discontinuation
Number of cases (n=72)
Number of patients stopped IPCT (n=72)
Cathater-related
8 (11.11%)
IP Cathater infection
23 (31.94%)
IP cathater malfunctioning
7 (9.72%)
Chemotherapy related
3 (4.17%)
Nausea
35 (48.61%)
2 (2.78%)
Neuropathy
27 (37.50%)
Others (Renal, methabolic, heart attack)
9 (12.50%)
1 (1.39%)
Disease progression

14. Reason for change/discontinuation Number of cases (n=72)
Number of patients stopped IPCT (n=72)
Possible catheter-related
5 (6.94%)
Abdominal pain
29 (40.27%)
1 (1.39%)
Other infections (urinary tract infections, sepsis)
8 (11.11%)
Bowel complications
6 (8.33%)
3 (4.17%)
Fistula formation during IPCT
1(1.39%)
Non-related complications
Stroke, aneurism, embolism
4 (5.55%)
Lost to follow up, patient refusal
2 (2.78%)
Fistula formation (before IPCT)
Total
25 (33.80%)

15. DISCUSSION
IP chemotherapy has advantages on increasing the survival rates in stage III ovarian cancers. Still, IP chemotherapy is not favored among physicians due to high rates of discontinuation.
With our new technique of port insertion, port related complications and discontinuation rates could decrease
Survival advantage increased as the number of cycles delivered increased. In patients who had 7 and more cycles it was more than 5 years (64 months).

16. With the laparoscopic approach adhesiolysis can be performed which also increases the probability to achieve IPCT. With changes in the chemotherapy regimes, early intervention in managing side effects could also increase the number of IP cycles received.

17. Thank you