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Imaizumi K, Nishizawa Y, Ikeda K, Tsukada Y, Sasaki T, Ito M. Prognostic Impact of Curative Resection for Peritoneal Recurrence of Colorectal Cancer. Ann Surg Oncol 2020; 27:2487-2497. [PMID: 32052301 DOI: 10.1245/s10434-020-08242-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Peritoneal recurrence (PR) of colorectal cancer is a poor prognostic factor but may be treatable by curative resection. We investigated the efficacy of this treatment and identified risk factors for postoperative recurrence. METHODS The subjects were patients who underwent radical surgery for colorectal cancer between January 2006 and March 2014. Those with PR were retrospectively reviewed. Prognostic factors for overall survival (OS) and risk factors for postoperative recurrence were identified. RESULTS Among 2256 patients, 66 had PR (2.9%). Surgical resection of PR was performed in 41 patients. Curative resection was achieved macroscopically in 38 cases without diffuse metastases in the peritoneum distant from the primary tumor and with a peritoneal cancer index < 10. In multivariate analysis, curative resection was a significant prognostic factor [hazard ratio (HR) 0.198] for better 5-year OS compared with cases without curative resection (68.7% vs. 6.3%, P < 0.001). In 28 cases with concurrent metastasis, curative resection significantly improved 5-year OS compared with no curative resection (78.7% vs. 0%, P = 0.008). In the 38 patients with curative resection, the 3-year recurrence-free survival rate was 21.4%. In multivariate analysis, concurrent metastasis was a significant risk factor [HR 3.394] for postoperative recurrence, and cases with concurrent metastasis more frequently had recurrence within 2 years after curative resection. CONCLUSIONS Curative resection improved the prognosis in patients with limited and resectable PR of colorectal cancer with or without concurrent metastasis. However, recurrence after curative resection was common and concurrent metastasis was a risk factor for this recurrence.
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Affiliation(s)
- Ken Imaizumi
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
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102
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Ravn S, Heide-Jørgensen U, Christiansen CF, Verwaal VJ, Hagemann-Madsen RH, Iversen LH. Overall risk and risk factors for metachronous peritoneal metastasis after colorectal cancer surgery: a nationwide cohort study. BJS Open 2020; 4:284-292. [PMID: 32207578 PMCID: PMC7093782 DOI: 10.1002/bjs5.50247] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/12/2019] [Indexed: 01/16/2023] Open
Abstract
Background This study aimed to identify the cumulative incidence and risk factors of metachronous peritoneal metastasis (M‐PM) from colorectal cancer in patients who had intended curative treatment. Methods Patients with colorectal cancer were identified using the Danish Colorectal Cancer Group database for 2006–2015. The Danish Pathology Registry and the Danish National Patient Registry were used to identify M‐PM to 2017. Risk factors were estimated by multivariable absolute risk regression, treating death and other cancers as competing risks. Overall risk and risk differences (RDs) were estimated at 1, 3 and 5 years. Results In 22 586 patients with colorectal cancer, the overall risk of M‐PM was reported to be 0·9 (95 per cent c.i. 0·8 to 1·0) per cent at 1 year, 1·9 (1·8 to 2·1) per cent at 3 years and 2·2 (2·0 to 2·4) per cent at 5 years. Advanced tumour category ((y)pT4 versus (y)pT1) increased the RD of both M‐PM (2·9 (95 per cent c.i. 2·1 to 3·7) at 1 year and 6·0 (4·9 to 7·2) at 3 years) and lymph node involvement ((y)pN2 versus (y)pN0) (2·5 (1·8 to 3·2) at year and 4·3 (3·2 to 5·3) at 3 years). No further increase in risk was observed at 5 years. In a subanalysis, tumour‐involved resection margin (R1 versus R0) was associated with M‐PM with a RD of 3·9 (1·6 to 6·2) at 1 year and 5·9 (2·6 to 9·3) at 3 years. Conclusion The overall risk of M‐PM in patients with colorectal cancer is low, but is increased in advanced T and N status. Follow‐up of at least 3 years after colorectal cancer surgery may be necessary, given the potential curative treatment of early diagnosed M‐PM.
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Affiliation(s)
- S Ravn
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - U Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - V J Verwaal
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - L H Iversen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Colorectal Cancer Group, Copenhagen, Denmark
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Blakely AM, Lafaro KJ, Eng OS, Ituarte PHG, Fakih M, Lee B, Raoof M. The Association of Tumor Laterality and Survival After Cytoreduction for Colorectal Carcinomatosis. J Surg Res 2019; 248:20-27. [PMID: 31841733 DOI: 10.1016/j.jss.2019.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/11/2019] [Accepted: 10/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Primary tumor location has emerged as an important surrogate for tumor biology in metastatic colorectal cancer treated with systemic chemotherapy. It is unclear if primary tumor location is associated with survival after cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy (HIPEC) for colorectal carcinomatosis. METHODS Study of a contemporary cohort merged data from the California Cancer Registry, 2004-2012, and the Office of Statewide Health Planning and Development inpatient database. For patients undergoing CRS/HIPEC, clinicopathologic variables, treatment characteristics, and survival were compared by right versus left colon primary site. Survival was analyzed by Cox proportional hazards. RESULTS Of 272 patients identified, 128 (47.1%) had right-sided tumors. Left- and right-sided cohorts had similar patient, tumor, and treatment factors. Patients with left-sided primary tumors had significantly prolonged overall survival (mean 34 versus 15.5 mo, P = 0.0010). Factors independently associated with decreased overall survival included age >80 (HR 7.0, P < 0.0001), advanced T4 stage (HR 3.6, P = 0.0031), and positive lymph nodes (HR 2.2, P = 0.0004). Metachronous peritoneal involvement (HR 0.38, P < 0.0001) and left-sided primary tumors (HR 0.72, P = 0.041) were independently associated with improved overall survival. CONCLUSIONS This study identifies location of primary tumor as an important determinant of long-term survival after CRS/HIPEC. Patients with left-sided tumors have a more favorable prognosis.
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Affiliation(s)
- Andrew M Blakely
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California
| | - Kelly J Lafaro
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California
| | - Oliver S Eng
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California; Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Philip H G Ituarte
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California
| | - Marwan Fakih
- Department of Medical Oncology and Experimental Therapeutics, City of Hope National Medical Center, Duarte, California
| | - Byrne Lee
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California
| | - Mustafa Raoof
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California.
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Badia S, Picchia S, Bellini D, Ferrari R, Caruso D, Paolantonio P, Carbone I, Laghi A, Rengo M. The Role of Contrast-Enhanced Imaging for Colorectal Cancer Management. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00443-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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105
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Macrì A, Arcoraci V, Belgrano V, Caldana M, Carbonari L, Cioppa T, De Cian F, De Manzoni G, De Simone M, Giardina C, Muffatti F, Orsenigo E, Robella M, Roviello F, Saladino E, Sammartino P, Vaira M. Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy used as treatment of colo-rectal carcinomatosis: a multicentric study. Updates Surg 2019; 72:163-170. [PMID: 31729630 DOI: 10.1007/s13304-019-00691-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/31/2019] [Indexed: 01/26/2023]
Abstract
The aim of this study is to assess the morbidity and mortality related to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colo-rectal carcinomatosis. A retrospective multi-institutional study from seven Italian Centers was performed. One hundred and seventy-two patients, submitted to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) to treat carcinomatosis of colorectal origin, were recorded. Postoperative morbidity was evaluated in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Post-operative mortality was evaluated as patients' death within 60 days from surgical procedures. Predictors of morbidity were evaluated with univariate and multivariate analyses. Post-operative morbidity occurred in 83 patients (48.3%): grades 1-2 in 29 cases (16.9%), and grades 3-4 in 54 (31.4%). Mortality occurred in four cases (2.3%). Number of anastomoses (OR 1.45; 95% CI 1.05-2.00; p = 0.024), number of blood transfusions (OR 1.31; 95% CI 1.11-1.54; p = 0.001) and chemotherapy regimen [Oxaliplatin (OX): OR 2.87; 95% CI 1.22-6.75; p = 0.015] remained, in multivariate analysis, in a statistically significant correlation with overall morbidity. The only variable that was proven to have statistically significant correlation with 3-4 morbidity was the number of blood transfusions (OR 1.25; 95% CI 1.07-1.46; p = 0.005). Morbidity and mortality do not preclude the use of CRS plus HIPEC in the treatment of peritoneal carcinomatosis of colorectal origin.
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Affiliation(s)
- Antonio Macrì
- Department of Human Pathology, Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Valerio Belgrano
- Department of Surgery, University of Genoa, Largo R. Benzi, 16132, Genoa, Italy
| | - Marina Caldana
- 1st Department of General Surgery, University of Verona, P.le A. Stefani, 37126, Verona, Italy
| | - Ludovica Carbonari
- Department of Surgery "Pietro Valdoni", Cytoreductive Surgery and Intraabdominal Chemotherapy Unit, University "Sapienza" of Rome, V.le del Policlinico, 00161, Rome, Italy
| | - Tommaso Cioppa
- Department of Medicine, Surgery and Neuroscience, University of Siena, Strada delle Scotte, 53100, Siena, Italy
| | - Franco De Cian
- Department of Surgery, University of Genoa, Largo R. Benzi, 16132, Genoa, Italy
| | - Giovanni De Manzoni
- 1st Department of General Surgery, University of Verona, P.le A. Stefani, 37126, Verona, Italy
| | - Michele De Simone
- Department of Surgical Oncology, Candiolo Cancer Insitute, SP 142, 10060, Candiolo, Torino, Italy
| | - Claudia Giardina
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Francesca Muffatti
- Department of Surgery, San Raffaele Scientific Institute, Via Olgettina, 20132, Milan, Italy
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Via Olgettina, 20132, Milan, Italy
| | - Manuela Robella
- Department of Surgical Oncology, Candiolo Cancer Insitute, SP 142, 10060, Candiolo, Torino, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neuroscience, University of Siena, Strada delle Scotte, 53100, Siena, Italy
| | | | - Paolo Sammartino
- Department of Surgery "Pietro Valdoni", Cytoreductive Surgery and Intraabdominal Chemotherapy Unit, University "Sapienza" of Rome, V.le del Policlinico, 00161, Rome, Italy
| | - Marco Vaira
- Department of Surgical Oncology, Candiolo Cancer Insitute, SP 142, 10060, Candiolo, Torino, Italy
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Ihemelandu C, Naeem A, Parasido E, Berry D, Chaldekas K, Harris BT, Rodriguez O, Albanese C. Clinicopathologic and prognostic significance of LGR5, a cancer stem cell marker in patients with colorectal cancer. COLORECTAL CANCER 2019; 8:CRC11. [PMID: 32038737 PMCID: PMC7000925 DOI: 10.2217/crc-2019-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim: To analyze the clinicopathologic and prognostic significance of Leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5), a cancer stem cell marker expression in a cohort of colorectal cancer patients (CRC). Patients & methods: A total of 76 formalin-fixed paraffin-embedded tissue blocks of primary or metastatic tumors from 49 CRC patients were collected for duration 2009–2015. LGR5 expression was assessed through immunohistochemical staining of a tissue microarray. Results: LGR5 was significantly over expressed in CRC tissue samples and found to be a statistically significant independent prognostic marker for an improved overall survival. Conclusion: LGR5 expression was higher in colorectal cancer than in normal tissue. LGR5 was an independent prognostic marker for better clinical outcomes and might be used as a potential therapeutic target in CRCs.
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Affiliation(s)
- Chukwuemeka Ihemelandu
- Program in Peritoneal Surface Oncology, MedStar Surgical Oncology, Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd, NW Washington, DC 20007, USA.,Preclinical Imaging Research Laboratory, Center for Cell Reprogramming, Department of Oncology and Pathology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Rd, NW Washington, DC 20007, USA
| | - Aisha Naeem
- Preclinical Imaging Research Laboratory, Center for Cell Reprogramming, Department of Oncology and Pathology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Rd, NW Washington, DC 20007, USA.,Biostatistician, Preclinical imaging Research Laboratory, Department of Oncology and Pathology, Lombardi Comprehensive Cancer Center, Georgetown University Medical center, 3800 Reservoir Rd, NW Washington, DC 20007, USA
| | - Erika Parasido
- Preclinical Imaging Research Laboratory, Center for Cell Reprogramming, Department of Oncology and Pathology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Rd, NW Washington, DC 20007, USA
| | - Deborah Berry
- Histopathology & Tissue Shared Resource, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3900 Reservoir Rd, Washington, DC 20007, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
| | - Krysta Chaldekas
- Histopathology & Tissue Shared Resource, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3900 Reservoir Rd, Washington, DC 20007, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
| | - Brent T Harris
- Histopathology & Tissue Shared Resource, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3900 Reservoir Rd, Washington, DC 20007, USA.,Departments of Neurology & Pathology, Georgetown University Medical Center
| | - Olga Rodriguez
- Preclinical Imaging Research Laboratory, Center for Cell Reprogramming, Department of Oncology and Pathology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Rd, NW Washington, DC 20007, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
| | - Christopher Albanese
- Preclinical Imaging Research Laboratory, Center for Cell Reprogramming, Department of Oncology and Pathology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Rd, NW Washington, DC 20007, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
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107
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Narasimhan V, Warrier S, Michael M, McCormick J, Ramsay R, Lynch C, Heriot A. Perceptions in the management of colorectal peritoneal metastases: A bi-national survey of colorectal surgeons. Pleura Peritoneum 2019; 4:20190022. [PMID: 31799373 PMCID: PMC6881667 DOI: 10.1515/pp-2019-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/03/2019] [Indexed: 12/16/2022] Open
Abstract
Background There is great variability in the uptake of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of colorectal peritoneal metastases (CRPM) in Australia and New Zealand. This study aims to provide a snapshot of perceptions among colorectal surgeons in the management of CRPM. Methods A structured ten-question online survey was sent to all colorectal surgeons, with three questions on clinical experience and demographics, one on health economics and six on hypothetical clinical scenarios. Scores were collated and reported based on Likert scales. Results Eighty-one respondents (36.2%) completed the survey. Most surgeons (66.7%) strongly disagreed with offering CRS and HIPEC at all hospitals. The majority (87.7%) agreed that CRS and HIPEC offered a higher survival benefit than systemic chemotherapy in pseudomyxoma peritonei (PMP), and 69.1% in CRPM (comparators: 60.5% ovarian cancer, 14.8% gastric cancer). There were mixed strategies in managing low-volume, isolated peritoneal recurrences. The majority did not recommend second-look laparoscopy, but favoured operative management of Krukenberg tumours. In the presence of incidental peritoneal metastases, only 29.6% favoured biopsy only and referring the patient to a peritoneal disease centre. Conclusions Response rate was relatively low. In Australia and New Zealand, colorectal surgeons see a strong role for CRS and HIPEC in the management of PMP and CRPM. The role of “second look” surgery in high-risk cases is controversial and not supported. Krukenberg tumours are viewed as surgical disease. Regular updates and collaboration with peritoneal centres may help surgeons stay abreast with latest evidence in the field.
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Affiliation(s)
- Vignesh Narasimhan
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Satish Warrier
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Michael
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jacob McCormick
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Robert Ramsay
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Craig Lynch
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander Heriot
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
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Evolution of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: 8-Year Single-Institutional Experience. Dis Colon Rectum 2019; 62:1195-1203. [PMID: 31490828 DOI: 10.1097/dcr.0000000000001456] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Colorectal cancer is the second leading cause of cancer-related mortality worldwide. Peritoneal metastases carry the worst prognosis among all sites of colorectal cancer metastases. In recent years, the advent and acceptance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have greatly improved survival for selected patients with low-volume peritoneal metastases. OBJECTIVE Here, we report the evolution of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases at a statewide tertiary referral center over an 8-year period. DESIGN This is a retrospective study from 2009 to 2017. SETTING The study was conducted at a single center over 8 years. PATIENTS Patients with colorectal peritoneal metastases undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were included. MAIN OUTCOMES Main outcomes included evaluation of grade III/IV morbidity rate, mortality rate, overall and relapse-free survival, and prognostic factors influencing survival on a Cox multivariate analysis model. RESULTS One hundred one cytoreductive surgeries were undertaken on 96 patients during this time for colorectal peritoneal metastases. The median patient age was 60 years with 55.2% being female. The median Peritoneal Carcinomatosis Index was 9, with complete cytoreduction achieved in 76 (75.2%) cases. Grade III or IV complications occurred in 26 cases (25.7%) with 2 (2%) perioperative mortalities. Median overall survival for the entire cohort was 32 months, with a 3-year survival of 38%. For patients who achieved a complete cytoreduction, median overall survival was 37 months, with a relapse-free survival of 13 months and a 3-year survival of 54%. Complete cytoreduction and nonmucinous histology were key factors independently associated with improved overall survival. LIMITATIONS The main limitation this study is its retrospective nature. CONCLUSION Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated low-volume colorectal peritoneal metastases is safe and effective, with low morbidity. It offers selected patients a highly favorable overall and relapse-free survival. See Video Abstract at http://links.lww.com/DCR/B2. EVOLUCIÓN DE LA CIRUGÍA CITORREDUCTIVA Y QUIMIOTERAPIA INTRAPERITONEAL HIPERTÉRMICA (HIPEC) PARA METÁSTASIS PERITONEALES COLORRECTALES: EXPERIENCIA INSTITUCIONAL DE 8 AÑOS: El cáncer colorrectal es la segunda causa de mortalidad relacionada con el cáncer en todo el mundo. Las metástasis peritoneales tienen el peor pronóstico entre todos los sitios de metástasis del cáncer colorrectal. En los últimos años, el advenimiento y la aceptación de la cirugía citorreductiva y la quimioterapia intraperitoneal hipertérmica ha mejorado enormemente la supervivencia de pacientes seleccionados con metástasis peritoneales de bajo volumen. OBJETIVO Aquí, informamos sobre la evolución de la cirugía citorreductiva y la quimioterapia intraperitoneal hipertérmica para las metástasis peritoneales colorrectales en un centro de referencia terciario para todo el estado durante un período de ocho años. DISEÑO:: Estudio retrospectivo del 2009 a 2017. CONFIGURACIÓN:: Centro único a lo largo de ocho años. PACIENTES Pacientes con metástasis peritoneales colorrectales sometidos a cirugía citorreductiva y quimioterapia intraperitoneal hipertérmica. RESULTADOS PRINCIPALES Los resultados principales incluyeron la evaluación de la tasa de morbilidad de grado III / IV, la tasa de mortalidad, la supervivencia general y libre de recaída y los factores pronósticos que influyen en la supervivencia en el modelo de análisis multivariado Cox. RESULTADOS Se realizaron el ciento uno cirugías citorreductivas en noventa y seis pacientes durante este tiempo por metástasis peritoneales colorrectales. La edad media de los pacientes fue de 60 años, con un 55.2% de mujeres. El Índice de Carcinomatosis Peritoneal mediano fue de 9, con una citorreducción completa lograda en 76 (75.2%) casos. Las complicaciones de grado III o IV ocurrieron en 26 casos (25.7%) con dos (2%) de mortalidad perioperatoria. La supervivencia mediana general para toda la cohorte fue de 32 meses, con una supervivencia de 3 años del 38%. Para los pacientes que lograron una citorreducción completa, la supervivencia global media fue de 37 meses, con una supervivencia sin recaída de 13 meses y una supervivencia de 3 años del 54%. La citorreducción completa y la histología no mucinosa fueron factores clave asociados de forma independiente con una mejor supervivencia general. LIMITACIONES La principal limitación es la naturaleza retrospectiva del estudio. CONCLUSIÓN:: La cirugía citorreductiva y la quimioterapia intraperitoneal hipertérmica para las metástasis peritoneales colorrectales aisladas de bajo volumen son seguras y eficaces, con baja morbilidad. Ofrece a los pacientes seleccionados una supervivencia global altamente favorable y libre de recaída. Vea el Resumen del video en http://links.lww.com/DCR/B2.
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109
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Duzgun O, Kalin M. Safety of coloanal/ileoanal anastomosis during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: results of 20 consecutive patients. J Int Med Res 2019; 47:4911-4919. [PMID: 31502496 PMCID: PMC6833411 DOI: 10.1177/0300060519872618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective No studies to date have focused on the safety of coloanal/ileoanal anastomosis (CAIAA) in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC), which is associated with severe morbidity and mortality. We herein present the outcomes of patients with peritoneal carcinomatosis (PC) who underwent CAIAA. Methods We evaluated the prospectively collected data from 20 patients with PC who underwent CRS + HIPEC with respect to the primary disease, synchronous resections, intraoperative chemotherapy regimen, timing of protective ileostomy closure, and overall postoperative complications. Results Most patients underwent CRS + HIPEC and CAIAA for PC due to colorectal cancer. Coloanal anastomosis was performed in 15 (75%) patients, and J-pouch ileoanal anastomosis was performed in 5 (25%) patients. No anastomosis-related complications occurred in any patients who underwent CAIAA; however, one patient died of pulmonary embolism on postoperative day 7. Conclusions CAIAA is associated with serious complications even after performing benign colorectal surgery. However, it may be challenging for surgeons to simultaneously perform CAIAA in patients with PC who undergo CRS + HIPEC. We emphasize that this procedure can be safely performed with experienced surgical teams by using a multidisciplinary approach.
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Affiliation(s)
- Ozgul Duzgun
- Department of General Surgery, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Murat Kalin
- Department of General Surgery, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey
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110
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Lemstrova R, Flasarova D, Spisarova M, Melichar B, Lovecek M, Havlik R, Neoral C, Mohelnikova-Duchonova B, Klos D. Evaluation and management of toxicity of cytoreductive surgery/hyperthermic intraperitoneal chemotherapy: the initial experience of a single centre study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:300-306. [PMID: 31435073 DOI: 10.5507/bp.2019.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment modality for peritoneal surface malignancies with efficacy reported in many trials. Discrepancies, however, in the indication criteria, the extent of the surgical procedure, HIPEC regimens and toxicity evaluation represent a problem when comparing this method with other therapeutic modalities. METHODS We describe the initial experience with CRS/HIPEC using different chemotherapy regimens (oxaliplatin, cisplatin, mitomycin C and doxorubicin) at the Comprehensive Oncology Centre Olomouc. RESULTS A perioperative mortality of 2% and perioperative morbidity of 11%, according to Clavien-Dindo were observed. Interestingly, all these patients underwent HIPEC with oxaliplatin 460 mg/m2. The median duration of admission to hospital was 6 days in the intensive care unit (range 2-28 days) and 7 days in the surgical ward (range 1-21 days). Hospital admission did not exceed 2 weeks in 75% of patients. These results are consistent with the published results of large centres performing this treatment modality mainly due to pre-operative preparation of patients and pre-treatment and post-treatment management of HIPEC/CRS toxicity. Evaluation of the efficacy in terms of time to progression and overall survival (OS) is limited by the short follow up period. CONCLUSION CRS/HIPEC performed is a safe method with low perioperative mortality.
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Affiliation(s)
- Radmila Lemstrova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Dominika Flasarova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Martina Spisarova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Martin Lovecek
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Roman Havlik
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Cestmir Neoral
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Beatrice Mohelnikova-Duchonova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Dusan Klos
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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111
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Salamanca IMG, Jaime MTE, Penco JMM, Martínez JS. Role of Peritoneal Cytology in Patients with Early Stage Colorectal Cancer. Pathol Oncol Res 2019; 26:1325-1329. [PMID: 31401769 DOI: 10.1007/s12253-019-00706-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/01/2019] [Indexed: 01/26/2023]
Abstract
The main objective of this study was to investigate the incidence of free tumour cells in peritoneal lavage cytology performed using a standard method before and after the resection of the tumour, and to assess the usefulness of this technique in scheduled interventions on colorectal cancer patients. Peritoneal lavage cytology was performed on a homogeneous sample of 188 patients undergoing colorectal cancer curative resection before and after the resection of the tumour. The procedure was performed systematically in all cases. Malignant cells were detected in the peritoneal lavage cytology performed before the resection of the tumour in three patients. Lymph node affection was the variable most associated with the prognosis of these colorectal cancer patients. Peritoneal lavage cytology can provide additional information for a small group of patients who need to be closely monitored and studied to decide on the most effective type of chemotherapy.
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Affiliation(s)
| | - M T Espín Jaime
- Department of Surgery, Infanta Cristina Hospital, Carrillo Areanas 20A. Villafranca de los Barros, 06220, Badajoz, Spain
| | - J M Moran Penco
- Department of Surgery, University of Extremadura, Badajoz, Spain
| | - J Salas Martínez
- Department of Surgery, Infanta Cristina Hospital, Carrillo Areanas 20A. Villafranca de los Barros, 06220, Badajoz, Spain
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112
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Abuzar SM, Ahn JH, Park KS, Park EJ, Baik SH, Hwang SJ. Pharmacokinetic Profile and Anti-Adhesive Effect of Oxaliplatin-PLGA Microparticle-Loaded Hydrogels in Rats for Colorectal Cancer Treatment. Pharmaceutics 2019; 11:E392. [PMID: 31387217 PMCID: PMC6723418 DOI: 10.3390/pharmaceutics11080392] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/17/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most malignant and fatal cancers worldwide. Although cytoreductive surgery combined with chemotherapy is considered a promising therapy, peritoneal adhesion causes further complications after surgery. In this study, oxaliplatin-loaded Poly-(d,l-lactide-co-glycolide) (PLGA) microparticles were prepared using a double emulsion method and loaded into hyaluronic acid (HA)- and carboxymethyl cellulose sodium (CMCNa)-based cross-linked (HC) hydrogels. From characterization and evaluation study PLGA microparticles showed smaller particle size with higher entrapment efficiency, approximately 1100.4 ± 257.7 nm and 77.9 ± 2.8%, respectively. In addition, microparticle-loaded hydrogels showed more sustained drug release compared to the unloaded microparticles. Moreover, in an in vivo pharmacokinetic study after intraperitoneal administration in rats, a significant improvement in the bioavailability and the mean residence time of the microparticle-loaded hydrogels was observed. In HC21 hydrogels, AUC0-48h, Cmax, and Tmax were 16012.12 ± 188.75 ng·h/mL, 528.75 ± 144.50 ng/mL, and 1.5 h, respectively. Furthermore, experimental observation revealed that the hydrogel samples effectively protected injured tissues from peritoneal adhesion. Therefore, the results of the current pharmacokinetic study together with our previous report of the in vivo anti-adhesion efficacy of HC hydrogels demonstrated that the PLGA microparticle-loaded hydrogels offer novel therapeutic strategy for CRC treatment.
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Affiliation(s)
- Sharif Md Abuzar
- College of Pharmacy, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon 21983, Korea
- Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon 21983, Korea
| | - Jun-Hyun Ahn
- College of Pharmacy, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon 21983, Korea
- Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon 21983, Korea
| | - Kyung Su Park
- Advanced Analysis Center, Korea Institute of Science and Technology, Hwarang-ro, Seongbuk-gu, Seoul 02792, Korea
| | - Eun Jung Park
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Seung Hyuk Baik
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Sung-Joo Hwang
- College of Pharmacy, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon 21983, Korea.
- Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Yeonsu-gu, Incheon 21983, Korea.
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113
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Sánchez-Hidalgo JM, Rodríguez-Ortiz L, Arjona-Sánchez Á, Rufián-Peña S, Casado-Adam Á, Cosano-Álvarez A, Briceño-Delgado J. Colorectal peritoneal metastases: Optimal management review. World J Gastroenterol 2019; 25:3484-3502. [PMID: 31367152 PMCID: PMC6658395 DOI: 10.3748/wjg.v25.i27.3484] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/20/2019] [Accepted: 06/23/2019] [Indexed: 02/06/2023] Open
Abstract
The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.
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Affiliation(s)
| | - Lidia Rodríguez-Ortiz
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Álvaro Arjona-Sánchez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Sebastián Rufián-Peña
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Ángela Casado-Adam
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Antonio Cosano-Álvarez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Javier Briceño-Delgado
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
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114
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Iwata Y, Kinoshita T, Kimura K, Komori K, Hayashi D, Akazawa T, Shigeyoshi I, Tsutsuyama M, Kawakami J, Ouchi A, Natsume S, Uemura N, Ito Y, Misawa K, Senda Y, Abe T, Ito S, Tajika M, Yatabe Y, Yoshida K, Shimizu Y. A long-term survival case of Sister Mary Joseph's nodule caused by colon cancer and treated with a multidisciplinary approach. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:325-329. [PMID: 31239600 PMCID: PMC6556460 DOI: 10.18999/nagjms.81.2.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Umbilical metastasis from intra-abdominal or pelvic malignancy, which is called Sister Mary Joseph's nodule (SMJN), is rare, and it has a poor prognosis. Its most common primary sites are the stomach and ovaries. SMJN caused by colon cancer is uncommon. A 42-year-old woman visited local clinics with complaints of an umbilical mass. After a detailed examination, she was diagnosed with peritoneal and umbilical metastasis caused by colon cancer. A radical surgery was performed after 12 months of chemotherapy. 6 months later, local recurrence and ovarian metastasis were suspected. Further radical surgery was performed, and 14 months after that (50 months after starting treatment), no recurrences have been observed. We experienced a long-term survival case of SMJN caused by colon cancer and treated with a multidisciplinary approach.
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Affiliation(s)
- Yoshinori Iwata
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Surgical Oncology, Gifu University School of Medicine, Gifu, Japan
| | - Takashi Kinoshita
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kenya Kimura
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Daisuke Hayashi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tomoyuki Akazawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Itaru Shigeyoshi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masayuki Tsutsuyama
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Jiro Kawakami
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akira Ouchi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Seiji Natsume
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Norihisa Uemura
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshiki Senda
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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115
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Ubink I, Bolhaqueiro ACF, Elias SG, Raats DAE, Constantinides A, Peters NA, Wassenaar ECE, de Hingh IHJT, Rovers KP, van Grevenstein WMU, Laclé MM, Kops GJPL, Borel Rinkes IHM, Kranenburg O. Organoids from colorectal peritoneal metastases as a platform for improving hyperthermic intraperitoneal chemotherapy. Br J Surg 2019; 106:1404-1414. [PMID: 31197820 PMCID: PMC6771632 DOI: 10.1002/bjs.11206] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 12/15/2022]
Abstract
Background Patients with peritoneal metastases from colorectal cancer have a poor prognosis. If the intraperitoneal tumour load is limited, patients may be eligible for cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment has improved overall survival, but recurrence rates are high. The aim of this study was to create a preclinical platform for the development of more effective intraperitoneal chemotherapy strategies. Methods Using organoid technology, five tumour cultures were generated from malignant ascites and resected peritoneal metastases. These were used in an in vitro HIPEC model to assess sensitivity to mitomycin C (MMC) and oxaliplatin, the drugs used most commonly in HIPEC. The model was also used to test a rational combination treatment involving MMC and inhibitors of the checkpoint kinase ATR. Results MMC was more effective in eliminating peritoneal metastasis‐derived organoids than oxaliplatin at clinically relevant concentrations. However, the drug concentrations required to eliminate 50 per cent of the tumour cells (IC50) were higher than the median clinical dose in two of five organoid lines for MMC, and all five lines for oxaliplatin, indicating a general resistance to monotherapy. ATR inhibition increased the sensitivity of all peritoneal metastasis‐derived organoids to MMC, as the IC50 decreased 2·6–12·4‐fold to well below concentrations commonly attained in clinical practice. Live‐cell imaging and flow cytometric analysis showed that ATR inhibition did not release cells from MMC‐induced cell cycle arrest, but caused increased replication stress and accelerated cell death. Conclusion Peritoneal metastasis‐derived organoids can be used to evaluate existing HIPEC regimens on an individual‐patient level and for development of more effective treatment strategies.
Surgical relevance Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) has improved prognosis of patients with peritoneal metastases from colorectal cancer, but disease recurrence is common. More effective and personalized HIPEC is urgently needed. Organoid technology is frequently used for drug screens, as patient‐derived organoids can accurately predict clinical therapeutic response in vitro. A panel of organoids was established from peritoneal metastases from colorectal cancer and used to develop a model for testing HIPEC regimens in vitro. Patient‐derived organoids differed in sensitivity to commonly used chemotherapeutics, in line with variable clinical outcomes following cytoreductive surgery–HIPEC. Combining MMC with an ATR inhibitor improved the efficacy of MMC. Peritoneal metastasis‐derived organoids can be used as a platform to test novel (combination) strategies that increase HIPEC efficacy. In the future, organoids could be used to select patent‐tailored HIPEC regimens.
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Affiliation(s)
- I Ubink
- Department of Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - A C F Bolhaqueiro
- Oncode Institute, Hubrecht Institute - Royal Academy of Arts and Sciences and University Medical Centre Utrecht, Utrecht, the Netherlands
| | - S G Elias
- Julius Centre for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - D A E Raats
- Department of Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - A Constantinides
- Department of Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - N A Peters
- Department of Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - E C E Wassenaar
- Department of Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands.,Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - K P Rovers
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - W M U van Grevenstein
- Department of Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - M M Laclé
- Department of Pathology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - G J P L Kops
- Oncode Institute, Hubrecht Institute - Royal Academy of Arts and Sciences and University Medical Centre Utrecht, Utrecht, the Netherlands
| | - I H M Borel Rinkes
- Department of Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - O Kranenburg
- Department of Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands.,Utrecht Platform for Organoid Technology, Utrecht University, Utrecht, the Netherlands
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116
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Ito K, Takemura N, Inagaki F, Mihara F, Kurokawa T, Gohda Y, Kiyomatsu T, Yano H, Kokudo N. Hepatectomy for metachronous colorectal liver metastases following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases: a report of three cases. World J Surg Oncol 2019; 17:99. [PMID: 31196097 PMCID: PMC6567639 DOI: 10.1186/s12957-019-1646-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/05/2019] [Indexed: 12/22/2022] Open
Abstract
Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis (PM) from colorectal cancer (CRC) has been reported to substantially improve the prognosis and the quality of life of patients in comparison to systemic chemotherapy or palliative approaches. This study aimed to demonstrate the safety and feasibility of hepatectomy for metachronous liver metastases from CRC following CRS and HIPEC for PM on the basis of three case reports. Case presentation We describe three cases involving patients who underwent hepatectomy for metachronous liver metastases from CRC after CRS and HIPEC for PM. All patients underwent CRS and HIPEC after primary tumor resection, and hepatectomy was performed for the metachronous liver metastases after CRS and HIPEC. The hepatectomy procedures for cases 1, 2, and 3 were left hemihepatectomy and partial resection of S5, posterior sectionectomy, and left-lateral sectionectomy and partial resection of S5 and S8, respectively. Although adhesion of surrounding organs to the liver surface was observed on a broad level, dissections and hepatectomy could be performed safely. No recurrence was detected in cases 1 and 2 after hepatectomy. In case 3, liver metastases were detected from the time of the initial diagnosis of the primary tumor, and complete remission was achieved once with systemic chemotherapy. Although we performed hepatectomy for the recurrence of liver metastases after complete remission, early re-recurrence was observed after hepatectomy. Conclusions Hepatectomy for metachronous liver metastases after CRS and HIPEC for PM could be a multi-modality treatment option for CRC recurrence.
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Affiliation(s)
- Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Toshiaki Kurokawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Yoshimasa Gohda
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Tomomichi Kiyomatsu
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Hideaki Yano
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
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117
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Lee JH, Ahn BK, Baik SS, Lee KH. Comprehensive Analysis of Somatic Mutations in Colorectal Cancer With Peritoneal Metastasis. In Vivo 2019; 33:447-452. [PMID: 30804124 DOI: 10.21873/invivo.11493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND To analyze for genetic mutations which may presage peritoneal metastasis by using targeted next-generation sequencing (NGS). MATERIALS AND METHODS Formalin-fixed, paraffin-embedded primary tumor specimens were obtained from 10 patients with small obstructing colorectal cancer and peritoneal metastasis (group A) and five with large non-obstructing colorectal cancer and no recurrence (group B). DNA was extracted for the sequencing of 409 cancer genes. The distribution of genetic mutations was compared between the two groups to find genetic mutations related to peritoneal metastasis. RESULTS When the samples were sorted based on similarity of gene expression by hierarchical clustering analysis, the samples were well divided between the two study groups. Mutations in AT-rich interactive domain-containing protein 1A (ARID1A), polycystic kidney and hepatic disease 1 (PKHD1), ubiquitin-protein ligase E3 component n-recognin 5 (UBR5), paired box 5 (PAX5), tumor protein p53 (TP53), additional sex combs like 1 (ASXL1) and androgen receptor (AR) genes were detected more frequently in group A. CONCLUSION A number of somatic mutations presumed to be relevant to colorectal cancer with peritoneal metastasis were identified in our study by NGS.
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Affiliation(s)
- Ju-Hee Lee
- Department of Surgery, Dongguk University Medical Center, Gyeongju, Republic of Korea
| | - Byung Kyu Ahn
- Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seung Sam Baik
- Department of Pathology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Kang Hong Lee
- Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
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118
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Port site metastases after minimally invasive resection for colorectal cancer: A retrospective study of 13 patients. Surg Oncol 2019; 29:20-24. [DOI: 10.1016/j.suronc.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 01/27/2023]
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119
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Pinto A, Pocard M. Hyperthermic intraperitoneal chemotherapy with cisplatin and mitomycin C for colorectal cancer peritoneal metastases: A systematic review of the literature. Pleura Peritoneum 2019; 4:20190006. [PMID: 31388562 PMCID: PMC6668656 DOI: 10.1515/pp-2019-0006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/10/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The randomized trial PRODIGE 7 failed to show the benefit of oxaliplatin hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal peritoneal metastasis treatment (CR PM). This systematic review focuses on the association of cisplatin (CDDP) with mitomycin C (MMC) in HIPEC in CR PM. CONTENT Experimental studies demonstrated that hyperthermia, in addition to CDDP ± MMC treatment, gradually improved the cytotoxic effect by increasing early apoptosis, eATP interaction, intracellular CDDP concentration (by 20%) and p73 expression. Recent studies with highly selected patients reported unusual prolonged survival with a median overall survival (OS) of approximately 60 months, with a HIPEC combination of CDDP (25 mg/m2/L) plus MMC (3.3 mg/m2/L) at a temperature of 41.5-42.5 °C for 60-90 min. Major complications occurred in less than 30% of patients with limited hematological toxicity (less than 15%). In addition, in a phase 2 trial, an adjuvant HIPEC benefit was demonstrated in colorectal cancer patients with high risk for peritoneal failure (5-year OS: 81.3% vs. 70% for the HIPEC group vs. the control group, respectively, p=0.047). After a recurrence, an iterative procedure permitted similar recurrence-free disease (13 vs. 13.7 months) with an acceptable morbidity (18.7% of severe complications). SUMMARY AND OUTLOOK The combination of CDDP and MMC seems to be an interesting protocol as an alternative to high-dose and short-term oxaliplatin.
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Affiliation(s)
- Amandine Pinto
- Inserm U1275 - Carcinose Péritoine et Paris-Technologie, INSERM, Paris, France
| | - Marc Pocard
- U1275 - Carcinose Péritoine et Paris-Technologie, INSERM, Paris, France
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120
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Burnett A, Lecompte MEA, Trabulsi N, Dubé P, Gervais MK, Trilling B, Cloutier AS, Sideris L. Peritoneal carcinomatosis index predicts survival in colorectal patients undergoing HIPEC using oxaliplatin: a retrospective single-arm cohort study. World J Surg Oncol 2019; 17:83. [PMID: 31092250 PMCID: PMC6521370 DOI: 10.1186/s12957-019-1618-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract Background Peritoneal carcinomatosis (PC) from colorectal cancer is associated with poor prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for patients with colorectal peritoneal carcinomatosis. However, standardization of HIPEC protocols, including which chemotherapeutic agent to use, is lacking in the literature. Therefore, we sought to report survival outcomes from colorectal cancer patients undergoing CRS/oxaliplatin-based HIPEC at our institution over the last 10 years. Methods Colorectal PC patients treated with CRS/oxaliplatin-based HIPEC 2004–2015 were included. Demographic, clinical, and oncologic data were abstracted from the medical record. Overall (OS) and disease-free survival (DFS) were calculated using Kaplan–Meier analysis. Univariate/multivariate Cox regression analysis was done. Results Laparotomy was performed in 113 patients for colorectal PC; 91 completed a curative intent CRS/HIPEC. At 3 and 5 years, OS for the CRS/HIPEC cohort was 75% and 55%, and DFS was 50% and 25%, respectively. On multivariate analysis, incremental increases in peritoneal carcinomatosis index (PCI) were associated with worse OS (p = 0.0001) and DFS (p = 0.0001). Grade III/IV complications were also associated with worse OS. Conclusions A standardized regimen of CRS and oxaliplatin-based HIPEC for colorectal PC is effective with favorable OS and DFS and acceptable complication rates.
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Affiliation(s)
| | - Marie-Eve Aubé Lecompte
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Nora Trabulsi
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Pierre Dubé
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mai-Kim Gervais
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Bertrand Trilling
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Alexis-Simon Cloutier
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Lucas Sideris
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
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Framery B, Gutowski M, Dumas K, Evrard A, Muller N, Dubois V, Quinonero J, Scherninski F, Pèlegrin A, Cailler F. Toxicity and pharmacokinetic profile of SGM-101, a fluorescent anti-CEA chimeric antibody for fluorescence imaging of tumors in patients. Toxicol Rep 2019; 6:409-415. [PMID: 31080749 PMCID: PMC6506861 DOI: 10.1016/j.toxrep.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 12/26/2022] Open
Abstract
Fluorescence guided surgery represents a considerable advance for oncology surgeons. SGM-101 is an innovative antibody-dye conjugate targeting carcinoembryonic antigen on digestive tumors. Pre-clinical toxicology, pharmacology and pharmacokinetic results are in favor of clinical use of SGM-101.
The real-time improvement of the intraoperative discrimination between different tissue types (particularly between tumor and adjacent normal tissue) using intraoperative imaging represents a considerable advance for oncology surgeons. However, the development of imaging agents is much slower than that of drug therapies, although surgery represents one of the few curative treatments for many solid tumors. SGM-101 is a recently described, innovative antibody conjugate in which the near-infrared fluorochrome BM-104 is covalently linked to a chimeric monoclonal antibody against carcinoembryonic antigen (CEA). SGM-101 was developed with the goal of providing oncology surgeons with an intraoperative imaging tool that allows the visualization of CEA-overexpressing tumors. This antigen is overexpressed in a wide range of human carcinomas, such as colorectal, gastric, pancreatic, non-small cell lung and breast carcinomas. Here we characterized SGM-101 safety prior to its clinical testing for real-time cancer mapping by oncology surgeons. Safety pharmacology and toxicology studies were performed after intravenous injection of SGM-101 in Wistar rats and in Beagle dogs. SGM-101 metabolism and pharmacokinetics were analyzed in rats and mice. Finally, the potential toxicity of the BM-104 dye and SGM-101 cross-reactivity were assessed in a panel of 42 human tissues. Our pre-clinical toxicology, pharmacology and pharmacokinetic results demonstrated the absence of significant adverse effects of both SGM-101 and BM-104 at doses well above the anticipated maximal human exposure. Taken together, the results of the pharmacology, pharmacokinetic and toxicology studies support the development of SGM-101 as a potentially useful and safe tumor-specific imaging tool that might improve the complete tumor resection rate.
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Key Words
- AUC, Area Under the Curve
- CEA, carcinoembryonic antigen
- Cancer
- Carcinoembryonic antigen
- FGS, fluorescence guided surgery
- Fluorescence guided surgery
- GLP, Good Laboratory Practices
- ICG, indocyanine green
- MRT, Mean Residence Time
- MTD, maximum tolerated dose
- NIR, near infra-red
- NOAEL, no observable adverse effect level (NOAEL)
- Near-infrared fluorochrome
- PK, pharmacokinetics
- Pharmacokinetics
- TMDD, target-mediated drug disposition
- Toxicity
- mAb, monoclonal antibody
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Affiliation(s)
- Bérénice Framery
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
| | - Marian Gutowski
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France
| | - Karen Dumas
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
| | - Alexandre Evrard
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, France.,INSERM, U1194, Montpellier, F-34298, France.,Université de Montpellier, Montpellier, F-34298, France
| | - Nathalie Muller
- Leads to Development, 3-5 Impasse Reille, 75014, Paris, France
| | - Vincent Dubois
- Leads to Development, 3-5 Impasse Reille, 75014, Paris, France
| | | | | | - André Pèlegrin
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, France.,INSERM, U1194, Montpellier, F-34298, France.,Université de Montpellier, Montpellier, F-34298, France
| | - Françoise Cailler
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
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Synchronous liver metastases and peritoneal carcinomatosis from colorectal cancer: different strategies for curative treatment? Langenbecks Arch Surg 2019; 404:477-488. [PMID: 31025165 DOI: 10.1007/s00423-019-01787-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Management of patients with resectable hepatic metastases (HMs) and colorectal peritoneal carcinomatosis (CRPC) is not currently standardised. OBJECTIVE The aims of this study were to evaluate the safety of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and hepatic surgery for patients with CRPC with synchronous hepatic metastases (HM), and its impact on survival rates. METHODS A retrospective analysis was performed, including patients undergoing CRS/HIPEC for CRPC from 2007 to September 2016 in two groups, with (HM+) and without (HM-) synchronous hepatic metastases. Patients with extra-abdominal metastases were excluded. The hepatic strategy was described. Morbimortality and survival were compared between the two groups. RESULTS One hundred nine patients underwent CRS/HIPEC for CRPC with or without hepatic surgery with curative intent: 33 patients with (HM+) and 76 patients without (HM-) synchronous HM. The median follow-up was 30 months. All patients with HM (HM+) received neoadjuvant chemotherapy vs. 88.1% in the HM- group (p = 0.04) associated with monoclonal antibody in 66.6% of cases in the HM+ group vs. 57% in the HM- group (p = 0.01). In the HM+ group, two steps were implemented to treat peritoneal and hepatic metastases in 15 patients (45%). In this group, planned hepatic resection in two procedures was performed for eight patients, all presenting bilobar HM. Postoperative morbidity did not differ between the two groups. No deaths occurred. Median overall survival (OS) and recurrence-free survival (RFS) were 31 and 65 months (p = 0.188), versus 21 and 24 months (p = 0.119), respectively, in the HM+ versus HM- groups. In multivariate analysis, the peritoneal cancer index (PCI) was the only significant prognostic factor whereas synchronous HM was not a significant prognostic factor. CONCLUSION Curative surgical treatment for CRPC with synchronous HM seems to be feasible and safe, and could facilitate long survival rates, compared to patients without HM. The hepatic strategy is not standardised. However, a "two-step" surgical strategy could be proposed in order to reduce postoperative morbidity rates.
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Hentzen JEKR, Rovers KP, Kuipers H, van der Plas WY, Been LB, Hoogwater FJH, van Ginkel RJ, Hemmer PHJ, van Dam GM, de Hingh IHJT, Kruijff S. Impact of Synchronous Versus Metachronous Onset of Colorectal Peritoneal Metastases on Survival Outcomes After Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Multicenter, Retrospective, Observational Study. Ann Surg Oncol 2019; 26:2210-2221. [PMID: 30877495 PMCID: PMC6545176 DOI: 10.1245/s10434-019-07294-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 12/21/2022]
Abstract
Background Careful selection of patients with colorectal peritoneal metastases (PM) for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial. It remains unknown whether the time of onset of colorectal PM (synchronous vs metachronous) influences surgical morbidity and survival outcomes after CRS with HIPEC. Methods Patients with histologically proven colorectal PM who underwent CRS with HIPEC between February 2006 and December 2017 in two Dutch tertiary referral hospitals were retrospectively included from a prospectively maintained database. The onset of colorectal PM was classified as synchronous (PM diagnosed at the initiational presentation with colorectal cancer) or metachronous (PM diagnosed after initial curative colorectal resection). Major postoperative complications (Clavien–Dindo grade ≥ 3), overall survival (OS), and disease-free survival (DFS) were compared between patients with synchronous colorectal PM and those with metachronous colorectal PM using Kaplan–Meier analyses, proportional hazard analyses, and a multivariate Cox regression analysis. Results The study enrolled 433 patients, of whom 231 (53%) had synchronous colorectal PM and 202 (47%) had metachronous colorectal PM. The major postoperative complication rate and median OS were similar between the patients with synchronous colorectal PM and those with metachronous colorectal PM (26.8% vs 29.7%; p = 0.693 and 34 vs 33 months, respectively; p = 0.819). The median DFS was significantly decreased for the patients with metachronous colorectal PM and those with synchronous colorectal PM (11 vs 15 months; adjusted hazard ratio, 1.63; 95% confidence interval, 1.18–2.26). Conclusions Metachronous onset of colorectal PM is associated with early recurrence after CRS with HIPEC compared with synchronous colorectal PM, without a difference in OS or major postoperative complications. Time to onset of colorectal PM should be taken into consideration to optimize patient selection for this major procedure. Electronic supplementary material The online version of this article (10.1245/s10434-019-07294-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith E K R Hentzen
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Koen P Rovers
- Department of Surgery, Division of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Hendrien Kuipers
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Willemijn Y van der Plas
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lukas B Been
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederik J H Hoogwater
- Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert J van Ginkel
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patrick H J Hemmer
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gooitzen M van Dam
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging and Intensive Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Division of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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124
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Lee RM, Cardona K, Russell MC. Historical perspective: Two decades of progress in treating metastatic colorectal cancer. J Surg Oncol 2019; 119:549-563. [PMID: 30806493 DOI: 10.1002/jso.25431] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
Colorectal cancer is the third most commonly diagnosed cancer in the United States. While screening methods strive to improve rates of early stage detection, 25% of patients have metastatic disease at the time of diagnosis, with the most common sites being the liver, lung, and peritoneum. While once perceived as hopeless, the last two decades have seen substantial strides in the medical, surgical, and regional therapies to treat metastatic disease offering significant improvements in survival.
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Affiliation(s)
- Rachel M Lee
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Kenneth Cardona
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Maria C Russell
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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125
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Berger Y, Jacoby H, Kaufmann MI, Ben-Yaacov A, Westreich G, Sharon I, Barda L, Sharif N, Nadler R, Horesh N, Nissan A, Gutman M, Hoffman A. Correlation Between Intraoperative and Pathological Findings for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2019; 26:1103-1109. [PMID: 30746598 DOI: 10.1245/s10434-019-07219-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to examine the correlation between intraoperative and pathological findings for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and to determine their prognostic significance. METHODS Pathological reports of all colorectal cancer (CRC) patients undergoing CRS/HIPEC between 2009 and 2016 were retrospectively reviewed. Pathological specimens lacking tumor cells were defined as negative pathological specimens (NPS). The intraoperative peritoneal cancer index (PCI) and pathological PCI (excluding NPS) were calculated separately. Receiver operating characteristic (ROC) curves were applied to compare the prognostic value of intraoperative and pathological scoring systems. RESULTS For 108 CRC patients, 113 CRS/HIPEC procedures were performed. Of 959 pathological specimens examined, 178 (18.6%) were NPS. Overall, 78 procedures (69%) showed NPS. In 52 procedures (46%), the pathological PCI differed from the intraoperative PCI (∆PCI > 0). The ROC areas for intraoperative PCI and pathological PCI were similar in predicting 1-year overall survival (OS), 2-year OS, and 1-year disease-free survival (all p values not significant). However, for the patients with NPS, the number of positive specimens (containing tumor tissue) was superior to intraoperative PCI in predicting 2-year OS (ROC under the curve areas, 0.69 vs. 0.58, respectively; p = 0.012). In addition, a subgroup of 15 patients with a high ∆PCI (≥ 3) had a more favorable median OS than a matched group of 30 patients with similar intraoperative PCI and a ∆PCI of 0 (median survival not reached vs. 21.6 months, respectively; p = 0.05). CONCLUSIONS In the majority of CRC CRS/HIPEC procedures, NPS may be found. Among patients with NPS, pathological correlation may have a prognostic significance.
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Affiliation(s)
- Y Berger
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel.
| | - H Jacoby
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - M I Kaufmann
- Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Ben-Yaacov
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - G Westreich
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - I Sharon
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - L Barda
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - N Sharif
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - R Nadler
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - N Horesh
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Nissan
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - M Gutman
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Hoffman
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
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Al-Haidari AA, Algethami N, Lepsenyi M, Rahman M, Syk I, Thorlacius H. Neutrophil extracellular traps promote peritoneal metastasis of colon cancer cells. Oncotarget 2019; 10:1238-1249. [PMID: 30815227 PMCID: PMC6383817 DOI: 10.18632/oncotarget.26664] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/31/2019] [Indexed: 01/21/2023] Open
Abstract
Cytoreductive surgery is the only curative option for patients with peritoneal carcinomatosis, however, intraperitoneal recurrence rate is high making new ways to prevent cancer recurrence an urgent need. Recent evidence suggests that neutrophils are involved in cancer progression. The purpose of our study was to examine the role of neutrophils in the spread of colon cancer cells in the peritoneal cavity. The number of metastatic noduli in the peritoneal cavity was quantified in mice injected with murine colon cancer cells (CT-26) intraperitoneally after surgical laparotomy and treated with a neutrophil depleting antibody or DNase I. In addition, peritoneal metastases were harvested from patients with peritoneal carcinomatosis. Scanning and transmission electron microscopy showed extensive neutrophil extracellular trap (NET) formation in peritoneal colon cancer metastases in mice and patients. Neutrophil depletion markedly reduced the number of metastases in laparotomised animals. Administration of DNase I decreased the number of metastatic nodules by 88% in laparotomised animals as well as NET-induced chemokine-dependent colon cancer cell migration and adhesion in vitro. Finally, CT-26 cancer cells were found to express the αvβ3 integrin and inhibition of αv integrin abolished NET-induced adhesion of colon cancer cells to vitronectin. Taken together, our data show that NETs play an important role in colon cancer cell metastasis in the peritoneal cavity and regulate colon cancer cell migration and adhesion to extracellular matrix proteins. These novel findings suggest that targeting NETs might be an effective strategy to antagonize intrabdominal recurrences of colon cancer after cytoreductive surgery in patients with peritoneal carcinomatosis.
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Affiliation(s)
- Amr A Al-Haidari
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 20502 Malmö, Sweden
| | - Nader Algethami
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 20502 Malmö, Sweden
| | - Mattias Lepsenyi
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 20502 Malmö, Sweden
| | - Milladur Rahman
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 20502 Malmö, Sweden
| | - Ingvar Syk
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 20502 Malmö, Sweden
| | - Henrik Thorlacius
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, 20502 Malmö, Sweden
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Bhullar DS, Barriuso J, Mullamitha S, Saunders MP, O'Dwyer ST, Aziz O. Biomarker concordance between primary colorectal cancer and its metastases. EBioMedicine 2019; 40:363-374. [PMID: 30733075 PMCID: PMC6413540 DOI: 10.1016/j.ebiom.2019.01.050] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/13/2019] [Accepted: 01/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background The use of biomarkers to target anti-EGFR treatments for metastatic colorectal cancer (CRC) is well-established, requiring molecular analysis of primary or metastatic biopsies. We aim to review concordance between primary CRC and its metastatic sites. Methods A systematic review and meta-analysis of all published studies (1991–2018) reporting on biomarker concordance between primary CRC and its metastatic site(s) was undertaken according to PRISMA guidelines using several medical databases. Studies without matched samples or using peripheral blood for biomarker analysis were excluded. Findings 61 studies including 3565 patient samples were included. Median biomarker concordance for KRAS (n = 50) was 93.7% [[67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100]], NRAS (n = 11) was 100% [[90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100]], BRAF (n = 22) was 99.4% [[80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100]], and PIK3CA (n = 17) was 93% [[42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100]]. Meta-analytic pooled discordance was 8% for KRAS (95% CI = 5–10%), 8% for BRAF (95% CI = 5–10%), 7% for PIK3CA (95% CI = 2–13%), and 28% overall (95% CI = 14–44%). The liver was the most commonly biopsied metastatic site (n = 2276), followed by lung (n = 438), lymph nodes (n = 1123), and peritoneum (n = 132). Median absolute concordance in multiple biomarkers was 81% (5–95%). Interpretation Metastatic CRC demonstrates high concordance across multiple biomarkers, suggesting that molecular testing of either the primary or liver and lung metastasis is adequate. More research on colorectal peritoneal metastases is required.
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Affiliation(s)
- D S Bhullar
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - J Barriuso
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - S Mullamitha
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - M P Saunders
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - S T O'Dwyer
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - O Aziz
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK.
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Li D, Henker R, Zhang F. Perianesthesia Measurement During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Procedure: A Case Report and Review of the Literature. J Perianesth Nurs 2019; 34:198-205. [DOI: 10.1016/j.jopan.2017.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 01/19/2023]
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129
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Song SE, Choi P, Kim JH, Jung K, Kim SE, Moon W, Park MI, Park SJ. Diagnostic Value of Carcinoembryonic Antigen in Ascites for Colorectal Cancer with Peritoneal Carcinomatosis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 71:332-337. [PMID: 29943560 DOI: 10.4166/kjg.2018.71.6.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background/Aims Diagnostic tests for carcinoembryonic antigen (CEA) in ascites have been performed in various malignant cases, but there is only few data on the applicability of CEA for colorectal cancer (CRC) patients with peritoneal carcinomatosis. We aimed to determine the usefulness of CEA in ascites (aCEA) as a diagnostic parameter for CRC with peritoneal carcinomatosis. Methods Between January 2000 and May 2013, the medical records of 259 patients who underwent paracentesis for the evaluation of ascites were retrospectively reviewed. CRC patients with ascites (n=82) and patients with non-malignant ascites (n=177) were evaluated. Patients who had other malignancies, including gastric or ovarian cancer, with ascites were excluded. The optimal diagnostic cut-off value of aCEA for CRC with peritoneal carcinomatosis was determined using receiver operating characteristic curve analysis. The value of aCEA for predicting the occurrence of peritoneal carcinomatosis was evaluated using a logistic regression model. Results The optimal cut-off value of aCEA to diagnose CRC with peritoneal carcinomatosis was 3.89 ng/mL, and the area under the curve for aCEA was 0.996 (sensitivity 96.3%, specificity 100%, positive predictive value 100%, negative predictive value 98.3%). Multivariate logistic regression analysis showed that aCEA was an independent factor predicting the occurrence of peritoneal carcinomatosis. Conclusions In this study, we showed that aCEA may be a useful parameter for diagnosing CRC with peritoneal carcinomatosis, and we propose an optimal aCEA cut-off value of 3.89 ng/mL. Further study that includes patients with other malignant ascites may be necessary to validate these findings.
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Affiliation(s)
- Sung Eun Song
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Paul Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Gao H, Meng XY, Wang HQ, Zhu FF, Guo AL, Zhu M, Song JC, Yu WF. Association between Anaesthetic Technique and Oncological Outcomes after Colorectal Carcinoma Liver Metastasis Resection. Int J Med Sci 2019; 16:337-342. [PMID: 30745816 PMCID: PMC6367527 DOI: 10.7150/ijms.28016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/22/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Recently published studies suggest that the anaesthetic technique used during oncologic surgery can improve patient outcomes. Therefore, the authors evaluated the survival of patients with resected colorectal carcinoma liver metastases (CRCLMs) who received either EGA (general anaesthesia [GA] combined with epidural anaesthesia [EA]) or GA alone. Methods: We conducted an ambispective cohort study including 225 post-surgical CRCLM patients between May 2007 and July 2012 and performed a follow-up investigation of survival in July 2017. Results: The basic characteristics in the two groups were largely similar. The median (quartiles) recurrence interval for all patients was 10 (2.5, 23) months, and the median (quartiles) survival for CRCLM patients post-surgically was 37 (30.5, 51.5) months. Perioperative EA was associated with survival (P =0.039, log-rank test), with an estimated hazard ratio of 0.737 (95% CI 0.551-0.985) in the univariate analysis. Kaplan-Meier estimates of survival for GA and EGA suggested that GA might provide better outcomes than EGA [P=0.028, hazard ratio of 0.7328 (95% CI 0.5433-0.9884)]. Significant differences in anaesthesia techniques were found (P=0.048), with an adjusted estimated hazard ratio of 0.741 (95% CI 0.550-0.998) in the multivariate analysis. Subgroup analyses of patients in different age groups (< 40, ≥ 40 but <60, and ≥ 60 years old) suggested that no significant differences existed among all three subgroups. Conclusions: Compared with EGA, GA may provide a better survival outcome for CRCLM patients. The benefits of anaesthetic techniques in oncological surgery are most likely related to certain cancer types.
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Affiliation(s)
- Hao Gao
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 225 Changhai Road, Shanghai, China
- Department of Anesthesiology, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, China
| | - Xiao-Yan Meng
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Hong-Qian Wang
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Feng-Feng Zhu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of the University of South China, 69 Chuanshan Road, Hunan, China
| | - Ai-Ling Guo
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Mei Zhu
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Jin-Chao Song
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Wei-Feng Yu
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 225 Changhai Road, Shanghai, China
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pudian Road, Shanghai, China
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131
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Variation in Clinical Application of Hyperthermic Intraperitoneal Chemotherapy: A Review. Cancers (Basel) 2019; 11:cancers11010078. [PMID: 30641919 PMCID: PMC6357036 DOI: 10.3390/cancers11010078] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 12/24/2022] Open
Abstract
Peritoneal metastasis (PM) originating from gastrointestinal and gynecological malignancies are associated with a poor prognosis and rapid disease progression. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment option with curative intent. Hyperthermia enhances the cytotoxicity of chemotherapeutic drugs, thereby killing microscopic tumors and reducing the risk of tumor recurrence. Eight parameters potentially have an impact on the efficacy of HIPEC: the type of drug, drug concentrations, carrier solution, volume of the perfusate, temperature of the perfusate, duration of the treatment, the technique of delivery, and patient selection. In this review, a literature search was performed on PubMed, and a total of 564 articles were screened of which 168 articles were included. Although HIPEC is a successful treatment, there is no standardized method for delivering HIPEC: the choice of parameters is presently largely determined by institutional preferences. We discuss the current choice of the parameters and hypothesize about improvements toward uniform standardization. Quantifying the effect of each parameter separately is necessary to determine the optimal way to perform HIPEC procedures. In vivo, in vitro, in silico, and other experimental studies should shed light on the role of each of the eight parameters.
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132
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Dresen RC, De Vuysere S, De Keyzer F, Van Cutsem E, Prenen H, Vanslembrouck R, De Hertogh G, Wolthuis A, D'Hoore A, Vandecaveye V. Whole-body diffusion-weighted MRI for operability assessment in patients with colorectal cancer and peritoneal metastases. Cancer Imaging 2019; 19:1. [PMID: 30616608 PMCID: PMC6322317 DOI: 10.1186/s40644-018-0187-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 12/26/2018] [Indexed: 02/06/2023] Open
Abstract
Background Correct staging of patients with colorectal cancer is of utmost importance for the prediction of operability. Although computed tomography (CT) has a good overall performance, estimation of peritoneal cancer spread is a known weakness, a problem that cannot always be overcome by Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT); especially in infiltrative and miliary disease spread. Due to its high spatial and contrast resolution magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) might have a better performance. Our aim was to evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for prediction of peritoneal cancer spread and operability assessment in colorectal cancer patients with clinically suspected peritoneal carcinomatosis (PC). Methods This institutional review board approved retrospective study included sixty colorectal cancer patients who underwent WB-DWI/MRI in addition to CT for clinically suspected peritoneal metastases. WB-DWI/MRI and CT were assessed for detecting PC following the peritoneal cancer index (PCI), determination of PCI-score categorized as PC < 12, PCI = 12–15 and PCI > 15, detection of nodal and distant metastases and estimation of overall operability. Histopathology after surgery and biopsy and/or 6 months follow-up were used as reference standard. Results For detection of PC, CT had 43.2% sensitivity, 95.6% specificity, 84.5% positive predictive value (PPV) and 75.2% negative predictive value (NPV). WB-DWI/MRI had 97.8% sensitivity, 93.2% specificity, 88.9% PPV and 98.7% NPV. WB-DWI/MRI enabled better detection of inoperable distant metastases (all 12 patients) than CT (2/12 patients) and significantly improved prediction of PCI category [WB-DWI/MRI PCI < 12: 37/39 patients (94.9%); PCI = 12–15: 4/4 patients (100%); PCI > 15: 16/17 patients (94.1%) versus CT PCI < 12: 38/39 patients (97.4%); PCI = 12–15: 0/4 patients (0%); PCI > 15: 2/17 patients (11.8%); p < 0.0001)]. WB-DWI/MRI improved prediction of inoperability over CT with 90.6% sensitivity compared to 25% (p < 0.0001). Conclusions WB-DWI/MRI significantly outperformed CT for estimation of spread of PC, overall staging and prediction of operability. Pending validation in larger prospective trials, WB-DWI/MRI could be used to guide surgical planning and minimize unnecessary exploratory laparotomies.
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Affiliation(s)
- Raphaëla Carmen Dresen
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Sofie De Vuysere
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Frederik De Keyzer
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eric Van Cutsem
- Department of Digestive Oncology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hans Prenen
- Department of Digestive Oncology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ragna Vanslembrouck
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, from the University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, from the University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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133
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Shi R, Xiang W, Kang X, Zhang L, Wang J, Miao H, He F. Alteration of Adaptive Immunity in a Colorectal Peritoneal Carcinomatosis Model. J Cancer 2019; 10:367-377. [PMID: 30719130 PMCID: PMC6360308 DOI: 10.7150/jca.27947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/03/2018] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) usually gives rise to transcoelomic spread and ultimately causes peritoneal carcinomatosis (PC). However, mechanism studies, especially the immunological basis of colorectal PC, are rarely revealed due to lack of a suitable PC model. Here we selected a mouse colorectal cancer cell line MC-38 for intraperitoneal inoculation in the C57BL/6 mice to mimic the development of colorectal PC. We demonstrated that the injected CRC cells preferentially and rapidly migrated and colonized in the visceral fat tissues, but not in other visceral organs. With flow cytometric analysis, we found the proportions of spleen T cells and B cells were not affected by PC progression, while the ratios of blood CD4+ and CD8+ T cells were largely influenced. Especially, the quantity or activity of CD4+ and CD8+ T cells in visceral fats were intimately regulated by PC development. Taken together, we successfully constructed a colorectal PC model in immune-competent mice and revealed the alteration of adaptive immunity in PC development. Our study might potentiate the research and therapy strategies of colorectal PC.
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Affiliation(s)
- Rongchen Shi
- Department of Biochemistry and Molecular Biology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Wei Xiang
- Department of Biochemistry and Molecular Biology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Xia Kang
- Department of Biochemistry and Molecular Biology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Lili Zhang
- Department of Military Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jinping Wang
- Department of Neurology, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Hongming Miao
- Department of Biochemistry and Molecular Biology, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Fengtian He
- Department of Biochemistry and Molecular Biology, Third Military Medical University (Army Medical University), Chongqing 400038, China
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134
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Alzahrani NA, Valle SJ, Fisher OM, Sugarbaker PH, Yonemura Y, Glehen O, Goere D, Honore C, Brigand C, de Hingh I, Verwaal VJ, Deraco M, Baratti D, Kusamura S, Pocard M, Piso P, Maerz L, Marchal F, Moran B, Levine EA, Dumont F, Pezet D, Abboud K, Kozman MA, Liauw W, Morris DL. Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional experience. J Surg Oncol 2018; 119:336-346. [PMID: 30554404 DOI: 10.1002/jso.25277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The aims of this multi-institutional study were to assess the feasibility of iterative cytoreductive surgery (iCRS)/hyperthermic intraperitoneal chemotherapy, iCRS in colorectal peritoneal carcinomatosis (CRPC), evaluate survival, recurrence, morbidity and mortality outcomes, and identify prognostic factors for overall survival. METHODS Patients with CRPC that underwent an iCRS, with or without intraperitoneal chemotherapy, from June 1993 to July 2016 at 13 institutions were retrospectively analyzed from prospectively maintained databases. RESULTS The study comprised of 231 patients, including 126 females (54.5%) with a mean age at iCRS of 51.3 years. The iterative high-grade (3/4) morbidity and mortality rates were 23.4% and 1.7%, respectively. The median recurrence-free survival was 15.0 and 10.1 months after initial and iCRS, respectively. The median and 5-year survivals were 49.1 months and 43% and 26.4 months and 26% from the initial and iCRS, respectively. Independent negative predictors of survival from the initial CRS included peritoneal carcinomatosis index (PCI) > 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI > 10 ( P = 0.03 for PCI 11-20; P < 0.001 for PCI > 20), high-grade complications ( P = 0.012), and incomplete cytoreduction ( P < 0.001). CONCLUSION iCRS can provide long-term survival benefits to highly selected colorectal peritoneal carcinomatosis patients with comparable mortality and morbidity rates to the initial CRS procedure. Careful patient selection is necessary to improve overall outcomes.
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Affiliation(s)
- Nayef A Alzahrani
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia.,College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sarah J Valle
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Oliver M Fisher
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Paul H Sugarbaker
- MedStar Washington Hospital Center, Peritoneal Surface Oncology Unit, Washington, DC
| | - Yutaka Yonemura
- Peritoneal Metastasis Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Olivier Glehen
- Surgical Oncology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Dianne Goere
- Institute Gustave Roussy Cancer Campus, Department of Digestive and Oncology Surgery, Paris, France
| | - Charles Honore
- Institute Gustave Roussy Cancer Campus, Department of Digestive and Oncology Surgery, Paris, France
| | - Cecile Brigand
- General & Digestive Surgery, CHRU Hautepierre, Strasbourg, France
| | - Ignace de Hingh
- Catharina Hospital, Department of Surgery, Eindhoven, Netherlands
| | - Vic J Verwaal
- Catharina Hospital, Department of Surgery, Eindhoven, Netherlands.,Department of Surgical Oncology, Aarhus University Hospital, Denmark
| | - Marcello Deraco
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Dario Baratti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Shigeki Kusamura
- Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy
| | - Mark Pocard
- Surgical Oncology Department, St. Louis Hospital Lariboisiere, Paris, France
| | - Pompiliu Piso
- Department of Surgical Oncology, Hospital Barmherzige Brueder Regensburg, Germany
| | - Loreen Maerz
- Department of Surgical Oncology, Hospital Barmherzige Brueder Regensburg, Germany
| | - Frederic Marchal
- Department of Surgical Oncology, Institute of Cancer, Vandoeeuvre Les Nancy, France
| | - Brendan Moran
- Peritoneal Malignancy Department, Basingstoke North Hampshire Hospital, Basingstoke, UK
| | - Edward A Levine
- Wake Forest Baptist Health, Surgical Oncology, Winston-Salem, North Carolina
| | - Frédéric Dumont
- Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - Denis Pezet
- Department of Digestive Surgery, CHU Estaing, Clermont Ferrand, France
| | - Karine Abboud
- Department of General Surgery, CHU Nord, Saint Etienne, France
| | - Mathew A Kozman
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
| | - Winston Liauw
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia.,Cancer Care Centre, St. George Hospital, Sydney, NSW, Australia
| | - David L Morris
- St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia
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135
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Sluiter NR, Tuynman JB. ASO Author Reflections: Advanced Imaging Allows Better Detection of Peritoneal Metastases. Ann Surg Oncol 2018; 26:165-166. [PMID: 30474765 PMCID: PMC6338702 DOI: 10.1245/s10434-018-7083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Nina Roelie Sluiter
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Jurriaan Benjamin Tuynman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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136
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Sluiter NR, Vlek SL, Wijsmuller AR, Brandsma HT, de Vet HCW, van Grieken NCT, Kazemier G, Tuynman JB. Narrow-Band Imaging Improves Detection of Colorectal Peritoneal Metastases: A Clinical Study Comparing Advanced Imaging Techniques. Ann Surg Oncol 2018; 26:156-164. [PMID: 30421052 PMCID: PMC6338718 DOI: 10.1245/s10434-018-7005-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Indexed: 12/20/2022]
Abstract
Background Colorectal peritoneal metastases (PM) are often diagnosed in an advanced disease stage. Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) improve survival of patients with colorectal PM, although most benefit is seen in patients with limited peritoneal disease. Advanced imaging techniques might improve the detection of PM, potentially leading to earlier diagnosis and improved cytoreduction. This prospective clinical trial compared three advanced techniques with conventional white-light imaging for the detection of colorectal PM: narrow-band imaging (NBI), near-infrared indocyanine green fluorescent imaging (NIR-ICG), and spray-dye chromoendoscopy (SDCE).
Methods Patients with colorectal PM were prospectively included. Prior to cytoreduction and HIPEC, all abdominal regions were inspected with white-light imaging, NBI, NIR-ICG, and SDCE during exploratory laparoscopy. Primary endpoints were sensitivity and specificity for the detection of PM, using pathological examination of biopsied lesions as the reference standard. The safety of all techniques was assessed. Results Between May 2016 and March 2018, four different techniques were analyzed in 28 patients, resulting in 169 biopsies. Sensitivity for the detection of PM significantly increased from 80.0% with white light to 96.0% with NBI (p = 0.008), without loss of specificity (74.8% vs. 73.1%, respectively, p = 0.804). The use of NIR-ICG and SDCE was discontinued after 10 patients had undergone treatment because the lesions were not fluorescent using NIR-ICG, and because SDCE did not visualize the whole peritoneum. No adverse events relating to the imaging techniques occurred. Conclusion NBI substantially increased the detection of PM. This method is safe and could improve the detection of metastatic lesions and help optimize cytoreduction in patients with colorectal PM. Electronic supplementary material The online version of this article (10.1245/s10434-018-7005-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nina Roelie Sluiter
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Stijn Lucas Vlek
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arthur Randolph Wijsmuller
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk Thijs Brandsma
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jurriaan Benjamin Tuynman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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137
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Prasanna T, Karapetis CS, Roder D, Tie J, Padbury R, Price T, Wong R, Shapiro J, Nott L, Lee M, Chua YJ, Craft P, Piantadosi C, Sorich M, Gibbs P, Yip D. The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern. Acta Oncol 2018. [DOI: 10.1080/0284186x.2018.1487581 10.1080/0284186x.2018.1487581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Thiru Prasanna
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
| | - Christos S. Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
| | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Robert Padbury
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Timothy Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre, Melbourne, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia
- Menzies Research Institute, Hobart, Australia
| | - Margaret Lee
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | - Yu Jo Chua
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | - Paul Craft
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | | | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
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138
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Prasanna T, Karapetis CS, Roder D, Tie J, Padbury R, Price T, Wong R, Shapiro J, Nott L, Lee M, Chua YJ, Craft P, Piantadosi C, Sorich M, Gibbs P, Yip D. The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern. Acta Oncol 2018; 57:1438-1444. [PMID: 30035653 DOI: 10.1080/0284186x.2018.1487581] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pattern of spread in patients with metastatic colorectal cancer (mCRC) is variable and may reflect different biology in subsets of patients. This is a retrospective study to explore the outcome of patients with mCRC based on their site of metastasis at diagnosis and to explore the association between tumor characteristics [KRAS/RAS, BRAF, mismatch repair (MMR) status, site of primary] and the site of metastasis. METHODS Patients from two Australian databases were divided into six groups based on site of metastasis at time of diagnosis of metastatic disease; lung-only, liver-only, lymph node-only or any patients with brain, bone or peritoneal metastases. Primary endpoint was overall survival (OS) of each cohort compared with the rest of the population. A Mantel-Haenszel chi-squared test used to explore the association between site of metastasis and selected tumor characteristics. RESULTS Five thousand nine hundred and sixty-seven patients were included. In a univariate analysis, median OS was significantly higher when metastases were limited to lung or liver and shorter for those with brain, bone or peritoneal metastases (p < .001) in both datasets. BRAF mutation was strongly associated with peritoneal metastases (relative risk = 1.8, p < .001) with lower incidence of lung (RR = 0.3, p = .004) and liver (RR = 0.7, p = .005) limited metastases. Lung-only metastases were more frequent with KRAS/RAS mutation (RR = 1.4, p = .007). Left colon tumors were associated with bone (RR = 1.6, p < .001) and lung-only metastases (RR = 2.3, p = .001) while peritoneal spread was less frequent compared with right colon tumors (RR = 0.6, p < .001). Rectal cancer was associated with brain, bone and lung metastases (RR = 1.7; p = .002, 1.7; p < .001, 2.0; p < .001). Liver-only metastases were less frequent in deficient MMR tumors (RR = 0.7, p = .01). CONCLUSION Survival duration with mCRC is related to the site of metastases with lung limited disease showing a more favorable survival outcome compared to other single metastatic site disease. The BRAF mutation and primary rectal cancer were associated with poor prognostic metastatic sites.
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Affiliation(s)
- Thiru Prasanna
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
| | - Christos S. Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
| | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Robert Padbury
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Timothy Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre, Melbourne, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia
- Menzies Research Institute, Hobart, Australia
| | - Margaret Lee
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | - Yu Jo Chua
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | - Paul Craft
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | | | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
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139
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Benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in patients with isolated peritoneal metastases from colorectal cancer. Int J Colorectal Dis 2018; 33:1559-1567. [PMID: 30132068 DOI: 10.1007/s00384-018-3146-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ever since Sugarbaker has established the cytoreductive surgery (CRS) in combination with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), there is a chance of cure for selected patients with peritoneal metastases from colorectal cancer. Objective of this study was to investigate the benefit of CRS and HIPEC compared to other therapy options in patients with isolated synchronous and metachronous peritoneal metastases of colorectal origin in terms of long-term overall survival. METHODS A retrospective population-based cohort study, including 370 patients diagnosed with isolated synchronous and metachronous peritoneal metastases of colorectal origin, was carried out. Therefore, data were acquired from the cancer registry at the Regensburg Tumor Center in Bavaria, Germany. Patients' overall survival (OAS) according to their therapy received was analyzed by means of Kaplan-Meier method and multivariable Cox regression. RESULTS Overall median survival was 41.6 months for patients treated with CRS and HIPEC, compared with surgery and chemotherapy (24.0 months, log-rank p = 0.015), chemotherapy only (14.1 months, p < 0.001), surgery only (11.4 months, p < 0.001), and best supportive care (7.9 months, p < 0.001). This benefit persisted after adjustment for further risk factors in multivariable analysis. CONCLUSION The effect of CRS and HIPEC stands out significantly in comparison to all other therapies. The multimodality approach should be a regular option for patients with isolated peritoneal metastases.
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de Jong LAW, Elekonawo FMK, de Reuver PR, Bremers AJA, de Wilt JHW, Jansman FGA, Ter Heine R, van Erp NP. Hyperthermic intraperitoneal chemotherapy with oxaliplatin for peritoneal carcinomatosis: a clinical pharmacological perspective on a surgical procedure. Br J Clin Pharmacol 2018; 85:47-58. [PMID: 30255585 DOI: 10.1111/bcp.13773] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 01/07/2023] Open
Abstract
Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard of care in the treatment of patients with peritoneal carcinomatosis of colorectal origin. The use of oxaliplatin for HIPEC has gained popularity. Although the HIPEC procedure is adopted throughout the world, major differences exist between treatment protocols regarding the carrier solution, perfusate volume, use of an open or closed technique, duration of the perfusion and application of additional flushing. These differences can influence the pharmacokinetics and pharmacodynamics of oxaliplatin and might thereby have an impact on the efficacy and/or safety of the treatment. Clinicians should be aware of the clinical importance of oxaliplatin pharmacology when performing HIPEC surgery. This review adds new insights into the complex field of the pharmacology of HIPEC and highlights an important worldwide problem: the lack of standardization of the HIPEC procedure.
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Affiliation(s)
- Loek A W de Jong
- Radboudumc, Department of Pharmacy, Radboud Institute for Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Fortuné M K Elekonawo
- Radboudumc, Department of Surgery, Radboud Institute for Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Philip R de Reuver
- Radboudumc, Department of Surgery, Radboud Institute for Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Andre J A Bremers
- Radboudumc, Department of Surgery, Radboud Institute for Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Johannes H W de Wilt
- Radboudumc, Department of Surgery, Radboud Institute for Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Frank G A Jansman
- Department of Clinical Pharmacy, Deventer Teaching Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, the Netherlands.,University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, P.O. Box 196, 9700 AD, Groningen, the Netherlands
| | - Rob Ter Heine
- Radboudumc, Department of Pharmacy, Radboud Institute for Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Nielka P van Erp
- Radboudumc, Department of Pharmacy, Radboud Institute for Health Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
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141
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Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World J Surg 2018; 42:2036-2042. [PMID: 29302727 DOI: 10.1007/s00268-017-4450-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Formation of protective stoma as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) may be an effective tool in reducing anastomotic leak incidence. Our aim was to evaluate the incidence and implications of stoma formation during CRS-HIPEC and to examine whether a creation of protective stoma reduces the postoperative morbidity. METHODS A cohort retrospective analysis of all CRS-HIPEC procedures performed between 2004 and 2016 was conducted. Predicting factors for stoma formation were assessed by comparing all patients who underwent stoma formation to those who did not; both groups were then restricted to cases with ≥2 bowel anastomoses and compared in terms of perioperative outcomes in order to determine whether protective stoma confers a morbidity benefit. RESULTS One hundred and ninety-nine CRS-HIPEC procedures were performed on 186 patients. Thirty-four patients (17%) underwent stoma formation, 24 of them as protective stoma. Formation of a stoma was correlated with higher peritoneal carcinomatosis index score (13.6 ± 8 vs. 9.5 ± 7.7, p = 0.007), larger number of organs resected (p < 0.001), greater number of anastomoses (p < 0.001), prolonged operative time (8.1 ± 2.7 vs. 6.6 ± 2.2 h, p = 0.002), and prolonged hospital stay (12 vs. 8.5 days, p = 0.001). In procedures requiring ≥2 anastomoses, formation of protective stoma reduced the anastomotic leak rate (6 vs. 37%, p = 0.025), the morbidity rate (6 vs. 41%, p = 0.017), and reoperation rate (0 vs. 28%, p = 0.03). Overall, 15 patients (44%) underwent stoma reversal, 3 of whom had a complication treated non-operatively. CONCLUSIONS Protective stoma should be considered in extensive CRS-HIPEC procedures requiring two or more bowel anastomoses in order to reduce the postoperative morbidity rate.
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Shan L, Bai B, Lv Y, Xie B, Huang X, Zhu H. Lobaplatin suppresses proliferation and peritoneal metastasis of colorectal cancer in a preclinical model. Biomed Pharmacother 2018; 108:486-491. [PMID: 30243080 DOI: 10.1016/j.biopha.2018.09.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 01/17/2023] Open
Abstract
Peritoneal metastasis from colorectal cancer (CRC) is related to poor prognosis. Intraperitoneal chemotherapy is an efficient method to treat peritoneal metastasis (PM); however, the outcomes remain unsatisfactory. The present study aimed to investigate the antitumor activity of lobaplatin and its role in intraperitoneal chemotherapy. The findings showed that the proliferation of CRC was inhibited in a dose-dependent manner when DLD1 and HCT116 cells were treated with various concentrations of lobaplatin (0, 6.3, 12.5, 25, 50, and 100 μg/mL, respectively). Flow cytometry and Western blot analysis confirmed that lobaplatin affected CRC cells by inducing apoptosis and modulating the caspase family. In the animal study, nude mice were injected with DLD1 cells and divided into three groups. Lobaplatin was injected intraperitoneally to simulate intraperitoneal chemotherapy. Group A was the control group treated with PBS. Group B was injected with DLD1 and treated with lobaplatin simultaneously, while group C was treated with lobaplatin 1 week after cell injection. The results showed that group A harbored maximal tumors on the peritoneal surface, while group B had the least number (9.2 ± 1.3 and 0.4 ± 0.5, respectively P < 0.01). These findings indicated that lobaplatin suppressed the tumor growth as an intraperitoneal chemotherapy agent and achieved a satisfactory therapeutic effect at an early stage. Further blood test and tissue staining did not reveal any liver and kidney toxicity that was induced by lobaplatin. In conclusion, lobaplatin could be an effective and safe agent for CRC treatment, thereby commissioning a novel strategy in intraperitoneal chemotherapy for patients with peritoneal metastasis.
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Affiliation(s)
- Lina Shan
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Biotherapy of Zhejiang province, Hangzhou, China
| | - Bingjun Bai
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Biotherapy of Zhejiang province, Hangzhou, China
| | - Yiming Lv
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Biotherapy of Zhejiang province, Hangzhou, China
| | - Binbin Xie
- Department of Medical Oncology, Sir Run Run Shaw hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuefeng Huang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongbo Zhu
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Biotherapy of Zhejiang province, Hangzhou, China.
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143
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Kuncewitch M, Levine EA, Shen P, Votanopoulos KI. The Role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Appendiceal Tumors and Colorectal Adenocarcinomas. Clin Colon Rectal Surg 2018; 31:288-294. [PMID: 30186050 DOI: 10.1055/s-0038-1642052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Peritoneal surface disease (PSD) has historically been used interchangeably with the term peritoneal carcinomatosis (PC) and has a dismal natural history. A variety of malignant pathologies, including colorectal and appendiceal primary tumors, can disseminate throughout the peritoneal cavity, leading to bowel obstruction and death. In general, peritoneal spread from high-grade appendiceal and colorectal primaries has the potential of hepatic and distant spread and best classified as PC. Low-grade appendiceal tumors are better categorized as PSD, due to low cellularity, high mucin production, and lack of potential spread outside the peritoneal cavity. Growing international experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) over the past 30 years has presented a therapeutic option to patients with PSD from colorectal and appendiceal tumors that can provide significant disease control, as well as potential for previously unattainable long-term survival. The proliferation of HIPEC centers and ongoing prospective trials are helping to standardize HIPEC techniques and patient selection.
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Affiliation(s)
- Michael Kuncewitch
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward A Levine
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Perry Shen
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Peritoneal and extraperitoneal relapse after previous curative treatment of peritoneal metastases from colorectal cancer: What survival can we expect? Eur J Cancer 2018; 100:94-103. [DOI: 10.1016/j.ejca.2018.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 01/08/2023]
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145
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Benlahfid M, Traboulsi W, Sergent F, Benharouga M, Elhattabi K, Erguibi D, Karkouri M, Elattar H, Fadil A, Fahmi Y, Aboussaouira T, Alfaidy N. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) and its receptor PROKR2 are associated to human colorectal cancer progression and peritoneal carcinomatosis. Cancer Biomark 2018; 21:345-354. [PMID: 29226856 DOI: 10.3233/cbm-170499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The highest risk factor for mortality among malignant tumors is metastasis. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is an angiogenic factor which biological activity is mediated via two G protein-coupled receptors, prokineticin receptor1 (PROKR1) and PROKR2. Recent studies suggested that EG-VEGF expression is deregulated in multiple cancers including colorectal cancer (CRC). METHODS Using distinctive CRC and peritoneal carcinomatosis (PC) cohorts and a corresponding control cohort, we determined the circulating levels of EG-VEGF and its in situ expression, and that of its related receptors. RESULTS Circulating EG-VEGF levels were significantly increased in patients with metastatic PC compared to CRC and control patients (p< 0.05). Furthermore, according to clinicopathologic examinations, local EG-VEGF expression correlated with higher tumor and nodal stages (p< 0.001) of CRC. EG-VEGF and PROKR2 were highly expressed in colorectal primary lesions compared to positive controls. PROKR1 expression was lower and did not change in tumor specimens. Also, EG-VEGF and its receptor PROKR2 were differentially expressed in the colorectal primary lesions and in the control groups. CONCLUSION Altogether these findings suggest that EG-VEGF/receptors system might be an important actor in the CRC progression into PC and might be involved in the ability of tumor cells to invade other organs. Circulating EG-VEGF could be proposed as a prognostic marker in human CRC and its progression into PC.
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Affiliation(s)
- Mohammed Benlahfid
- Laboratory of Scientific and Clinical Researches in Cancerous Pathologies, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco
| | - Wael Traboulsi
- Institut National de la Santé et de la Recherche Médicale U1036, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives, Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Frederic Sergent
- Institut National de la Santé et de la Recherche Médicale U1036, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives, Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Mohamed Benharouga
- University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives, Biosciences and Biotechnology Institute of Grenoble, Grenoble, France.,Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5249, Laboratoire de Chimie et Biologie des Métaux, Grenoble, France
| | - Khalid Elhattabi
- Laboratory of Scientific and Clinical Researches in Cancerous Pathologies, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco.,Ibn Rochd University Hospital of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Driss Erguibi
- Laboratory of Scientific and Clinical Researches in Cancerous Pathologies, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco.,Ibn Rochd University Hospital of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Mehdi Karkouri
- Ibn Rochd University Hospital of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Hicham Elattar
- Laboratory of anatomopathology Moulay Driss 1er, Casablanca, Morocco
| | - Abdelaziz Fadil
- Ibn Rochd University Hospital of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Yassine Fahmi
- Ibn Rochd University Hospital of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Touria Aboussaouira
- Laboratory of Scientific and Clinical Researches in Cancerous Pathologies, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco.,Laboratory of Scientific and Clinical Researches in Cancerous Pathologies, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco
| | - Nadia Alfaidy
- Institut National de la Santé et de la Recherche Médicale U1036, Grenoble, France.,University Grenoble-Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives, Biosciences and Biotechnology Institute of Grenoble, Grenoble, France.,Laboratory of Scientific and Clinical Researches in Cancerous Pathologies, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco
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146
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Hentzen JE, de Jongh SJ, Hemmer PH, van der Plas WY, van Dam GM, Kruijff S. Molecular fluorescence-guided surgery of peritoneal carcinomatosis of colorectal origin: A narrative review. J Surg Oncol 2018; 118:332-343. [PMID: 29938400 PMCID: PMC6174973 DOI: 10.1002/jso.25106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 12/14/2022]
Abstract
Patients with peritoneal carcinomatosis (PC) from colorectal origin may undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as a curative approach. One major prognostic factor that affects survival is completeness of cytoreduction. Molecular Fluorescence Guided Surgery (MFGS) is a novel intraoperative imaging technique that may improve tumor identification in the future, potentially preventing over- and under-treatment in these patients. This narrative review outlines a chronological overview of MFGS development in patients with PC of colorectal origin.
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Affiliation(s)
- Judith E.K.R. Hentzen
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Steven J. de Jongh
- Department of Gastroenterology and Hepatology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Patrick H.J. Hemmer
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Willemijn Y. van der Plas
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Gooitzen M. van Dam
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Nuclear Medicine and Molecular Imaging and Intensive Care, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Schelto Kruijff
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
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147
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Trumbeckaite S, Cesna V, Jasukaitiene A, Baniene R, Gulbinas A. Different mitochondrial response to cisplatin and hyperthermia treatment in human AGS, Caco-2 and T3M4 cancer cell lines. J Bioenerg Biomembr 2018; 50:329-338. [DOI: 10.1007/s10863-018-9764-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/15/2018] [Indexed: 12/11/2022]
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148
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Mikuła-Pietrasik J, Stryczyński Ł, Uruski P, Tykarski A, Książek K. Procancerogenic activity of senescent cells: A case of the peritoneal mesothelium. Ageing Res Rev 2018; 43:1-9. [PMID: 29355719 DOI: 10.1016/j.arr.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 01/18/2023]
Abstract
Human peritoneal mesothelial cells belong to a narrow group of somatic cells in which both the triggers and the mechanisms of senescence have already been well defined. Importantly, senescent mesothelial cells have been found in the peritoneal cavity in vivo. From a clinical point of view, peritoneal mesothelial cells have been recognized as playing a critical role in the intraperitoneal development of tumor metastases. The pro-cancerogenic behavior of mesothelial cells is even more pronounced when the cells exhaust their proliferative capacity and become senescent. In this review, we summarize the current state of art regarding the contribution of peritoneal mesothelial cells in the progression of ovarian, colorectal, and pancreatic carcinomas, with particular attention paid to the cancer-promoting activity of their senescent counterparts. Moreover, we delineate the mechanisms, mediators, and signaling pathways that are engaged by the senescent mesothelial cells to support such vital elements of cancer progression as adhesion, proliferation, migration, invasion, epithelial-mesenchymal transition, and angiogenesis. Finally, we discuss the experimental evidence regarding both natural and synthetic compounds that may either prevent or restrict cancer development by delaying senescence of mesothelial cells.
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Affiliation(s)
- Justyna Mikuła-Pietrasik
- Department of Hypertensiology, Angiology and Internal Medicine, Poznań University of Medical Sciences, Długa 1/2 Str., 61-848 Poznań, Poland.
| | - Łukasz Stryczyński
- Department of Hypertensiology, Angiology and Internal Medicine, Poznań University of Medical Sciences, Długa 1/2 Str., 61-848 Poznań, Poland.
| | - Paweł Uruski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznań University of Medical Sciences, Długa 1/2 Str., 61-848 Poznań, Poland.
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznań University of Medical Sciences, Długa 1/2 Str., 61-848 Poznań, Poland.
| | - Krzysztof Książek
- Department of Hypertensiology, Angiology and Internal Medicine, Poznań University of Medical Sciences, Długa 1/2 Str., 61-848 Poznań, Poland.
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149
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Pathway of peritoneal carcinomatosis maybe hematogenous metastasis rather than peritoneal seeding. Oncotarget 2018; 8:41549-41554. [PMID: 28099909 PMCID: PMC5522242 DOI: 10.18632/oncotarget.14607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/08/2017] [Indexed: 12/12/2022] Open
Abstract
Goals This study aimed to summarize the clinicopathological data of the cases of gastric cancer or colon cancer with regular metastasis in the mesentery of small intestine and explore the pathway of peritoneal carcinomatosis. Materials and methods We retrospectively analyzed 5 cases of gastric cancer and 3 cases of colon cancer with regular metastasis in the mesentery of the small intestine from January 2014 to June 2016, including clinical information, gross manifestations during operation, treatment, and pathology. Results The clinical characteristics of all 8 cases were fully collected. The symptoms were various without specificity. All patients were found to present with metastasis in peritoneum during operation and the metastatic lesions arranged along the blood vessels orderly. The metastatic lesions of all studied patients were proved to be malignant carcinoma histopathologically, the same as the original tumor. Tumor emboli were seen in the vessel and invasive neoplastic foci was also seen in the vascular wall. Conclusions The traditional view that peritoneal carcinomatosis is due to seeding has no sufficient basis. Hematogenous metastasis maybe the real way of peritoneal carcinomatosis combined with clinical presentation.
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150
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Leiker A, Khatri G, Meyer J. Rectal cancer presenting with synchronous intraperitoneal spread of disease. Proc (Bayl Univ Med Cent) 2018; 31:219-221. [DOI: 10.1080/08998280.2018.1435119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 10/17/2022] Open
Affiliation(s)
- Andrew Leiker
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gaurav Khatri
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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