Mitomycin C is the most commonly administered agent in hyperthermic intraperitoneal chemotherapy, however oxaliplatin has been used as well. These agents are utilized because of a highly favorable ratio between intraperitoneal concentration versus plasma concentration over time (2),(12)-(14). The combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy maximizes the therapeutic benefit and has been shown to improve survival and quality of life in select patients (7),(15),(16). The goal of cytoreduction is the resection

of all gross tumor, and this can necessitate resection of the peritoneum with multivisceral resections, such as splenectomy. Current Inhibitors,research,lifescience,medical morbidity rates range from 27% to 56% at centers which perform hyperthermic intraperitoneal

chemotherapy (7), and one component of this is hematologic toxicity. Splenectomy results in elevated postoperative cell counts, primarily due to decreased clearance of senescent cells (17). Therefore, we investigated the effect of splenectomy on postoperative hematologic toxicity in a series of 195 Inhibitors,research,lifescience,medical patients undergoing hyperthermic intraperitoneal Inhibitors,research,lifescience,medical chemotherapy. Materials and methods Approval for this retrospective study was obtained from the Internal Review Board at Wake Forest University Medical Center in Winston-Salem, North Carolina. We studied a total of 195 patients with peritoneal carcinomatosis, who underwent initial cytoreductive surgery followed immediately by hyperthermic intraperitoneal chemotherapy, between December 2003 and December 2007, at our tertiary care institution. All patients were evaluated in the surgical oncology clinics preoperatively

and had pathologic confirmation of peritoneal Inhibitors,research,lifescience,medical carcinomatosis prior to the procedure. Cytoreductive surgery Cytoreductive surgery was performed with the goal of the removal of all gross tumor and involved organs, Inhibitors,research,lifescience,medical peritoneum, or tissue BKM120 deemed technically feasible and safe for the patient. Any tumors adherent or invasive to vital structures that could not be removed were cytoreduced using the cavitational ultrasonic surgical aspirator (CUSA; Valleylab, Boulder, whatever Colo.). Peritonectomy procedures were performed as indicated. The resection status of patients was judged after cytoreductive surgery using the following classification: R0-complete removal of all visible tumor and negative cytologic findings or microscopic margins; R1-complete removal of all visible tumor and positive post-perfusion cytologic findings or microscopic margins; R2a-minimal residual tumor, nodule(s) measuring 0.5 cm or less; R2b-gross residual tumor, nodule greater than 0.5 cm but less than or equal to 2 cm; and R2c-extensive disease remaining, nodules greater than 2 cm. Splenectomy was performed when gross disease was found on the capsule of the spleen, indicating a higher burden of peritoneal dissemination requiring more extensive surgery.