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Hari A, Štabuc B. Possible use of 2D shear wave liver elastography in new-onset ascites evaluation. BMC Gastroenterol 2024; 24:68. [PMID: 38331713 PMCID: PMC10851554 DOI: 10.1186/s12876-024-03159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND No data on the use of 2D shear wave elastography exists regarding the evaluation of the new-onset ascites causality. AIMS To determine whether 2D shear wave elastography can help in the non-invasive assessment of the new-onset ascites cause. To assess the applicability of liver stiffness measured by 2D shear wave elastography using Esaote MyLab Nine apparatus in patients with ascites. METHODS In 52 consecutive patients with new-onset ascites (January 2020 to October 2021), liver stiffness using 2D shear wave elastography was prospectively measured. The reliable measurements were used for further analysis. Relevant clinical and laboratory data was collected. RESULTS The calculated liver stiffness measurement cut-off value of 14.4 kPa held 94% accuracy, 100% sensitivity, and 83% specificity when determining ascites with serum ascites albumin gradient ≥11 g/L. Reliable 2D shear wave elastography success rate was 84%. CONCLUSIONS 2D shear wave elastography may potentially be used to differentiate transudative from exudative ascites, especially in patients with portal hypertension and peritoneal carcinomatosis.
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Affiliation(s)
- Andrej Hari
- Department of gastroenterology and hepatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
| | - Borut Štabuc
- Department of gastroenterology and hepatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Petrović A, Jurković I, Krušlin B. Primary undifferentiated carcinoma of rete testis with extensive peritoneal carcinomatosis and fatal outcome: Case report. Urol Case Rep 2023; 51:102573. [PMID: 37854463 PMCID: PMC10579956 DOI: 10.1016/j.eucr.2023.102573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
Carcinoma of rete testis is an extremely rare malignant tumor arising from its epithelium. Prognosis is poor with mean survival of 8 months. Lymph node metastases and the size of the tumor larger than 5 cm are poor prognostic factors. We report a case of primary undifferentiated carcinoma of the rete testis in a 46-year-old man who presented with testicular enlargement without previous trauma or cryptorchidism, and with extensive peritoneal carcinomatosis, retroperitoneal lymph node metastases and fatal outcome. We present this case because of the rarity of the carcinoma of the rete testis and its challenging diagnosis.
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Affiliation(s)
- Andreja Petrović
- Dpt of Pathology and Cytology, Clinical Hospital Merkur, Zagreb, Croatia
| | - Ilija Jurković
- Dpt of Pathology and Cytology, Dubrovnik General Hospital, Dubrovnik, Croatia
| | - Božo Krušlin
- Dpt of Pathology and Cytology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- Dpt of Pathology, School of Medicine, Zagreb, Croatia
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Turrel E, Chopin N, Meeus P, Blache A, Ray-Coquard I, Tredan O, Treilleux I, Ebring C, Heinemann M, Rossi L. Do surgeons overestimate diaphragmatic peritoneal disease in interval debulking surgery of ovarian cancer? Eur J Surg Oncol 2023; 49:106963. [PMID: 37394316 DOI: 10.1016/j.ejso.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Cytoreductive surgery is a key point in ovarian cancer treatment. Substantial morbidity may be consecutive to this major radical surgery. However, the objective of no residual tumor (CC-0) had demonstrated its clear improvement of prognosis. Could macroscopically-driven interval debulking surgery (IDS) overestimate active cancer cells and be unnecessarily morbid? MATERIALS AND METHODS This retrospective cohort study was conducted in Center Leon Berard Cancer Center between 2000 and 2018. We included women with advanced epithelial ovarian cancer who received neoadjuvant chemotherapy and underwent an IDS including resection of peritoneal metastases on the diaphragmatic domes. The primary endpoint was the pathological outcome of peritoneal resections of diaphragmatic domes. RESULTS Peritoneal resections of diaphragmatic domes consisted of 117 patients. 75 patients required resection of nodules from the right cupola only, 2 patients from the left cupola only, and 40 patients bilaterally. Pathological analysis of the diaphragmatic domes found that 84.6% of samples demonstrated the presence of malignant cells, and only 12.8% found no tumor involvement. Pathology analysis could not be performed for 3 patients (2.6%) (vaporization). CONCLUSION Surgical evaluation after neoadjuvant chemotherapy in ovarian cancer does not often overestimate peritoneal involvement by active carcinomatosis. Potential surgical morbidity due to peritoneal resection in IDS is admissible.
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Affiliation(s)
- Estelle Turrel
- Centre Jean Perrin, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France; Centre Léon Bérard, Lyon, France
| | | | | | | | - Isabelle Ray-Coquard
- Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
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Pocard M, So JBY, Huchon C, Robella M, Chavatte-Palmer P, Eveno C, Glehen O, Peng Yong W. PIPAC nebulizer: How to test the new devices in the market, expert recommendations. J Visc Surg 2023; 160:52-54. [PMID: 36270954 DOI: 10.1016/j.jviscsurg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pressurized intraperitoneal aerosol chemotherapy, named PIPAC, is now used in many centers around the world and as an intraperitoneal drug delivery system for treatment of peritoneal carcinomatosis. Recently, many of us have encountered problems during PIPAC procedures due to changes in material and production features of the original PIPAC nebulizer. Concomitantly, new PIPAC nebulizers proposed by other manufacturers are being launched on the market; which claim that they are the same as the original device in delivering PIPAC. However, these new devices are all different in terms of materials, technical characteristics and costs. We have considered that, to maintain the acquired results of PIPAC, we must ensure that the new systems are equivalent. The characteristics deemed essential by the expert group are as follows: 1: The nebulizer must be able to create droplets through an injector pressure between 10 and 20 bars, 2: The mean droplet size must be 3 micrometers, with 95% of the droplets between 0 and 10 micrometers, 3: The diffusion angle must be 70 degrees, which is the minimum.
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Affiliation(s)
- M Pocard
- Université Paris Cité, INSERM, U1275 CAP Paris-Tech, 75010 Paris, France; Hepato-Biliary-pancreatic Gastrointestinal Surgery and Liver Transplantation, Pitié Salpêtrière Hospital, AP-HP, 49, boulevard de l'Hôpital, 75013 Paris, France.
| | - J B Y So
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C Huchon
- Department of gynecologic surgery, Lariboisiere Hospital, Université Paris Cité, 2, rue Ambroise Paré, 75010 Paris, France
| | - M Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Canndiolo, Italy
| | - P Chavatte-Palmer
- Université Paris-Saclay, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France; École Nationale Vétérinaire d'Alfort, BREED, Maisons-Alfort 94700, France
| | - C Eveno
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - O Glehen
- Surgical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; CICLY - EA3738, Université Claude Bernard Lyon I (UCBL1), Lyon, France
| | - W Peng Yong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore
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Razak O A, Yang SY, Cho MS, Min BS, Han YD. Palliative surgery as a bridge to systemic treatment for malignant bowel obstruction due to peritoneal metastases: A retrospective, case-control study. Asian J Surg 2023; 46:160-165. [PMID: 35260331 DOI: 10.1016/j.asjsur.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High-quality data on palliative surgery in patients with malignant bowel obstruction (MBO) caused by peritoneal metastases (PM) are lacking. We aimed to determine the utility of palliative surgery for such patients. METHODS We retrospectively analyzed patients considered for surgery for MBO, caused by PM, in our department from January 2019 to October 2020. None of them could tolerate a diet, despite conservative treatment. We investigated the clinical characteristics and perioperative outcomes and calculated overall survival (OS). Kaplan-Meier survival analysis was performed, with the log-rank test to evaluate differences in OS rates. Multivariate Cox regression was performed to determine prognostic factors. RESULTS Sixty (67%) patients underwent surgery, whereas, 30 (33%) received the best supportive care (BSC) treatment. A better (p = 0.002) median OS was observed in patients undergoing surgery (3.9 months) than in those receiving BSC (2.6 months). Severe complications were observed in 12 (20%) patients, including 30-day mortality (7 patients). Forty-eight (80%) patients in the surgery group could tolerate a diet and the hospital stay (mean ± standard deviation) was 20.0 ± 23.1 days. Re-obstruction was observed in five (8.3%) patients after 78.6 ± 63.3 days. Patients in the postoperative chemotherapy group exhibited a better (p < 0.001) median OS (12.3 months) than did those in the no-postoperative chemotherapy group (3.5 months). Only postoperative chemotherapy (hazard ratio 0.264, 95% confidence interval 0.143-0.487, p < 0.001) was identified as an independent prognostic factor. CONCLUSIONS Compared with BSC, surgery is associated with a better OS in patients with MBO due to PM. Surgery should be considered as a bridge to systemic treatment for such patients.
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Affiliation(s)
| | - Seung Yoon Yang
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Soo Cho
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Dae Han
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Cascales Campos PA, González Gil A, Gómez Ruiz ÁJ, Balaguer Román A, Gil Gómez E, Alconchel Gago F, Martínez J, Nieto Díaz A, Barceló Valcárcel F, Gil Martínez J. Interval cytoredutive surgery and HIPEC in advanced ovarian cancer with small-bowel disease: results and reflections. Clin Transl Oncol 2022. [PMID: 35274202 DOI: 10.1007/s12094-022-02795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/24/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Small-bowel involvement in patients with ovarian cancer has been strongly correlated with the possibility of cytoreduction and thus with survival. The main objective of this study was to evaluate the prognostic significance of small-bowel involvement in patients undergoing optimal-complete interval cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). METHODS We included a series of patients diagnosed with stage IIIC-IVA (pleural effusion) high-grade serous epithelial ovarian cancer and in whom CRS + HIPEC was indicated after neoadjuvant systemic chemotherapy (NACT). The study period extended from January 2008 to January 2020, with a minimum follow-up of 12 months from the inclusion of the last patient. A multivariate analysis using Cox regression allowed us to identify the variables that were independently related to disease-free survival. RESULTS A total of 144 patients were selected, 13 (9%) of whom were excluded from the analysis, because their disease was considered unresectable. The study included a series of 131 patients with a median age of 62 years (34-79 years) and a median Peritoneal Cancer Index (PCI) calculated during surgery of 9 (1-35). The median PCI of bowel areas 9-12 (SB-PCI) was 3 (1-10). Performance of a CC-1 cytoreduction (HR: 1.93, 95% CI: 1.02-3.64, p = 0.042) and SB-PCI greater than 3 (HR: 2.25, 95%CI: 1.13-4.48, p = 0.21) were independent factors associated with shorter disease-free survival. CONCLUSION Small-bowel involvement, even in patients with a macroscopically complete resection, showed a correlation with worse prognostic outcomes and could be considered as a variable in the postoperative management of these patients.
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Gomes David M, Bakrin N, Salleron J, Kaminsky MC, Bereder JM, Tuech JJ, Lehmann K, Mehta S, Glehen O, Marchal F. Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) vs CRS alone for treatment of endometrial cancer with peritoneal metastases: a multi-institutional study from PSOGI and BIG RENAPE groups. BMC Surg 2022; 22:1. [PMID: 34996419 PMCID: PMC8742414 DOI: 10.1186/s12893-021-01449-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/20/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To investigate the benefit of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of endometrial peritoneal carcinomatosis compared to CRS alone. Methods We conducted a retrospective multicentre study of patients from experienced centres in treating peritoneal malignancies from 2002 to 2015. Patients who underwent surgery for peritoneal evolution of endometrial cancer (EC) were included. Two groups of 30 women were matched and compared: “CRS + HIPEC” which used HIPEC after CRS, and “CRS only” which did not use HIPEC. We analysed clinical, pathologic and treatment data for patients with peritoneal metastases from EC. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS). Results In “CRS plus HIPEC” group, 96.7% of women were treated for recurrence, while in “CRS only” 83.3 were treated for primary disease. There was no significant difference between Peritoneal Carcinomatosis Index at laparotomy or Completeness of Cytoreduction score. Grade III and IV complications rates did not significantly differ between “CRS plus HIPEC” group and “CRS only” group (20.7% vs 20.7%, p = 0.739). Survival analysis showed no statistical difference between both groups. Median OS time was 19.2 months in “CRS plus HIPEC” group and 29.7 months in “CRS only” group (p = 0.606). Median PFS survival time was 10.7 months in “CRS plus HIPEC” group and 13.1 months in “CRS only” group (p = 0.511). Conclusion The use of HIPEC combined to CRS did not have any significance as regard the DFS and OS over CRS alone in patients with primary or recurrent peritoneal metastasis of endometrial cancer.
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Affiliation(s)
- Manuel Gomes David
- Département de Chirurgie Oncologique, Institut de Cancérologie de Lorraine, Université de Lorraine, 6 Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy, France.
| | - Naoual Bakrin
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Julia Salleron
- Institut de Cancérologie de Lorraine, Cellule Data Biostatistiques, Université de Lorraine, 54519, Vandœuvre-lès-Nancy, France
| | - Marie Christine Kaminsky
- Département d'oncologie, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519, Vandœuvre-lès-Nancy, France
| | | | | | | | | | - Olivier Glehen
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Marchal
- Département de Chirurgie Oncologique, Institut de Cancérologie de Lorraine, Université de Lorraine, 6 Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy, France.,CRAN, UMR 7039, CNRS, Université de Lorraine, Boulevard des Aiguillettes, 54506, Vandoeuvre-les-Nancy, France
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Marulanda K, Maduekwe UN. Disparities in the Management of Peritoneal Surface Malignancies. Surg Oncol Clin N Am 2021; 31:29-41. [PMID: 34776062 DOI: 10.1016/j.soc.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Peritoneal surface malignancies are a group of aggressive cancers involving the peritoneum. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can improve outcomes and survival in select patients. Despite significant advancements in care, racial disparities in peritoneal malignancy outcomes persist and may have even worsened over time. Poor adherence to guideline-recommended therapy introduces wide variability in patient care and often results in fewer options and suboptimal treatment of vulnerable populations. This review explores biological, sociodemographic, and environmental factors that contribute to disparities in peritoneal malignancy outcomes.
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Affiliation(s)
- Kathleen Marulanda
- Department of Surgery, University of North Carolina, 4001 Burnett-Womack Building 170 Manning Drive, CB #7050, Chapel Hill, NC 27599-7050, USA. https://twitter.com/kmaruMD
| | - Ugwuji N Maduekwe
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, 170 Manning Drive, CB #7213, Chapel Hill, NC 27599-7213, USA.
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Sanae A, Hajar EA, Selma K, Hounayda J, Rachida L, Basma EK, Youssef O. Peritoneal thickening: It's not always carcinomatosis. Radiol Case Rep 2021; 16:2620-3. [PMID: 34285732 DOI: 10.1016/j.radcr.2021.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/06/2022] Open
Abstract
The peritoneal pseudotumor localization of tuberculosis is a rare clinical form, representing 1 to 3% of extrapulmonary site of tuberculosis. It represents the sixth most common extra pulmonary site of tuberculosis. It is a great mimicker with major overlapping clinical and imaging features. Differentiating peritoneal tuberculosis and peritoneal carcinomatosis in imaging remains challenging. We present a case of a 37-year old woman complaining of chronic abdominal pain and distension who has been diagnosed to have peritoneal carcinomatosis based on CT findings, histopathological study then revealed necrotizing, granulomatous inflammation consistent with tuberculosis. This case showed the interest to be aware of the common and uncommon imaging features of tuberculosis by radiologists to better assess for alternative differential diagnosis.
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Casanova J, Jurgiel J, Henriques V, Nabais H, Pinto LV, Cunha JF. Peritoneal deciduosis mimicking peritoneal Carcinomatosis: A case report. Gynecol Oncol Rep 2021; 37:100827. [PMID: 34277919 PMCID: PMC8264598 DOI: 10.1016/j.gore.2021.100827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/05/2022] Open
Abstract
Deciduosis is defined as the presence of decidual tissue in an ectopic location. It is caused by progesterone-mediated metaplasia of mesenchymal cells. We describe a case of a non-pregnant patient with extensive peritoneal spread. As in this report, this entity might mimic oncological conditions.
Ectopic decidual reaction (or deciduosis) can be rarely seen in the peritoneum and most of the cases in the literature are associated with pregnancy. It is more commonly found in the ovaries, uterus and cervix. Although its pathophysiology is not totally understood, it is accepted that peritoneal deciduosis develops as a result of the progesterone induced metaplasia of subserosal stromal cells during pregnancy. It is important to distinguish this entity from oncologic conditions, namely metastatic carcinoma and mesothelioma. We report an unusual case of a 40 year-old non pregnant patient that presented with imaging findings suggestive of peritoneal carcinomatosis.
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Affiliation(s)
- João Casanova
- Gynecologic Oncology Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | | | | | - Henrique Nabais
- Gynecologic Oncology Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Luís Vieira Pinto
- Gynecologic Oncology Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Jose Filipe Cunha
- Digestive Surgery Unit, Champalimaud Clinical Centre, Lisbon, Portugal
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Sergi W, Marchese TRL, Botrugno I, Baglivo A, Spampinato M. Primary ovarian Burkitt's lymphoma presentation in a young woman: A case report. Int J Surg Case Rep 2021; 83:105904. [PMID: 34051445 PMCID: PMC8176312 DOI: 10.1016/j.ijscr.2021.105904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Burkitt's lymphoma is one of the fastest growing human cancers and it needs a rapid diagnosis. CASE PRESENTATION A young woman presented to our institution with acute abdominal pain, tenderness and constipation. Ultrasound reported a right ovarian mass; at laparoscopy, we discovered ascites, peritoneal carcinomatosis and a voluminous pelvic mass. CLINICAL DISCUSSION Diagnosis was confirmed as non-Hodgkin sporadic Burkitt's lymphoma: the careful workup was the key to initiate multiagent chemotherapy. CONCLUSION Primary ovarian Burkitt's lymphoma, in a young woman in a non-endemic zone, is a rarity that represents a strong diagnostic challenge, but rapid identification can lead the patient to appropriate therapies and improvement of prognosis.
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Affiliation(s)
- William Sergi
- Department of General Surgery, S.C. General and Emergency Surgery, "Vito Fazzi" Hospital, Lecce, Italy.
| | | | - Ivan Botrugno
- Department of General Surgery, S.C. General and Emergency Surgery, "Vito Fazzi" Hospital, Lecce, Italy
| | - Arturo Baglivo
- Department of General Surgery, S.C. General and Emergency Surgery, "Vito Fazzi" Hospital, Lecce, Italy
| | - Marcello Spampinato
- Department of General Surgery, S.C. General and Emergency Surgery, "Vito Fazzi" Hospital, Lecce, Italy
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Jónsdóttir B, Ripoll MA, Bergman A, Silins I, Poromaa IS, Ahlström H, Stålberg K. Validation of 18F-FDG PET/MRI and diffusion-weighted MRI for estimating the extent of peritoneal carcinomatosis in ovarian and endometrial cancer -a pilot study. Cancer Imaging 2021; 21:34. [PMID: 33849649 PMCID: PMC8042953 DOI: 10.1186/s40644-021-00399-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/25/2021] [Indexed: 12/25/2022] Open
Abstract
Background The extent of peritoneal carcinomatosis is difficult to estimate preoperatively, but a valid measure would be important in identifying operable patients. The present study set out to validate the usefulness of integrated 18F-FDG PET/MRI, in comparison with diffusion-weighted MRI (DW-MRI), for estimation of the extent of peritoneal carcinomatosis in patients with gynaecological cancer. Methods Whole-body PET/MRI was performed on 34 patients with presumed carcinomatosis of gynaecological origin, all scheduled for surgery. Two radiologists evaluated the peritoneal cancer index (PCI) on PET/MRI and DW-MRI scans in consensus. The surgeon estimated PCI intraoperatively, which was used as the gold standard. Results Median total PCI for PET/MRI (21.5) was closer to surgical PCI (24.5) (p = 0.6), than DW-MRI (median PCI 20.0, p = 0.007). However, both methods were highly correlated with the surgical PCI (PET/MRI: β = 0.94 p < 0.01, DW-MRI: β = 0.86, p < 0.01). PET/MRI was more accurate (p = 0.3) than DW-MRI (p = 0.001) when evaluating patients at primary diagnosis but no difference was noted in patients treated with chemotherapy. PET/MRI was superior in evaluating high tumour burden in inoperable patients. In the small bowel regions, there was a tendency of higher sensitivity but lower specificity in PET/MRI compared to DW-MRI. Conclusions Our results suggest that FDG PET/MRI is superior to DW-MRI in estimating total spread of carcinomatosis in gynaecological cancer. Further, the greatest advantage of PET/MRI seems to be in patients at primary diagnosis and with high tumour burden, which suggest that it could be a useful tool when deciding about operability in gynaecological cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-021-00399-2.
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Affiliation(s)
- Björg Jónsdóttir
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden.
| | | | - Antonina Bergman
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - Ilvars Silins
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | | | - Håkan Ahlström
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden.,Antaros, Medical AB, Uppsala, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
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Rotolo S, Di Giorgio A, Santullo F, Attalla El Halabieh M, Lodoli C, Abatini C, Pacelli F. Cytoreductive surgery and mitomycin C hyperthermic intraperitoneal chemotherapy with CO 2 recirculation (HIPEC-CO 2) for colorectal cancer peritoneal metastases: analysis of short-term outcomes. Updates Surg 2021; 73:1443-8. [PMID: 33782856 DOI: 10.1007/s13304-021-01034-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
Peritoneal dissemination from colorectal cancer (CRC) has long been associated with unfavorable prognosis. However, in the last decades, the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was able to obtain up to 30% 5-year survival rate in selected centers. Despite the wide diffusion of CRS and HIPEC, until now, there are no clear recommendations on the drug of choice for HIPEC nor its technique, and safety and efficacy data of HIPEC regimens and techniques are lacking. We performed a retrospective analysis of a prospectively maintained database of 26 CRS and mitomycin C HIPEC with CO2 recirculation (HIPEC-CO2) for CRC peritoneal metastasis (PM) performed at our center. The main endpoints were morbidity, mortality, the temperature of perfusate during HIPEC and metabolic changes throughout the procedure. Morbidity was assessed by analysis of postoperative adverse events according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.0). Continuous variables of Arterial Blood Gas (ABG) analysis at three time-points were compared by the Student t test. There were no postoperative deaths. The overall grade 3-4 CTCAE complications rate at 30 days was 38.4%, with ten severe adverse events occurring to six (23.0%) patients. The temperature within HIPEC perfusion maintained between 41 and 42 °C in all cases and we experienced no HIPEC-related intraoperative complications. We observed a significant difference between all baseline and pre-HIPEC ABG parameters evaluated but no statistically significant differences between pre- and post-HIPEC ABG outcomes. This study shows that mitomycin C HIPEC-CO2 is feasible and has a safety profile comparable to that of other HIPEC techniques reported in the literature. Further research is needed to validate prospectively the safety and efficacy of this technique.
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Binda C, Dabizzi E, Sinagra E, Fornelli A, Saragoni L, Cennamo V, Anderloni A, Fabbri C. Micro-Biopsy Forceps in the Assessment of Peritoneal Carcinomatosis: A Possible New Indication? Clin Endosc 2021; 54:613-617. [PMID: 33765374 PMCID: PMC8357587 DOI: 10.5946/ce.2020.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is defined as a metastatic involvement of the peritoneum by several other primary sites and it is characterized by a marked worsening of prognosis, with limited treatment opportunities. Subsequently, PC should be ruled out before any invasive treatment is administered. A new through-the-needle micro-biopsy forceps (MF) was recently introduced that permits micro-histology cores. In this case series, we evaluated the feasibility of MF in the assessment of PC to complete patient diagnostic work-ups. Five consecutive patients referred for endoscopic ultrasound staging were sampled using MF. Sampling was feasible in all patients with a technical success of 100%. No adverse events were reported in any cases. This technique was feasible and safe with a technical success rate of 100%. It permitted sampling of peritoneal irregularity, obtained high-quality tissue fragments in all cases, and enabled an additional assessment, i.e., immunohistochemical staining.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì - Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Emanuele Sinagra
- Servizio di Endoscopia Digestiva, Fondazione Istituto G. Giglio di Cefalù, Cefalù (PA), Italy.,Section of Nutrition, Istituto Euromediterraneo di Scienze e Tecnologia (IEMEST), Palermo, Italy
| | - Adele Fornelli
- Pathology Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, AUSL Romagna, Forlì, Italy
| | - Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì - Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
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15
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Kim HI, Wilson BC. Photodynamic Diagnosis and Therapy for Peritoneal Carcinomatosis from Gastrointestinal Cancers: Status, Opportunities, and Challenges. J Gastric Cancer 2020; 20:355-375. [PMID: 33425438 PMCID: PMC7781745 DOI: 10.5230/jgc.2020.20.e39] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022] Open
Abstract
Selective accumulation of a photosensitizer and the subsequent response in only the light-irradiated target are advantages of photodynamic diagnosis and therapy. The limited depth of the therapeutic effect is a positive characteristic when treating surface malignancies, such as peritoneal carcinomatosis. For photodynamic diagnosis (PDD), adjunctive use of aminolevulinic acid- protoporphyrin IX-guided fluorescence imaging detects cancer nodules, which would have been missed during assessment using white light visualization only. Furthermore, since few side effects have been reported, this has the potential to become a vital component of diagnostic laparoscopy. A variety of photosensitizers have been examined for photodynamic therapy (PDT), and treatment protocols are heterogeneous in terms of photosensitizer type and dose, photosensitizer-light time interval, and light source wavelength, dose, and dose rate. Although several studies have suggested that PDT has favorable effects in peritoneal carcinomatosis, clinical trials in more homogenous patient groups are required to identify the true benefits. In addition, major complications, such as bowel perforation and capillary leak syndrome, need to be reduced. In the long term, PDD and PDT are likely to be successful therapeutic options for patients with peritoneal carcinomatosis, with several options to optimize the photosensitizer and light delivery parameters to improve safety and efficacy.
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Affiliation(s)
- Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
- Open NBI Convergence Technology Research Laboratory, Severance Hospital, Seoul, Korea
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brian C. Wilson
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Rotolo S, Ferracci F, Santullo F, Lodoli C, Inzani F, Abatini C, Pacelli F, Di Giorgio A. Systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC): A case report of a multimodal treatment for peritoneal metastases of pancreatic origin. Int J Surg Case Rep 2020; 77S:S75-S78. [PMID: 33191190 PMCID: PMC7876684 DOI: 10.1016/j.ijscr.2020.10.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
Integration of PIPAC to systemic chemotherapy can have good tolerance profile. Repeated biopsies performed during PIPAC allowed therapy-response monitoring. Analysis of biopsies performed during PIPAC allowed tailoring of chemotherapy. Integration of PIPAC to systemic chemotherapy can permit good quality of life.
Introduction Pancreatic ductal adenocarcinoma (PDAC) with peritoneal metastases (PM) has a dismal prognosis and palliative systemic chemotherapy, which represents the standard treatment option, has significant pharmacokinetics limitations and low efficacy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new method of drug delivery that is expected to maximize exposure of peritoneal nodules to antiblastic agents. A combination of systemic chemotherapy and PIPAC may be valuable. Presentation of case A 55 years old male affected by PDAC with synchronous PM underwent a multimodal treatment comprising systemic chemotherapy and PIPAC without any procedural-related adverse events. Tumor genomic profiling evaluation from peritoneal biopsies addressed further tailored systemic chemotherapy. Discussion The presented case illustrates the possibility of adding PIPAC to systemic chemotherapy with a fair tolerance profile and good quality of life while allowing monitoring of therapy-response and tailoring of the antiblastic treatment.
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Affiliation(s)
- Stefano Rotolo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Federica Ferracci
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Lodoli
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Frediano Inzani
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Abatini
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Pacelli
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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17
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Brind'Amour A, De Guerke L, Fortin S, Gervais MK, Dubé P, Sidéris L. Recurrent High-grade Ovarian Immature Teratoma with Peritoneal Dissemination. J Pediatr Adolesc Gynecol 2020; 33:586-589. [PMID: 32535217 DOI: 10.1016/j.jpag.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peritoneal dissemination of ovarian immature teratoma in children is a rare entity and is associated with a poor prognosis. There are no guidelines on the optimal management of these patients with regard to surgery and systemic treatments. CASE This is the case of a 16-year-old patient who experienced an early recurrence of immature teratoma with peritoneal dissemination after surgery and systemic chemotherapy failure, and was treated with an aggressive salvage cytoreductive surgery. She was still disease-free 6 months after her second surgery. SUMMARY AND CONCLUSION Upfront aggressive surgical management with complete cytoreductive surgery is recommended when patients present with disease recurrence and peritoneal dissemination of ovarian immature teratoma. Such cases should be managed in centers with local expertise in the treatment of peritoneal surface malignancies.
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Affiliation(s)
- Alexandre Brind'Amour
- Surgical Oncology Division, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
| | - Lara De Guerke
- Gynecologic Oncology Division, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Suzanne Fortin
- Gynecologic Oncology Division, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Mai-Kim Gervais
- Surgical Oncology Division, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Pierre Dubé
- Surgical Oncology Division, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Lucas Sidéris
- Surgical Oncology Division, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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18
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Pravong V, Brind'Amour A, Sidéris L, Dubé P, Tremblay JF. A rare case of recurrent epidermoid anal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy-case report. World J Surg Oncol 2020; 18:152. [PMID: 32622361 PMCID: PMC7335445 DOI: 10.1186/s12957-020-01935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background Anal cancer is a rare cancer with chemoradiation being the mainstay of treatment for locoregional presentation. In North America, the most common subtype is anal squamous cell carcinoma (epidermoid). A surgical approach is considered for persistent or recurrent anal disease and systemic chemotherapy for metastatic disease. We are presenting a unique case of recurrent anal cancer with isolated peritoneal malignancy, an oligometastatic state which is rare in itself. It was treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. There are currently no clear guidelines for the aforementioned presentation. The discussion drew on the feasibility and safety of this approach. Case presentation A 68-year-old woman diagnosed with an epidermoid anal cancer (stage 3B) was initially treated with chemoradiation therapy (Standard Nigro Protocol) in 2014. At the 5-year mark post-treatment, she was diagnosed with a recurrent anal epidermoid cancer in the form of isolated peritoneal carcinomatosis proven by biopsy. After declining systemic chemotherapy, she underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with Mitomycin-C©. Peritoneal carcinomatosis index was evaluated at 10, and intraoperative frozen sections were positive for carcinoma of epidermoid origin compatible with anal cancer. A completeness of cytoreduction score of 0 was achieved during the cytoreductive surgery, and her hospital course was unremarkable. She remains disease-free 12 months later. Conclusions To our knowledge, this is the first case reporting the disease presentation of anal cancer with oligometastatic dissemination to the peritoneum. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were performed. Thus far, this approach seems to be a safe and feasible option for short-term control of the disease.
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Affiliation(s)
- Vera Pravong
- Department of General Surgery, University of Montreal, Montreal, Quebec, Canada.,The Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Alexandre Brind'Amour
- The Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada.,Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Lucas Sidéris
- The Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada.,Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Pierre Dubé
- The Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada.,Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jean-François Tremblay
- The Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada. .,Division of Colorectal Surgery, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
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19
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Petursdottir A, Gunnarsson O, Valsdottir EB. [Outcome of Icelandic patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) abroad]. LAEKNABLADID 2020; 106:344-8. [PMID: 32608356 DOI: 10.17992/lbl.2020.0708.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Peritoneal carcinomatosis is a known complication of colorectal cancer and has long been considered very difficult to manage. The survival has been reported to be under two years after systemic chemotherapy with or without palliative surgery. The most recent method of treatment is compiled of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and has been suggested to significantly increase survival. The aim of this study was to research the cases of Icelandic patients undergoing this treatment overseas and the impact it has had on their disease. METHODS A retrospective study of all Icelandic patients who have undergone CRS-HIPEC treatment abroad 2008-2017. Information was retrieved from medical records and from registry of the Icelandic Health Insurance committee of medical treatments abroad. RESULTS A total of 11 patients have undergone CRS-HIPEC treatment after having received their initial treatment in Landspitali University Hospital. All of the surgeries were performed in the United States by the same surgeon in the years 2008-2017. The group consists of 10 women and 1 man with a mean age of 53 years. The cause of peritoneal carcinomatosis was appendiceal cancer for 7 patients (67%) and colon cancer for 3 patients (27%). One patient had a primary malignancy of the peritoneum, mesothelioma. Three patients suffered complications within 30 days of surgery, 2 had infection and 1 had an anastomotic leak. Another patient had a late complication of bowel stenosis and later a fistula. Five patients have completed their five year observation period post surgery without diagnosis of recurrence and mean follow-up time was 44 months. Out of 11 patients, 10 are still alive. Five have been diagnosed with recurrence of disease. CONCLUSION Icelandic patients who have undergone CRS-HIPEC treatment have in most cases done well and survival is comparable to other studies. Half of the survivors did not have recurrence of disease within 5 years of surgery. Prognosis has improved since the introduction of this treatment and every reason to keep sending selected Icelandic patients abroad to receive it.
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20
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Segura-Sampedro JJ, Morales-Soriano R, Arjona-Sánchez Á, Cascales-Campos P. Secondary surgical cytoreduction needs to be assessed taking into account surgical technique, completeness of cytoreduction, and extent of disease. World J Surg Oncol 2020; 18:92. [PMID: 32393274 PMCID: PMC7216587 DOI: 10.1186/s12957-020-01853-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Recent evidence suggested that secondary surgical cytoreduction followed by chemotherapy does not result in longer overall survival in patients with platinum-sensitive recurrent ovarian cancer. This statement is based on a phase III multicenter, randomized clinical trial that lacks a description of the surgical protocol, the surgical technique, and the surgical variables. In a study that evaluates surgical cytoreduction, it is mandatory to assess the grade of cytoreductive surgery achieved (Sugarbaker PH, Langenbeck’s Arch Surg 384:576–87, 1999), the extent of disease using PCI (Peritoneal Cancer Index), the technique itself, and the existence of a multidisciplinary approach with extensive upper abdominal procedures in experienced centers (Ren et al, BMC Cancer 15:1-12, 2015). There is evidence proving that the quality of cytoreduction (Al Rawahi et al, Cochrane Database Syst Rev 2013, 2013), the measurement of the amount of disease by PCI (Elzarkaa et al, J Gynecol Oncol 29, 2018), and a multidisciplinary approach with supramesocolic procedures (Ren et al, BMC Cancer 15:1-12, 2015) impact overall survival. This study fails to compare chemotherapy with secondary cytoreductive surgery since, due to the lack of variables, we can assess neither the performed surgery nor its criteria. This study should not be taken into account to recommend chemotherapy alone over a surgical approach in this group of patients.
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Affiliation(s)
- Juan José Segura-Sampedro
- Department of General and Digestive Surgery, Son Espases University Hospital, Spain, 07010 Palma de Mallorca, Spain. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain. School of Medicine, University of the Balearic Islands (UIB), Palma de Mallorca, Spain.
| | - Rafael Morales-Soriano
- Department of General and Digestive Surgery, Son Espases University Hospital, Spain, 07010 Palma de Mallorca, Spain. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Álvaro Arjona-Sánchez
- General & Digestive Surgery Department, University Hospital Reina Sofía, School of Medicine, University of Córdoba, Córdoba, Spain
| | - Pedro Cascales-Campos
- General & Digestive Surgery Department, University Hospital Virgen de la Arrixaca, School of Medicine, University of Murcia, Murcia, Spain
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21
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Allen CJ, Blumenthaler AN, Das P, Minsky BD, Blum M, Roy-Chowdhuri S, Ajani JA, Ikoma N, Mansfield PF, Badgwell BD. Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma. World J Surg Oncol 2020; 18:39. [PMID: 32066454 PMCID: PMC7026970 DOI: 10.1186/s12957-020-01813-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/06/2020] [Indexed: 12/22/2022] Open
Abstract
Background Staging laparoscopy and peritoneal cytology can detect occult metastatic disease prior to treatment of gastric cancer. The yield of peritoneal staging in patients with early stage disease is lacking. We assess the yield of peritoneal staging in early stage gastric cancer and its impact on survival. Methods Data were obtained from a prospective database of patients who underwent staging laparoscopy and peritoneal cytology for gastric cancer at our institution between July 1995 and July 2018. Clinical stage was determined by endoscopic ultrasound, and early stage was defined as cT1-2 and cN0. Rates of positive cytology and carcinomatosis at time of laparoscopy were obtained. Univariate analyses were used to compare groups, and Kaplan-Meier survival analyses were used to assess survival outcomes. Results Eight hundred sixty-seven patients underwent staging laparoscopy and peritoneal cytology; 56 were defined as early stage. Age was 61 ± 12 years, 66.4% were male, and 62.3% were white. Of the patients with early stage disease, 17.9% had either gross carcinomatosis (10.7%) and/or positive peritoneal cytology (10.9%). All cases of peritoneal disease were in patients with cT2 disease. There were no differences in age, gender, or race based on peritoneal disease (all p > 0.05). The presence of carcinomatosis or positive cytology significantly affected overall survival (p < 0.001), regardless of clinical T or N stage. Conclusions Peritoneal staging identifies metastatic disease in a significant number of patients with early stage disease. Given its poor prognosis and alternate therapy options, independent staging laparoscopy and peritoneal cytology should be considered in patients with early stage gastric adenocarcinoma.
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Affiliation(s)
- Casey J Allen
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA
| | - Alisa N Blumenthaler
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mariela Blum
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA
| | - Paul F Mansfield
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA.
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22
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Ploug M, Graversen M, Pfeiffer P, Mortensen MB. Bidirectional treatment of peritoneal metastasis with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) and systemic chemotherapy: a systematic review. BMC Cancer 2020; 20:105. [PMID: 32041558 PMCID: PMC7011374 DOI: 10.1186/s12885-020-6572-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/23/2020] [Indexed: 02/08/2023] Open
Abstract
Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is used in the palliative treatment of peritoneal metastasis. The combination of intraperitoneal and systemic chemotherapy seems rational, and the aim of this systematic review was to compare PIPAC directed monotherapy with a bidirectional treatment approach (PIPAC in combination with systemic chemotherapy). Main outcomes were survival and quality of life. Methods A systematic literature search in Medline, Embase, Cochrane and the “Pleura and Peritoneum” was conducted and analyzed according to PRISMA guidelines. Studies in English reporting on bidirectional treatment with PIPAC and systemic chemotherapy and published before April 2019 were included. Results Twelve studies with a total of 386 patients were included. None were specifically designed to compare mono- versus bidirectional treatment, but 44% of the patients received bidirectional treatment. This was more frequent in women (non-gynecological cancers) and one-third of the bidirectional treated patients had received no prior chemotherapy. Data from the included studies provided no conclusions regarding survival or quality of life. Conclusion Bidirectional treatment with PIPAC and systemic chemotherapy is practised and feasible, and some patients are enrolled having received no prior systemic chemotherapy for their PM. The difficulty in drawing any conclusions based on this systematic review has highlighted the urgent need to improve and standardize reports on PIPAC directed therapy. We have, therefore, constructed a list of items to be considered when reporting on clinical PIPAC research. Trial registration International Prospective Register of Systematic Reviews, PROSPERO. Registration number: 90352, March 5, 2018.
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Affiliation(s)
- Magnus Ploug
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B.Winsløvs Vej 4, 5000, Odense C, Denmark.
| | - Martin Graversen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B.Winsløvs Vej 4, 5000, Odense C, Denmark
| | - Per Pfeiffer
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B.Winsløvs Vej 4, 5000, Odense C, Denmark
| | - Michael Bau Mortensen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Upper GI and HPB Section, Department of Surgery, Odense University Hospital, J.B.Winsløvs Vej 4, 5000, Odense C, Denmark
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23
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Izquierdo F, Sherman SK, Schuitevoerder D, Turaga KK. Modern Surgical Techniques in Cytoreductive Surgery. J Gastrointest Surg 2020; 24:454-459. [PMID: 31197686 DOI: 10.1007/s11605-019-04243-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/22/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Francisco Izquierdo
- Department of Surgery, University of Chicago, 5837 S. Maryland Ave, MC 9034, Chicago, IL, 60637, USA
| | - Scott K Sherman
- Department of Surgery, University of Chicago, 5837 S. Maryland Ave, MC 9034, Chicago, IL, 60637, USA
| | - Darryl Schuitevoerder
- Department of Surgery, University of Chicago, 5837 S. Maryland Ave, MC 9034, Chicago, IL, 60637, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, 5837 S. Maryland Ave, MC 9034, Chicago, IL, 60637, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fotopoulou C, Berg T, Hausen A, Hennig R, Jalan R, Malagó M, Capel J, De Gottardi A, Stirnimann G. Continuous low flow ascites drainage through the urinary bladder via the Alfapump system in palliative patients with malignant ascites. BMC Palliat Care 2019; 18:109. [PMID: 31805921 PMCID: PMC6896754 DOI: 10.1186/s12904-019-0497-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant Ascites (MA) is a therapeutic dilemma significantly impairing patients' quality of life (QoL). The Sequana Medical alfapump System (AP), a subcutaneous, externally rechargeable, implantable device, continually draining ascites via the urinary bladder, has been well established in liver cirrhosis, but not yet in MA. The AP-system was evaluated in cancer patients in reducing the need for large volume paracentesis (LVP). METHODS A retrospective multicentre evaluation of all eligible patients who received an AP for MA-palliation was performed. AP was evaluated for its ability to reduce LVP and cross-correlated with adverse events (AE), survival and retrospective physician-reported QoL. RESULTS Seventeen patients with median age of 63 years (range: 18-81), 70.6% female, across 7 primary tumour types were analysed. Median duration of AP-implantation was 60 min (range: 30-270) and median post-implantation hospital stay: 4 days (range: 2-24). Twelve protocol-defined AE occurred in 5 patients (29.4%): 4 kidney failures, 4 pump/catheter-related blockages, 3 infections/peritonitis and 1 wound dehiscence. Median ascitic volume (AV) pumped daily was 303.6 ml/day (range:5.6-989.3) and median total AV drained was 28 L (range: 1-638.6). Median patient post-AP-survival was 111 days (range:10-715) and median pump survival was 89 days (range: 0-715). Median number of paracenteses was 4 (range: 1-15) per patient pre-implant versus 1 (range: 0-1) post-implant (p = 0.005). 71% of patients were reported to have an improvement of at least one physician reported QoL-parameters. CONCLUSIONS AP appears to be effective in palliating patients with MA by an acceptable morbidity profile. Its broader implementation in oncology services should be further explored. TRIAL REGISTRATION NCT03200106; June 27, 2017.
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Affiliation(s)
- Christina Fotopoulou
- Imperial College London, Department of Surgery and Cancer, Gynecologic Oncology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK. .,Present address: Krankenhaus Freudenstadt, Karl-von-Hahn-Straße 120, 72250, Freudenstadt, Germany.
| | - Thomas Berg
- Sektion Hepatologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Annekristin Hausen
- Medizinische Klinik und Poliklinik I - Innere Medizin und Gastroenterologie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - René Hennig
- Allgemein- und Viszeralchirurgie, Klinikum Stuttgart - Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Germany
| | - Rajiv Jalan
- Royal Free Hospital, Institute for Liver and Digestive Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Massimo Malagó
- Royal Free Hospital, Institute for Liver and Digestive Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Jeroen Capel
- Sequana Medical, Technoparkstrasse 1, 8005, Zürich, Switzerland
| | - Andrea De Gottardi
- University Clinic for Visceral Surgery and Medicine, University Hospital Inselspital and University of Bern, Bauchzentrum Bern, 3010, Bern, Switzerland
| | - Guido Stirnimann
- University Clinic for Visceral Surgery and Medicine, University Hospital Inselspital and University of Bern, Bauchzentrum Bern, 3010, Bern, Switzerland
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Kim S, Kang SI, Kim S, Jang MH, Kim JH. Abdominopelvic Actinomycosis Mimicking Peritoneal Carcinomatosis: A Case Report. Ann Coloproctol 2019; 36:417-420. [PMID: 32054258 PMCID: PMC7837399 DOI: 10.3393/ac.2019.11.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022] Open
Abstract
Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.
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Affiliation(s)
- Sungjin Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sohyun Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Min Hye Jang
- Department of Pathology, Yeungnam University Medical Center, Daegu, Korea
| | - Jae Hwang Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
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Linnehan B, Snyman H, DeLay J, Mareschal A, Jackson C, Dennison S, Haulena M. URINARY BLADDER TRANSITIONAL CELL CARCINOMA AND CARCINOMATOSIS IN A LINNAEUS'S TWO-TOED SLOTH, CHOLOEPUS DIDACTYLUS. J Zoo Wildl Med 2019; 50:278-81. [PMID: 31120692 DOI: 10.1638/2018-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 19-yr-old female Linnaeus's two-toed sloth (Choloepus didactylus) with a history of urinary incontinence, ascites, and behavioral changes was euthanized after diagnostic imaging revealed a large bladder mass. On gross necropsy, the sloth had a severely thickened bladder mucosa, partial urinary obstruction, and nonseptic exudate in the peritoneal cavity. Histopathology showed a malignant and highly invasive transitional cell (urothelial) carcinoma with transmural and intra-abdominal invasion and diffuse carcinomatosis. Immunohistochemistry for expression of pancytokeratin (AE1/AE3), cytokeratin 7 (CK7), cytokeratin 20 (CK20), and uroplakin III was performed to confirm the diagnosis of transitional cell carcinoma. Neoplastic cells had a strong cytoplasmic immunoreactivity with the antipancytokeratin antibody clone AE1/AE3, which was consistent with a neoplasm of epithelial origin. Neoplastic cells were negative for expression of CK20. This is the first detailed report describing the antemortem diagnosis of urinary bladder transitional cell carcinoma with carcinomatosis in a two-toed sloth.
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Abboud K, André T, Brunel M, Ducreux M, Eveno C, Glehen O, Goéré D, Gornet JM, Lefevre JH, Mariani P, Pinto A, Quenet F, Sgarbura O, Ychou M, Pocard M. Management of colorectal peritoneal metastases: Expert opinion. J Visc Surg 2019; 156:377-379. [PMID: 31466831 DOI: 10.1016/j.jviscsurg.2019.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
When peritoneal metastases are diagnosed (strong agreement of experts): (i) seek advice from a multidisciplinary coordination meeting (MCM) with large experience in peritoneal disease (e.g. BIG RENAPE network); (ii) transfer (or not) the patient to a referral center with experience in hyperthermic intraperitoneal chemotherapy (HIPEC), according to the advice of the MCM. With regard to systemic chemotherapy (strong agreement of experts): (i) it should be performed both before and after surgery, (ii) for no longer than 6 months; (iii) without postoperative anti-angiogenetic drugs. With regard to cytoreductive surgery (strong agreement of experts): (i) Radical surgery requires a xiphopubic midline incision; (ii) no cytoreductive surgery via laparoscopy. With regard to HIPEC: HIPEC can be proposed for trials outside an HIPEC referral center (weak agreement between experts): (i) if surgery is radical; (ii) if the expected morbidity is "reasonable"; (iii) if the indication for HIPEC was suggested by a MCM, and; (iv) mitomycin is preferred to oxaliplatin (which cannot be recommended) for this indication.
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Affiliation(s)
- K Abboud
- Service de chirurgie générale et thoracique, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - T André
- Service d'oncologie médicale, Sorbonne université, hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75571 Paris, France
| | - M Brunel
- Service de chirurgie digestive, hôpital Mignot, 177, rue de Versailles, 78157 Le Chesnay, France
| | - M Ducreux
- Département d'oncologie médicale, Gustave-Roussy cancer campus, université Paris-Saclay, 94800 Villejuif, France
| | - C Eveno
- Équipe «Mucines, différenciation épithéliale, et cancérogenèse», unité mixte de recherche 1172-JPARC, Inserm, département de chirurgie digestive et oncologique, centre de recherche Jean-Pierre Aubert, centre hospitalier universitaire (CHU) de Lille, CHU Claude-Huriez, université de Lille, 59000 Lille, France
| | - O Glehen
- Département de chirurgie oncologique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France; EMR 3738, Lyon 1 université, 69000 Lyon, France
| | - D Goéré
- Service de chirurgie générale et oncologique, hôpital Saint-Louis, assistance publique, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - J-M Gornet
- Département de gastroentérologie, hôpital Saint-Louis, assistance publique, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - J H Lefevre
- Département de chirurgie digestive, Sorbonne université, hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - P Mariani
- Département de chirurgie oncologique, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - A Pinto
- Unité Inserm U1275 CAP Paris-Tech, carcinose péritoine Paris technologiques, université de Paris, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - F Quenet
- Département de chirurgie oncologique, institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France; Université de Montpellier, 34000 Montpellier, France
| | - O Sgarbura
- Département de chirurgie oncologique, institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France; Université de Montpellier, 34000 Montpellier, France
| | - M Ychou
- Université de Montpellier, 34000 Montpellier, France; Département d'oncologie digestive, institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France
| | - M Pocard
- Unité Inserm U1275 CAP Paris-Tech, carcinose péritoine Paris technologiques, université de Paris, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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Picard L, Bourgin C, Penault-Llorca F, Beguinot M, Cornou C, Le Bouedec G, Mouret-Reynier MA, Selle F, Pomel C. [HIPEC in ovarian cancer: What should we expect?]. Bull Cancer 2019; 106:1023-1028. [PMID: 31126679 DOI: 10.1016/j.bulcan.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 12/01/2022]
Abstract
The results of PRODIGE 7 study demonstrate that the use of HIPEC is not beneficial for patients in the treatment of colorectal carcinomatosis. Nevertheless, a recent study published in NewEnglandJournalofMedicine showed that hyperthermic intraperitoneal chemotherapy (HIPEC) increased overall survival for patients with ovarian peritoneal carcinomatosis. Although, the emergence of targeted therapies (anti-angiogenic agents, PARP-inhibitors, anti-PDL1) results in new standards of treatment in first line or recurrence disease. In this general context, what is the potential interest of HIPEC for the treatment of ovarian carcinoma?
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Affiliation(s)
- Léonie Picard
- Centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - Charlotte Bourgin
- Institut de cancérologie de l'Ouest, 15, rue André-Boquel, 49055 Angers, France
| | | | - Marie Beguinot
- Centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - Caroline Cornou
- Centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | | | | | - Frédéric Selle
- Hôpital des diaconesses, 12-18, rue du Sergent-Bauchat, 75012 Paris, France
| | - Christophe Pomel
- Centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
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Carroll RD, Leigh EC, Curtis Z, Thorpe A, Ballengee J, Pacioles T. A Case of Leptomeningeal Carcinomatosis from Aggressive Metastatic Prostate Cancer. Case Rep Oncol 2019; 12:311-316. [PMID: 31123457 PMCID: PMC6514516 DOI: 10.1159/000499761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 12/03/2022] Open
Abstract
Leptomeningeal carcinomatosis (LC) is a rare leptomeningeal spread of diffusely metastatic tumors. It occurs more commonly with hematologic tumors, less commonly with solid tumors, and is exceedingly rare in prostate cancer. Due to its scarcity, it has traditionally been difficult to diagnose LC but advancement of MRI has helped considerably. However, even with technological improvements, pre-mortem diagnosis of LC remains difficult and controversial. Our case is a 71-year-old male with prostate cancer with bone metastases who presented to our facility with altered mental status (AMS), lower extremity weakness, and worsening diarrhea. The diarrhea was responsive to antibiotic therapy, but his AMS did not resolve. A head CT without contrast was negative but follow-up brain MRI revealed leptomeningeal enhancement highly suggestive of LC. Cerebrospinal fluid (CSF) cytology results were negative and other CSF studies were inconclusive. Although further studies were planned, the patient continued to deteriorate, and the family elected to withdraw care. He passed away without beginning treatment for the LC. Despite advances in cancer therapies, LC remains difficult to diagnose and treat. Imaging may be suggestive of the condition but the confirmatory tests such as repeated CSF cytology or meningeal biopsy are not only invasive but also usually occur postmortem. Additional methods of CSF testing have been studied to evaluate their role in accurately diagnosing LC but low specificity for LC has somewhat limited their use. Although treatment options are mainly palliative in nature, prompt recognition and early treatment could grant valuable time for patients and families.
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Affiliation(s)
- Ryan David Carroll
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - E Cindy Leigh
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Zachary Curtis
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Anthony Thorpe
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Jason Ballengee
- Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA
| | - Toni Pacioles
- Department of Oncology, Marshall University, Huntington, West Virginia, USA
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Floch F, Boissy L, Lanore D, Sayag D, Serres F. Evaluation of intracavitary carboplatin chemotherapy for treatment of pleural carcinomatosis in cats: a retrospective study of eight cases. J Feline Med Surg 2019; 22:84-90. [PMID: 30720396 DOI: 10.1177/1098612x19826401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the benefit of intracavitary carboplatin chemotherapy in cats with malignant pleural effusion of epithelial origin. METHODS The medical records of cats with a cytological diagnosis of neoplastic pleural effusion of epithelial origin were reviewed at three referral institutions between January 2013 and June 2018. Only cats treated with intracavitary carboplatin chemotherapy were enrolled. Data collection included signalment, medical history, clinical signs, pleural effusion analysis, diagnostic imaging findings, intracavitary carboplatin chemotherapy protocol, adverse events, response to chemotherapy, outcome and underlying primary tumour, if possible. RESULTS Eight cats met the inclusion criteria. Three cats had previous surgical removal of a tumour, including a poorly differentiated primary lung carcinoma, a uterine adenocarcinoma and a benign mammary tumour. The main clinical signs were tachypnoea and/or dyspnoea, inappetence and weight loss. Thoracic radiographs revealed marked bilateral pleural effusion in all cats. Pleural fluid analysis was consistent with a modified transudate, with malignant epithelial cells on cytology, leading to a diagnosis of pleural carcinomatosis. All cats received only one cycle of intracavitary carboplatin chemotherapy at a dose of 200-240 mg/m2. Recurrence of pleural effusion was reported in 7/8 cats within 4-15 days of chemotherapy, and death was recorded in all cats within 5-16 days, owing to recurrent pleural effusion or poor general condition. The primary cancer was suspected to be of pulmonary, mammary and pancreatic origin in four cats, two cats and one cat, respectively, and of unknown origin in the remaining cat. CONCLUSIONS AND RELEVANCE In this study, intracavitary carboplatin chemotherapy seems ineffective in managing neoplastic pleural effusion of epithelial origin in cats with pleural carcinomatosis. Other cytotoxic drugs and/or techniques should be investigated in the future to improve the quality of life and survival of cats with pleural carcinomatosis.
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Affiliation(s)
- Franck Floch
- ONCOVET, Veterinary Clinic of Referrals, Villeneuve d'Ascq, France
| | - Laurie Boissy
- ONCOVET, Veterinary Clinic of Referrals, Villeneuve d'Ascq, France
| | | | - David Sayag
- Oncology Service - ADVETIA Veterinary Hospital Centre, Vélizy-Villacoublay, France
| | - François Serres
- ONCOVET, Veterinary Clinic of Referrals, Villeneuve d'Ascq, France
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Park JH, Yang JY, Park YH, Lee WK. The long-term prognostic difference between gastrectomy with and without preoperative chemotherapy in patients with clinical stage IV gastric cancer. Asian J Surg 2019; 42:922-9. [PMID: 30685146 DOI: 10.1016/j.asjsur.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND/OBJECTIVE The role of gastrectomy for stage IV gastric cancer (GC) has not yet been established. Thus, we aimed to compare the prognoses of patients with clinical stage IV GC who underwent gastrectomy with and without preoperative chemotherapy after precise recategorization of patients. METHODS We retrospectively reviewed a total of 92 clinical stage IV GC patients who underwent gastrectomy with or without preoperative chemotherapy between 2010 and 2016 at a single institution. Yoshida's classification was used to categorize the patients into the following categories: 1, technically resectable metastasis; 2, marginally resectable metastasis; 3, unresectable peritoneal dissemination; and 4, incurable peritoneal dissemination with distant organ metastasis. Two-year disease-specific survival (DSS) rates were compared between patients who underwent primary surgery and preoperative chemotherapy for each category. RESULTS The two-year DSS rates of primary surgery vs. preoperative chemotherapy in Categories 1, 2, 3, and 4 (n = 35, 39, 14, and 4, respectively) were 48.6% vs. 41.7% (p = 0.829), 52.6% vs. 40.0% (p = 0.855), 50.0% vs. 75.0% (p = 0.027), and 0% vs. 66.7% (p = 0.083), respectively. Patients in Categories 1 and 2 who underwent preoperative chemotherapy tended to have lower two-year DSS rates (p = 0.911), whereas patients in Categories 3 and 4 had significantly higher two-year DSS rates than those who underwent primary surgery (p = 0.014). CONCLUSIONS Primary surgery may be performed in patients without peritoneal dissemination when GC is technically resectable. However, if peritoneal dissemination is suspected, chemotherapy should be prioritized.
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Abstract
Despite advances in the management of peritoneal carcinomatosis, morbidity remains high with survival often measured in weeks to months. Patients are often subjected to symptoms and complications that impact quality of life. Much of the management revolves around palliation of symptoms and providing support and resources to address emotional and existential concerns. This article reviews surgical and nonsurgical palliative treatments for the symptoms and complications associated with advanced, incurable peritoneal carcinomatosis. It is important that providers caring for patients with peritoneal carcinomatosis be knowledgeable in the palliative management of this condition, including the usefulness of early palliative care referral.
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Affiliation(s)
- Laura A Lambert
- Surgical Oncology, Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Ryan J Hendrix
- Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue N., Worcester, MA 01608, USA
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Abstract
The presence of a peritoneal barrier results in a pharmacokinetic advantage associated with intraperitoneal (IP) delivery of anticancer drugs. The anticancer efficacy of IP chemotherapy depends, however, on its ability to penetrate the tumor stroma. Tumor tissue transport is governed by diffusion and convection and is affected by numerous physical, biological, and pharmaceutical variables. From preclinical and clinical studies, it appears that tissue penetration after IP chemotherapy delivery is very limited. Several approaches are studied in order to improve tissue penetration of small molecular and macromolecular anticancer drugs after IP instillation.
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Affiliation(s)
- Nick Lagast
- Department of Surgery, Ghent University, Cancer Research Institute Ghent (CRIG), Ghent B-9000, Belgium
| | - Charlotte Carlier
- Department of Surgery, Ghent University, Cancer Research Institute Ghent (CRIG), Ghent B-9000, Belgium
| | - Wim P Ceelen
- Department of Surgery, Ghent University, Cancer Research Institute Ghent (CRIG), Ghent B-9000, Belgium.
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Cloyd JM, Abdel-Misih S, Hays J, Dillhoff ME, Pawlik TM, Schmidt C. Impact of Synchronous Liver Resection on the Perioperative Outcomes of Patients Undergoing CRS-HIPEC. J Gastrointest Surg 2018; 22:1576-84. [PMID: 29713875 DOI: 10.1007/s11605-018-3784-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/12/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND While liver resection (LR) and cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) are commonly performed for hepatic and peritoneal metastases, respectively, the safety of synchronous LR and CRS-HIPEC has not been established. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) databases from 2005 to 2016 were used to identify patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative outcomes were compared among patients who underwent CRS-HIPEC with and without synchronous LR. RESULTS Among 1168 patients who underwent CRS-HIPEC, 100 (8.6%) underwent synchronous LR and 1068 (91.4%) did not. The most common primary diagnosis was unspecified (65.3%) followed by appendix (16.0%) and colorectal (12.5%). Among patients who underwent CRS-HIPEC plus LR, the majority had a partial hepatectomy (96.0%), while a small subset underwent trisegmentectomy (2.0%) or hemihepatectomy (2.0%). Patients who underwent CRS-HIPEC plus LR underwent a greater number of operative procedures (8.3 ± 2.5 vs 6.7 ± 2.5, p < 0.001), had a longer operative time (520.7 ± 155.3 vs 454.6 ± 160.7 min, p = 0.001), had a longer hospital length of stay (16.7 ± 15.6 vs 11.1 ± 11.5 days, p < 0.001), were more likely to require reoperation (13.0 vs 6.9%, p = 0.03), and experienced greater 30-day morbidity (47.0 vs 27.4%, p < 0.001), but not mortality (3.0 vs 1.4%, p = 0.22). On multivariate logistic regression, LR was strongly associated with increased risk of postoperative morbidity even after controlling for potential confounders (OR 1.65, 95% CI 1.03-2.64). CONCLUSIONS Simultaneous LR and CRS-HIPEC was associated with increased operative time, length of hospital stay, reoperation, and postoperative morbidity compared to CRS-HIPEC alone. For patients with synchronous hepatic and peritoneal metastases, a staged operative approach should be considered.
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Guerrero W, Munene G, Dickson PV, Stiles ZE, Mays J, Davidoff AM, Glazer ES, Shibata D, Deneve JL. Outcome and factors associated with aborted cytoreduction for peritoneal carcinomatosis. J Gastrointest Oncol 2018; 9:664-673. [PMID: 30151262 DOI: 10.21037/jgo.2018.04.05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) offers a potential cure for peritoneal carcinomatosis (PC), whereas aborted cytoreduction is associated with a poor outcome. We evaluate factors associated with aborted CRS procedures. Methods An IRB approved retrospective review was performed from 12/2011 to 2/2016. Clinicopathologic variables and outcomes are described. Results Seventy-four patients underwent attempted CRS/HIPEC which was completed in 51 (69%) and aborted in 23 (31%). There was no difference in age, race, gender or prior treatment between groups. Patients who underwent aborted procedures had a higher peritoneal cancer index (PCI, 26.1±9.9 vs. 16.2±10.5, P=0.001). Overall survival (OS) was significantly improved for patients who underwent completed CRS/HIPEC (41.0±10.4 vs. 6.0±2.3 months, P<0.0001). Patients with an appendiceal and colorectal primary who underwent CRS/HIPEC had a significantly better outcome (median not reached vs. 6±5.4 months, P<0.0001, and 28.0±7.5 vs. 8.0±4.0 months, P<0.0001, respectively). Colorectal pathology (P=0.014) and PCI score (<0.0001) were independent predictors of aborted CRS procedures. Conclusions One-third of patients with PC had significant disease which prevented successful completion of CRS/HIPEC. PCI and colorectal primary tumor pathology were associated with a greater likelihood of aborted CRS procedures.
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Affiliation(s)
- Whitney Guerrero
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gitonga Munene
- Western Michigan University, Homer Stryker School of Medicine, West Michigan Cancer Center, Kalamazoo, MI, USA
| | - Paxton V Dickson
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Zachary E Stiles
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Johnathan Mays
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Molfino S, Ballarini Z, Gheza F, Portolani N, Baiocchi GL. Is there a role for treatment-oriented surgery in stage IV gastric cancer? A systematic review. Updates Surg 2018; 71:21-27. [PMID: 30039281 DOI: 10.1007/s13304-018-0571-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/30/2018] [Indexed: 12/19/2022]
Abstract
To analyze the available evidence on the role of treatment-oriented surgery in stage IV gastric cancer (metastatic disease), a systematic literature search was undertaken using Medline, Embase, Cochrane, and Web-of-Science libraries. The search was not restricted to articles published within a given year range. Articles written in English language (or with abstracts written in English) were considered. All references in the chosen articles were further screened to find additional relevant publications. Both clinical series and literature reviews were included. Stage IV gastric cancer is classified into four subcategories: positive peritoneal cytology without clear macroscopic peritoneal involvement (surgery is usually performed in these cases); gross appearance peritoneal carcinomatosis [surgery, eventually with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) may be considered in very selected cases with limited PCI]; nodal metastases outside the loco-regional nodes (surgery may not be denied for metastatic nodes in stations 13 and 16); and hematogenous metastases (surgery should be performed in selected cases with liver metastases suitable to R0 resection). The analysis incorporated the new biological classification of stage IV gastric cancer recently proposed by Japanese researchers (Yoshida et al. in Gastric Cancer 19:329-338. https://doi.org/10.1007/s10120-015-0575-z , 2015) into the four aforementioned subcategories to make the comparison of the issues discussed meaningful. The take home message from the existing literature is that treatment-oriented surgery may be performed in a significant proportion of patients with stage IV gastric cancer.
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Affiliation(s)
- Sarah Molfino
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Zeno Ballarini
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy. .,Chirurgia Generale 3, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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Abstract
We present a patient diagnosed with skin sarcoidosis, breast cancer, pulmonary tuberculosis, and peritoneal sarcoidosis with a past history of colorectal cancer. During stage work up for breast cancer, suspicious lesions on peritoneum were observed in imaging studies. Considering our patient’s history and imaging findings, we initially suspected peritoneal carcinomatosis. However, the peritoneal lesion was diagnosed as sarcoidosis in laparoscopic biopsy. This case demonstrates that abdominal sarcoidosis might be considered as a differential diagnosis when there is a lesion suspected of being peritoneal carcinomatosis with nontypical clinical presentations.
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Affiliation(s)
- Won Seok Roh
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seungho Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Park
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Guerrero WL, Munene G, Dickson PV, Darby D, Davidoff AM, Martin MG, Glazer ES, Shibata D, Deneve JL. Early experience with cytoreduction and hyperthermic intraperitoneal chemotherapy at a newly developed center for peritoneal malignancy. J Gastrointest Oncol 2018; 9:338-347. [PMID: 29755773 DOI: 10.21037/jgo.2018.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has improved outcomes for patients with peritoneal carcinomatosis (PC). We present our experience from a newly developed peritoneal surface malignancy program. Methods An IRB approved retrospective review was performed for the first 50 patients treated with CRS/HIPEC with clinicopathologic data described. Results Patients treated with CRS/HIPEC were Caucasian (64%), female (66%) with a median age of 53 years (range, 11-73 years). Primary pathology included: appendix (40%, n=20), ovary (20%, n=10), colon (14%, n=7), desmoplastic small round cell tumor (14%, n=7) or other (12%, n=6). The median peritoneal cancer index (PCI) score was 15.5 (range, 1-39) and 92% underwent complete cytoreduction (CCR 0/1). Median hospital length of stay was 9.0 days (range, 6-35 days). Eight patients (16%) suffered major morbidity with 2 (4%) 30-day mortalities. Conclusions Short-term outcomes observed after CRS/HIPEC in a newly developed center for PC are consistent with published higher volume center experiences.
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Affiliation(s)
- Whitney L Guerrero
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gitonga Munene
- Western Michigan University, Homer Stryker School of Medicine, West Michigan Cancer Center, Kalamazoo, MI, USA
| | - Paxton V Dickson
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dina Darby
- University of Tennessee Medical Practice, Surgical Oncology, Methodist Healthcare, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Pediatric Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Evan S Glazer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Goussous N, Maqsood H, Patel K, Ferdosi H, Muhammad N, Sill AM, Kowdley GC, Cunningham SC. Clues to predict incidental gallbladder cancer. Hepatobiliary Pancreat Dis Int 2018; 17:149-154. [PMID: 29709218 DOI: 10.1016/j.hbpd.2018.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Consequences of incidental gallbladder cancer (iGBC) following cholecystectomy may include repeat operation (depending on T stage) and worse survival (if bile spillage occurred), both avoidable if iGBC were suspected preoperatively. METHODS A retrospective single-institution review was done. Ultrasound images for cases and controls were blindly reviewed by a radiologist. Chi-square and Student's t tests, as well as logistic regression and Kaplan-Meier analyses were used. A P ≤ 0.01 was considered significant. RESULTS Among 5796 cholecystectomies performed 2000-2013, 26 (0.45%) were iGBC cases. These patients were older (75.61 versus 52.27 years), had more laparoscopic-to-open conversions (23.1% versus 3.9%), underwent more imaging tests, had larger common bile duct diameter (7.13 versus 5.04 mm) and higher alkaline phosphatase. Ultrasound imaging showed that gallbladder wall thickening (GBWT) without pericholecystic fluid (PCCF), but not focal-versus-diffuse GBWT, was associated significantly with iGBC (73.9% versus 47.4%). On multivariable logistic regression analysis, GBWT without PCCF, and age were the strongest predictors of iGBC. The consequences iGBC depended significantly on intraoperative bile spillage, with nearly all such patients developing carcinomatosis and significantly worse survival. CONCLUSIONS Besides age, GBWT, dilated common bile duct, and elevated alkaline phosphatase, number of preoperative imaging modalities and the presence of GBWT without PCCF are useful predictors of iGBC. Bile spillage causes poor survival in patients with iGBC.
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Affiliation(s)
- Naeem Goussous
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Hadia Maqsood
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Kalpesh Patel
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Hamid Ferdosi
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Naseem Muhammad
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Anne M Sill
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Gopal C Kowdley
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Steven C Cunningham
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA.
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Alberghina N, Sánchez-Montes C, Tuñón C, Maurel J, Araujo IK, Ferrer J, Sendino O, Córdova H, Vaquero EC, González-Suárez B, Martínez-Palli G, Ginès À, Fernández-Esparrach G. Endoscopic ultrasonography can avoid unnecessary laparotomies in patients with pancreatic adenocarcinoma and undetected peritoneal carcinomatosis. Pancreatology 2017; 17:858-864. [PMID: 28844696 DOI: 10.1016/j.pan.2017.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/01/2017] [Accepted: 08/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE To assess the relationship between the presence of ascites detected by endoscopic ultrasonography (EUS) and peritoneal carcinomatosis (PC) in patients with pancreatic adenocarcinoma. METHODS Consecutive patients who underwent a EUS for preoperative staging of a pancreatic adenocarcinoma between 1998 and 2014 were retrospectively reviewed. The diagnosis of PC was confirmed by histopathology or peritoneal fluid cytology. The main outcome of the study was the relationship of ascites at EUS and PC in patients with pancreatic cancer. Secondarily, to evaluate the relationship between this finding and survival as well as the development of PC during follow-up. RESULTS A total of 136 patients were included: 30 patients with local unresectable tumor or metastatic disease and 106 potentially-resectable candidates based on CT staging. EUS showed ascites in 27 (20%) patients, of whom 8 (29.6%) had PC. The sensitivity, specificity, PPV, NPV and accuracy of ascites by EUS in the detection of PC in this group of patients were 67%, 85%, 30%, 96% and 83%, respectively. Ascites detected by EUS was the only independent predictive factor of PC with an OR of 11 (CI 95%: 3-40). The detection of ascites by EUS was associated with a shorter survival (median survival time 7,3 months; range 0-60 vs 14.2 months; range 0-140) (p = 0.018) and earlier development of PC during follow-up (median 3.2 months, range 1.4-18.1 vs 12.7 months, range 5.4-54.8; p = 0.003). CONCLUSION The finding of ascites at EUS in patients with pancreatic adenocarcinoma is highly associated with PC and a poor outcome.
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Affiliation(s)
- Nadia Alberghina
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Cristina Sánchez-Montes
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Carlos Tuñón
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Joan Maurel
- Oncology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Isis K Araujo
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Joana Ferrer
- Surgical Department, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Oriol Sendino
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Henry Córdova
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Eva C Vaquero
- Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Begoña González-Suárez
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Graciela Martínez-Palli
- Anesthesiology Department, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Àngels Ginès
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Glòria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, Spain.
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Maciver AH, Lee N, Skitzki JJ, Boland PM, Francescutti V. Cytoreduction and hyperthermic intraperitoneal chemotherapy (CS/HIPEC) in colorectal cancer: Evidence-based review of patient selection and treatment algorithms. European Journal of Surgical Oncology (EJSO) 2017; 43:1028-1039. [PMID: 28029523 DOI: 10.1016/j.ejso.2016.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/29/2016] [Accepted: 09/13/2016] [Indexed: 02/06/2023]
Abstract
Cytoreduction and heated intraperitoneal chemotherapy (CS/HIPEC) is increasingly utilized as a treatment strategy for patients with peritoneal metastases from various primary tumor sites. For this heterogenous procedure, related to patient characteristics, patient selection, and the extent of surgical completeness of cytoreduction, high level evidence (ex: multiple randomized controlled trials) is not available to support efficacy. This review of the available literature supporting application of the procedure, focusing on colorectal cancer, provides a summary of current evidence for patient selection and treatment algorithms based on patient presentation.
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Affiliation(s)
- A H Maciver
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - N Lee
- Department of Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - J J Skitzki
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - P M Boland
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - V Francescutti
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
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Gallicchio R, Nardelli A, Venetucci A, Capacchione D, Pelagalli A, Sirignano C, Mainenti P, Pedicini P, Guglielmi G, Storto G. F-18 FDG PET/CT metabolic tumor volume predicts overall survival in patients with disseminated epithelial ovarian cancer. Eur J Radiol 2017; 93:107-113. [PMID: 28668403 DOI: 10.1016/j.ejrad.2017.05.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We evaluated the prognostic impact of quantitative assessment by maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG) on [F-18] FDG PET/CT for patients with peritoneal carcinomatosis from epithelial ovarian cancer (EOC). METHODS Thirty-one patients with EOC underwent PET/CT for an early restaging after cytoreductive surgery, having been diagnosed with carcinomatosis (before chemotherapy). The SUVmax, MTV (cm3; 42% threshold) and TLG (g) were registered on residual peritoneal lesions. The patients were followed up 20±12months thereafter. The PET/CT results were compared to overall survival (OS). RESULTS The Kaplan-Meier survival analysis for the SUVmax did not reveal significant differences in OS (p=0.48). The MTV survival analysis showed a significant higher OS in patients presenting with a higher tumour burden than those with less tumour burden (p=0.01; 26 vs. 14 months), whereas TLG exhibited a similar trend though not significant (p=0.06). Apart from chemo-resistance, the higher the MTV, the better will be the response to chemotherapy. CONCLUSIONS Quantitative assessment by MTV rather than by SUVmax and TLG on PET/CT may be helpful for stratifying patients who present with peritoneal carcinomatosis from EOC, in order to implement the appropriate therapeutic regimen.
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Affiliation(s)
- Rosj Gallicchio
- Medicina Nucleare, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy
| | - Anna Nardelli
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche (CNR), Naples, Italy
| | - Angela Venetucci
- Medicina Nucleare, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy
| | - Daniela Capacchione
- Medicina Nucleare, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy
| | - Alessandra Pelagalli
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche (CNR), Naples, Italy
| | - Cesare Sirignano
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche (CNR), Naples, Italy
| | - Pierpaolo Mainenti
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche (CNR), Naples, Italy
| | - Piernicola Pedicini
- Medicina Nucleare, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy
| | | | - Giovanni Storto
- Medicina Nucleare, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy.
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Graversen M, Detlefsen S, Bjerregaard JK, Pfeiffer P, Mortensen MB. Peritoneal metastasis from pancreatic cancer treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC). Clin Exp Metastasis. 2017;34:309-314. [PMID: 28516306 DOI: 10.1007/s10585-017-9849-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/08/2017] [Indexed: 12/14/2022]
Abstract
Patients with peritoneal metastasis (PM) from pancreatic cancer have a short life expectancy. Systemic combination chemotherapy leads to a median overall survival of 7-8 months. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a treatment alternative, where studies in patients with PM from ovarian, gastric and colorectal cancer show a high safety profile and interesting results. This case study report data on the PIPAC treatment in patients with PM from pancreatic cancer. In a standard laparoscopy, chemotherapeutics (cisplatin and doxorubicin) are nebulized within the peritoneal cavity. After 30 min, the chemotherapeutics are evacuated through a closed system. The PIPAC procedure is repeated every 4-6 weeks. Five patients with PM from pancreatic cancer were treated with a total of 16 PIPAC procedures. All patients received >1 PIPAC and were eligible for evaluation of histological regression. Four patients demonstrated histological regression, and one patient had stable disease. Three patients are still alive, and the median overall survival is 14 months (range 10-20) since the diagnosis of PM. The histological regression and survival figures in this pilot study suggest activity of PIPAC with low-dose cisplatin and doxorubicin in pretreated peritoneal metastasis of pancreatic origin. This should now be evaluated in prospective studies.
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Kapoor S, Bassily-Marcus A, Alba Yunen R, Tabrizian P, Semoin S, Blankush J, Labow D, Oropello J, Manasia A, Kohli-Seth R. Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. World J Crit Care Med 2017; 6:116-123. [PMID: 28529913 PMCID: PMC5415851 DOI: 10.5492/wjccm.v6.i2.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/14/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
METHODS Our study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied. Fifty-one patients came to the ICU postoperatively out of 170 who underwent CRS and HIPEC therapy during the study period. Data analysis was performed using descriptive statistics.
RESULTS Of the 170 patients who underwent CRS and HIPEC therapy, 51 (30%) came to the ICU postoperatively. Mean ICU length of stay was 4 d (range 1-60 d) and mean APACHE II score was 15 (range 7-23). Thirty-one/fifty-one (62%) patients developed postoperative complications. Aggressive intraoperative and postoperative fluid resuscitation is required in most patients. Hypovolemia was seen in all patients and median amount of fluids required in the first 48 h was 6 L (range 1-14 L). Thirteen patients (25%) developed postoperative hypotension with seven requiring vasopressor support. The major cause of sepsis was intraabdominal, with 8 (15%) developing anastomotic leaks and 5 (10%) developing intraabdominal abscess. The median survival was 14 mo with 30 d mortality of 4% (2/51) and 90 d mortality of 16% (8/51). One year survival was 56.4% (28/51). Preoperative medical co morbidities, extent of surgical debulking, intraoperative blood losses, amount of intra op blood products required and total operative time are the factors to be considered while deciding ICU vs non ICU admission.
CONCLUSION Overall, ICU outcomes of this study population are excellent. Triage of these patients should consider preoperative and intraoperative factors. Intensivists should be vigilant to aggressive postop fluid resuscitation, pain control and early detection and management of surgical complications.
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Abstract
PURPOSE We analyzed radiologic and histologic characteristics, and prognosis of abdominal seeding from renal cell carcinoma (RCC). METHODS Consecutive 25 patients with RCC and histologically or radiologically diagnosed abdominal seeding were analyzed. No patient had another type of malignancy. Histologic subtype, Fuhrman grade, sarcomatoid differentiation, and T-stage of primary tumors were assessed. Pre- or postoperative presentation of seeding was investigated. Median survival time and RCC-specific survival rates were evaluated. RESULTS Of 25 patients, 15 (60%) died and 4 (16%) were hopelessly discharged (median follow-up time, 6 months; range 1-62 months). Histologic subtypes were clear cell (76%, 19/25), papillary (16%, 4/25), chromophobe (4%, 1/25), and poorly differentiated (4%, 1/25). Fuhrman grades were 4 (48%, 12/25), 3 (36%, 9/25), 2 (12%, 3/25), and unknown (4%, 1/25). T-stage of the four patients with grade 2 or unknown was 3a. Sarcomatoid differentiation and postoperative occurrence were found in 32% (8/25) and 80% (20/25), respectively. Median survival time was 13 months, and 1-year, 2-year, and 3-year RCC-specific survival rates were 51%, 41%, and 31%, respectively. CONCLUSION Abdominal seeding may occur in various subtypes of RCC with high Fuhrman grade including sarcomatoid differentiation or high T-stage, and appears to be related to poor prognosis.
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Affiliation(s)
- Seung Hyun Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Young Taik Oh
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Dae Chul Jung
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Deuk Choi
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Jouvin I, Najah H, Pimpie C, Canet Jourdan C, Kaci R, Mirshahi M, Eveno C, Pocard M. Reduction of carcinomatosis risk using icodextrin as a carrier solution of intraperitoneal oxaliplatin chemotherapy. Eur J Surg Oncol 2017; 43:1088-1094. [PMID: 28089175 DOI: 10.1016/j.ejso.2016.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/29/2016] [Accepted: 12/08/2016] [Indexed: 01/14/2023] Open
Abstract
There is no standard treatment in patients with high risk metachronous peritoneal carcinomatosis (PC) in colonic cancer, as perforated tumour or synchronous ovarian metastasis. Icodextrin 4% (ICDX), presently used to prevent postoperative abdominal adhesions, could inhibit the coactivation of the tumour cells and the microenvironment cells, associated with the development of PC. The aim of this study was to inhibit the formation of the PC in a murine model mimicking surgical situation using ICDX and intraperitoneal (IP) prophylactic chemotherapy. We created a model of growing PC in mice using cells of murine colonic cancer CT26. Cells and treatments were injected simultaneously. Five groups were created: CT26 (control group), CT26 + ICDX (ICDX group), CT26 + chemotherapy (oxaliplatin and 5FU) (chemo group), CT26 + chemotherapy + ICDX (ICDX chemo group), ICDX (toxicity group). At day 15, PC was evaluated with rodents PCI. In the chemo group, PCI was significantly lower than in the control group (3.2 versus 8.4, p = 0.02). ICDX had a synergetic effect on PC with chemotherapy; indeed PCI in ICDX chemo group was lower than in chemo group (1.4 versus 3.2, p = 0.04). There was no morbidity linked to ICDX in toxicity group. Safety of ICDX needs to be verified, particularly on colonic anastomosis before ICDX associated to IP chemotherapy could be used as a preventive treatment of PC in high risk patients. This prophylactic treatment is easy to use and would be administrated at the end of a curative surgery for a colonic cancer.
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Affiliation(s)
- I Jouvin
- Department of Oncologic & Digestive Surgery, Hospital Lariboisière - AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, Carcinomatosis Angiogenesis Translational Research, INSERM U965, F-74575 Paris, France
| | - H Najah
- Department of Oncologic & Digestive Surgery, Hospital Lariboisière - AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, Carcinomatosis Angiogenesis Translational Research, INSERM U965, F-74575 Paris, France
| | - C Pimpie
- Université Paris Diderot, Sorbonne Paris Cité, CART, Carcinomatosis Angiogenesis Translational Research, INSERM U965, F-74575 Paris, France
| | - C Canet Jourdan
- Université Paris Diderot, Sorbonne Paris Cité, CART, Carcinomatosis Angiogenesis Translational Research, INSERM U965, F-74575 Paris, France
| | - R Kaci
- Department of Anatomopathology, Hôpital Lariboisière - AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France
| | - M Mirshahi
- Université Paris Diderot, Sorbonne Paris Cité, CART, Carcinomatosis Angiogenesis Translational Research, INSERM U965, F-74575 Paris, France
| | - C Eveno
- Department of Oncologic & Digestive Surgery, Hospital Lariboisière - AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, Carcinomatosis Angiogenesis Translational Research, INSERM U965, F-74575 Paris, France
| | - M Pocard
- Department of Oncologic & Digestive Surgery, Hospital Lariboisière - AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, Carcinomatosis Angiogenesis Translational Research, INSERM U965, F-74575 Paris, France.
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Kamaleshwaran KK, Joseph J, Kalarikal RK, Shinto AS. Image Findings of Rare Case of Peritoneal Carcinomatosis from Non Small Cell Lung Cancer and Response to Erlotinib in F-18 FDG Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2017; 32:140-142. [PMID: 28533646 PMCID: PMC5439196 DOI: 10.4103/0972-3919.202239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is currently one of the most common malignancies in the world. Metastatic disease is observed in ~ 40% of patients with lung cancer, with the most common sites of metastasis being the bone, liver, brain and adrenal glands. Peritoneal carcinomatosis (PC) is defined as the progression of the primary cancer to the peritoneum. PC is a rare clinical event in lung cancer. Tyrosine kinase inhibitors targeting the epidermal growth factor receptor (EGFR), such as erlotinib are used for the treatment of patients with advanced non-small cell lung cancer (NSCLC). F-18 FDG PET/CT has proven capable of predicting response to therapy with erlotinib. We present a rare F-18 FDG PET/CT image findings of a 45 year old male with NSCLC with PC treated with erlotinib showing response to the treatment.
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Affiliation(s)
| | - Jephy Joseph
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
| | - Radha Krishnan Kalarikal
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
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James KM, Bogue CO, Murphy AJ, Navarro OM. Peritoneal Malignancy in Children: A Pictorial Review. Can Assoc Radiol J 2016; 67:402-408. [PMID: 27523447 DOI: 10.1016/j.carj.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/23/2016] [Indexed: 12/15/2022] Open
Abstract
Peritoneal malignancies are a rare occurrence in children, often metastatic and rarely originating primarily in the peritoneum. The imaging findings of these entities in the pediatric age have not been recently reviewed or they have been previously described or depicted mostly as part of articles discussing each entity separately. This is a review of the most relevant peritoneal malignancies in childhood emphasizing imaging features. Knowledge of these appearances may facilitate diagnosis and staging of these neoplasms.
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Affiliation(s)
- Karl M James
- Radiology Department, Cork University Hospital, Bishopstown Road, Cork, Ireland
| | - Conor O Bogue
- Radiology Department, Cork University Hospital, Bishopstown Road, Cork, Ireland; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Amanda J Murphy
- Department of Pathology, Southern General Hospital, Glasgow, Scotland
| | - Oscar M Navarro
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
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50
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Weinberger V, Fischerova D, Semeradova I, Slama J, Dundr P, Dusek L, Cibula D, Zikan M. Prospective Evaluation of Ultrasound Accuracy in the Detection of Pelvic Carcinomatosis in Patients with Ovarian Cancer. Ultrasound Med Biol 2016; 42:2196-2202. [PMID: 27365257 DOI: 10.1016/j.ultrasmedbio.2016.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/06/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
We analyzed the accuracy of transvaginal sonography in detection of pelvic carcinomatosis in ovarian cancer patients and factors (age, body mass index, performance status, ascites, stage, histotype, tumor grade) influencing the performance of ultrasound. In this prospective study, all 191 consecutively included patients underwent a pre-operative ultrasound staging examination according to institutional protocol. Peritoneal spread was assessed on the basis of peri-operative findings or histology. The area under the receiver operating characteristic curve for the detection of carcinomatosis was 0.90 (0.84-0.93); the sensitivity was 84% (95% confidence interval [CI]: 75%-%90), specificity 96% (95% CI: 89%-99%), positive predictive value 96% (95% CI: 89%-99%), negative predictive value 83% (95% CI: 74%-90%) and overall accuracy 89% (95% CI: 84%-93%). We report that transvaginal sonography is clinically useful in the detection of pelvic carcinomatosis.
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Affiliation(s)
- Vit Weinberger
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniela Fischerova
- Gynecologic Oncology Center, Department of Gynecology and Obstetrics, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Ivana Semeradova
- Gynecologic Oncology Center, Department of Gynecology and Obstetrics, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Jiri Slama
- Gynecologic Oncology Center, Department of Gynecology and Obstetrics, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Pavel Dundr
- Department of Pathology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - David Cibula
- Gynecologic Oncology Center, Department of Gynecology and Obstetrics, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Michal Zikan
- Gynecologic Oncology Center, Department of Gynecology and Obstetrics, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic.
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