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Cytoreduction surgery

Paul H Sugarbaker
BACKGROUND: Mucinous appendiceal neoplasms (MAN) with peritoneal dissemination is treated as a standard of care using cytoreductive surgery and hyperthermic perioperative chemotherapy. The extent of the resection of peritoneal surfaces and visceral structures is generally well defined. Exception to this consensus regarding structures to be removed are the right colon and adjacent ileocolic lymph nodes. METHODS: From a prospectively maintained database, all patients with a histologic diagnosis of peritoneal mucinous carcinoma (PMCA) who underwent complete cytoreductive surgery were assessed for the presence versus absence of adenocarcinoma in lymph nodes within the appendiceal mesentery and/or in the lymph nodes of the ileocolic group...
October 21, 2016: Annals of Surgical Oncology
Min Hyeong Jo, Jung Wook Suh, Jeong Seok Yun, Hwan Namgung, Dong-Guk Park
PURPOSE: The purpose of this study was to examine 2-year follow-up results of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis (PC) of colorectal cancer. METHODS: We performed 54 cases of CRS and IPC in 53 patients with PC of colorectal cancer from December 2011 to December 2013. We collected data prospectively and analyzed the grade of PC, morbidity and mortality, and short-term follow-up (median, 10 months; range, 2-47 months) results...
October 2016: Annals of Surgical Treatment and Research
Takuya Toyonaga, Shigeru Yamaguchi, Kenji Hirata, Kentaro Kobayashi, Osamu Manabe, Shiro Watanabe, Shunsuke Terasaka, Hiroyuki Kobayashi, Naoya Hattori, Tohru Shiga, Yuji Kuge, Shinya Tanaka, Yoichi M Ito, Nagara Tamaki
PURPOSE: Metabolic activity and hypoxia are both important factors characterizing tumor aggressiveness. Here, we used F-18 fluoromisonidazole (FMISO) and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) to define metabolically active hypoxic volume, and investigate its clinical significance in relation to progression free survival (PFS) and overall survival (OS) in glioblastoma patients. EXPERIMENTAL DESIGN: Glioblastoma patients (n = 32) underwent FMISO PET, FDG PET, and magnetic resonance imaging (MRI) before surgical intervention...
October 18, 2016: European Journal of Nuclear Medicine and Molecular Imaging
Ming-Shyen Yen, Jen-Ruei Chen, Peng-Hui Wang, Kuo-Chang Wen, Yi-Jen Chen, Heung-Tat Ng
Uterine sarcoma is a very aggressive and highly lethal disease. Even after a comprehensive staging surgery or en block cytoreduction surgery followed by multimodality therapy (often chemotherapy and/or radiation therapy), many patients relapse or present with distant metastases, and finally die of diseases. The worst outcome of uterine sarcomas is partly because of their rarity, unknown etiology, and highly divergent genetic aberration. Uterine sarcomas are often classified into four distinct subtypes, including uterine leiomyosarcoma, low-grade uterine endometrial stromal sarcoma, high-grade uterine endometrial stromal sarcoma, and undifferentiated uterine sarcoma...
October 2016: Taiwanese Journal of Obstetrics & Gynecology
Hee Seung Kim, Robert E Bristow, Suk-Joon Chang
OBJECTIVE: The majority of advanced ovarian cancer patients have peritoneal carcinomatosis involving from the pelvis to upper abdomen, which is a major obstacle to optimal cytoreduction. Since total parietal peritonectomy was introduced for treating peritoneal carcinomatosis from colorectal cancer [3], similar surgical techniques including pelvic peritonectomy have been applied in advanced ovarian cancer with peritoneal carcinomatosis [1], and these can increase the rate of complete cytoreduction up to 60% [2]...
October 13, 2016: Gynecologic Oncology
Eleftheria Kalogera, Jamie N Bakkum-Gamez, Amy L Weaver, James P Moriarty, Bijan J Borah, Carrie L Langstraat, Christopher J Jankowski, Jenna K Lovely, William A Cliby, Sean C Dowdy
OBJECTIVE: To investigate opioid use and pain scores associated with incisional injection of liposomal bupivacaine compared with bupivacaine hydrochloride after laparotomy for gynecologic malignancies. METHODS: A retrospective cohort study was conducted to compare abdominal incision infiltration with liposomal bupivacaine with bupivacaine hydrochloride after modification of a pre-existing enhanced recovery pathway. Patients undergoing staging laparotomy or complex cytoreductive surgery under the updated pathway were compared with patients treated under the original pathway (historic controls)...
October 6, 2016: Obstetrics and Gynecology
Geert A Simkens, Vic J Verwaal, Valery E Lemmens, Harm J Rutten, Ignace H de Hingh
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an extensive procedure with considerable morbidity. Since only few hospitals perform CRS + HIPEC, this might lead to confounded outcomes between hospitals when audited. This study aims to compare outcomes between peritoneally metastasized (PM) colon cancer patients treated with CRS + HIPEC and patients undergoing conventional colon surgery. Furthermore, the impact of CRS + HIPEC on the risk of postoperative complications will be assessed, probably leading to better insight into how to report on postoperative outcomes in this distinct group of patients undergoing extensive colon surgery...
October 2016: Medicine (Baltimore)
Maya Koren-Michowitz, Noa Lavi, Martin H Ellis, Alessandro M Vannucchi, Ruben Mesa, Claire N Harrison
Extreme thrombocytosis (ExT) has been associated with an increased bleeding risk in myeloproliferative neoplasm (MPN) patients and is included in the high risk category in treatment guidelines. Treatment of patients with ExT has not been studied in prospective trials. To study physicians' approaches to ExT, we distributed a web based questionnaire with clinical case scenarios to 202 members of MPN working groups. Cases included low thrombotic risk essential thrombocythemia (ET) with either JAK2V617F or CALR mutation, polycythemia vera with ExT either with or without leukocytosis, an ET patient needing urgent orthopedic surgery, and a poorly controlled ET patient with acute cerebral venous sinus thrombosis...
October 13, 2016: Annals of Hematology
C Raspé, L Flöther, R Schneider, M Bucher, P Piso
Due to the significantly improved outcome and quality of life of patients with different tumor entities after cytoreductive surgery (CRS) and HIPEC, there is an increasing number of centers performing CRS and HIPEC procedures. As this procedure is technically challenging with potential high morbidity and mortality, respectively, institutional experience also in the anesthetic and intensive care departments is essential for optimal treatment and prevention of adverse events. Clinical pathways have to be developed to achieve also good results in more comorbid patients with border line indications and extensive surgical procedures...
September 28, 2016: European Journal of Surgical Oncology
Liz Edmund, Katherine L Rotker, Nelli S Lakis, Joseph M Brito, Marcos Lepe, Kara A Lombardo, Joseph F Renzulli, Andres Matoso
Prostate cancer management changed in recent times given the recommendation against PSA-screening, adherence to active surveillance, and "cytoreductive" surgery. We hypothesized that radical prostatectomy (RP) findings changed as well. All consecutive RPs (n=1348), and first time prostate needle biopsies (n=1719) in a period of 9 years were reviewed. The cohort was separated into 3 groups: 1) from 5/2006 to 4/2009; 2) from 5/2009 to 4/2012; 3) from 5/2012 to 4/2015.The number of RPs decreased 15% from 551 in group-1 to 476 in group-2 and decreased further 35% to 311 in group-3...
October 5, 2016: Human Pathology
Atul B Shinagare, Chong Hyun Suh, Kyung Won Kim, Bhanusupriya Somarouthu, Annick D Van den Abbeele, Nikhil H Ramaiya
PURPOSE: To create and validate an evidence-based prediction rule to optimize use of follow-up chest CT for ovarian cancer. METHODS: In this Institutional Review Board-approved retrospective study performed at two academic medical centers, electronic medical records from January through December 2013 at center 1 (USA) and January 2012 through December 2013 at center 2 (South Korea) were searched to identify consecutive chest CTs performed within 5 years of initial cytoreductive surgery in patients with pathologically proven ovarian cancer...
October 6, 2016: Journal of the American College of Radiology: JACR
Yeqian Huang, Nayef A Alzahrani, Winston Liauw, Thamer B Traiki, David L Morris
BACKGROUND: There is little evidence for the use of early postoperative intraperitoneal chemotherapy (EPIC) in patients with low-grade appendiceal mucinous neoplasms (LAMNs) with pseudomyxoma peritonei (PMP). This study aims to assess the outcomes regarding the use of EPIC in a large cohort of patients with LAMNs with PMP uniformly treated by cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC), all of whom received hyperthermic intraperitoneal chemotherapy (HIPEC), and most of whom also received EPIC...
October 7, 2016: Annals of Surgical Oncology
Paul H Sugarbaker
PURPOSE: Adrenal cortical carcinoma is a rare cancer that often presents in an advanced stage. Not only systemic metastases but also local recurrence and peritoneal metastases prevent long-term survival in these patients. METHODS: A profoundly symptomatic patient with extensive peritoneal metastases and local recurrence was treated using cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with melphalan as the chemotherapy agent. RESULTS: Relative sparing of the small bowel within the abdomen and pelvis allowed a visible complete resection of all cancer...
September 27, 2016: Tumori
Marco Lotti, Michela Giulii Capponi, Luca Campanati, Elia Poiasina, Luca Ansaloni, Eugenio Poletti, Luigi Frigerio
INTRODUCTION: Hyperthermic intraperitoneal chemotherapy (HIPEC) is delivered after cytoreductive surgery (CRS) in selected patients with peritoneal carcinomatosis. The closed-abdomen technique, preferred by many centers, prevents heat loss and drug spillage, but does not warrant homogeneous distribution of the perfusion fluid (PF). The hypothesized formation of intra-abdominal adhesions during the closed-abdomen perfusion period has never been described. MATERIALS AND METHODS: From March 2014 to April 2016, 10 consecutive patients with peritoneal carcinomatosis, selected for CRS, underwent the Laparoscopy-Enhanced HIPEC technique to explore the abdominal cavity during the perfusion...
October 5, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Wankyu Eo, Hong-Bae Kim, Yong Joo Lee, Dong Soo Suh, Ki Hyung Kim, Heungyeol Kim
OBJECTIVE: To determine whether the preoperative lymphocyte-monocyte ratio (LMR) is a predictor of suboptimal cytoreduction in advanced-stage epithelial ovarian cancer (EOC). METHODS: Preoperative clinico-pathologic and hematologic parameters were reviewed in a total of 154 patients with EOC submitted to primary cytoreductive surgery. Patients were categorized into two different groups according to the results of cytoreductive surgery: optimal and suboptimal cytoreduction...
2016: Journal of Cancer
Ahmed Al-Niaimi, Elizabeth L Dickson, Cassandra Albertin, Jennifer Karnowski, Cassandra Niemi, Ryan Spencer, Mian M K Shahzad, Shitanshu Uppal, Sandeep Saha, Laurel Rice, Amy Mc Nally
OBJECTIVE: To quantify the impact of perioperative β blocker use on survival after primary cytoreductive surgery for epithelial ovarian cancer. METHODS: We conducted a multi-center retrospective study of all women who underwent primary cytoreductive surgery for ovarian cancer (2000-2010). One institution had routinely used perioperative β blockers for patients "at risk" for coronary events. The other institution did not routinely use perioperative β blockers...
September 29, 2016: Gynecologic Oncology
Peter G Rose, James J Java, Mark A Morgan, Angeles Alvarez-Secord, Joshua P Kesterson, Frederick B Stehman, David P Warshal, William T Creasman, Parviz Hanjani, Robert T Morris, Larry J Copeland
PURPOSE: GOG 152 was a randomized trial of secondary cytoreductive surgery (SCS) in patients with suboptimal residual disease (residual tumor nodule >1cm in greatest diameter) following primary cytoreductive surgery for advanced stage ovarian cancer. The current analysis was undertaken to evaluate the impact of disease findings at SCS on progression-free survival (PFS) and overall survival (OS). METHODS: Among the 550 patients enrolled on GOG-152, two-hundred-sixteen patients were randomly assigned following 3cycles of cisplatin and paclitaxel to receive SCS...
September 27, 2016: Gynecologic Oncology
Nikolas Katelaris, Declan Murphy, Nathan Lawrentschuk, Athos Katelaris, Daniel Moon
BACKGROUND: Cytoreductive surgery for metastatic prostate cancer is an emerging area of interest with a potential upside that includes local control, delayed initiation of hormone therapy, and possibly improved cancer specific survival. In order for radical prostatectomy to be an effective treatment option for men in this group, the benefits must outweigh the surgical morbidity. The aim of this study was to present a case series and assess the literature feasibility of cytoreductive surgery for men with metastatic prostate cancer...
September 2016: Prostate International
Zachary Zihui Yong, Grace Hwei Ching Tan, Joelle Fui Sze Wong, Cindy Lim, Khee Chee Soo, Melissa Ching Ching Teo
BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are the treatment of choice for selected patients with peritoneal metastasis. Despite a stringent selection process, some patients were found to be unresectable only at surgery, which leads to disappointment and poor utilisation of limited infrastructural resources. This study aims to determine the pre-operative factors associated with unresectability in planned CRS and HIPEC. METHODS: Retrospective analysis of 172 consecutive patients eligible for CRS and HIPEC at the National Cancer Centre Singapore from April 2004 to May 2014 was performed...
December 2016: International Journal of Hyperthermia
Luigina Graziosi, Elisabetta Marino, Verena De Angelis, Alberto Rebonato, Annibale Donini
: Malignant ascites is an abnormal accumulation of fluid in the peritoneal cavity of patients with intraperitoneal cancer dissemination. This clinical condition could represent the terminal evolution of a lethal disease and could influence the prognosis, severely impairing the patients' quality of life. Treatment options include a multitude of different procedures with limited efficacy and some degree of risk; diuretics, paracentesis, peritoneo-venous shunts and intraperitoneal biologic agents like anti-VEGF molecules, metalloproteinase inhibitors and immunomodulators are included...
2016: Annali Italiani di Chirurgia
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