Palliative Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Is It Safe and Effective?

INTRODUCTION

Palliation is a controversial indication for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Patients with peritoneal carcinomatosis (PC) are living longer, and the roles of palliative CRS and HIPEC are increasingly challenged. The purpose of this study is to evaluate indications, morbidity, and symptom improvement from CRS/HIPEC in advanced PC.

METHODS

A retrospective review of patients undergoing CRS and/or HIPEC with a palliative intent at a single institution from February 2008 to February 2018 was performed. Main end points included symptom improvement, symptom-free interval, and overall survival.

RESULTS

Two hundred and seventy seven patients were referred for CRS/HIPEC during the study period and 17 underwent 20 palliative procedures. Appendiceal (n = 6) and colorectal cancers (n = 6) were the most common malignancies. Ascites (n = 8) and bowel obstruction (n = 8) were the most common indications for intervention. The postoperative complication rate was 50% and major complication rate was 20%. Partial symptom improvement or resolution of symptoms was achieved in 18 (90%) cases. A durable symptom control at 90 d was achieved in 13 (65%) cases. The median time to symptom recurrence was 5.1 mo (interquartile range: 2-11.4), and the median overall survival was 11.6 mo (interquartile range: 3.8-28.5).

CONCLUSIONS

Palliative CRS and/or HIPEC achieve symptom improvement in patients with advanced PC. Risk assessment and expected time to recovery from surgery remain paramount for patient selection.

Acetylsalicylic acid (aspirin) test for the diagnosis of renovascular hypertension

OBJECTIVE

To determine whether the administration of acetylsalicylic acid (ASA, also known as Aspirin) differentiates patients with renovascular hypertension from those with essential hypertension, in order to provide a simple alternative to more expensive forms of diagnosis for this condition.

DESIGN

Trial of ASA test in patients with previously diagnosed essential and renovascular hypertension.

SETTING

Inpatient department of an academic health sciences centre in Poznan, Poland.

PATIENTS

Forty patients with essential hypertension and 21 patients with renovascular hypertension.

INTERVENTIONS

Patients were given an intravenous injection of ASA (10 mg/kg body weight), blood pressure was measured and blood was sampled and assayed for plasma renin activity (PRA) before and 30 minutes after the injection.

RESULTS

ASA infusion in patients with renovascular hypertension resulted in a decrease in PRA from 15.2 (standard deviation [SD] 12.4) ng/mL per hour to 7.2 (SD 9.8) ng/mL per hour, whereas in patients with essential hypertension the initial PRA was significantly lower before ASA administration and did not change afterward. In patients with renovascular hypertension, the mean systolic, diastolic and arterial pressure decreased significantly (p < 0.001) after ASA infusion, but these did not change in patients with essential hypertension. Based on the criterion of 4 mm Hg as a detectable decrease in mean blood pressure, the sensitivity of the ASA test was 95.0% and the specificity 82.5%; its positive predictive value was 74% and its negative predictive value 97%.

CONCLUSION

The precise measurement of blood pressure during the ASA test may provide a useful method of differentiating between patients with renovascular and essential hypertension.

[Selected hemodynamic parameters in overweight patients with mild and moderate hypertension treated with low caloric diet]

Basic haemodynamic parameters - blood volume (BV), cardiac output (CO), stroke volume (SV), and total peripheral resistance (TPR) were studied in two groups of overweight patients with mild and moderate hypertension. Each group consisted of 15 subjects. The patients of the first group were kept on low caloric diet (1000-1100 cal per day). Patients of the second-control-group were treated with propranolol (120 mg per day). The duration of each study was 24 weeks. Blood pressure fell due to body weight reduction. BV, CO and SV decreased without changes in TPR. In the control group treated with propranolol in which the body weight did not change a fall in blood pressure, cardiac output, and stroke volume was seen without changes in blood volume and total peripheral resistance values.