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Early Postoperative Intraperitoneal Chemotherapy

Martin Hübner, Hugo Teixeira Farinha, Fabian Grass, Anita Wolfer, Patrice Mathevet, Dieter Hahnloser, Nicolas Demartines
Background. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced as a novel repeatable treatment for peritoneal carcinomatosis. The available evidence from the pioneer center suggests good tolerance and high response rates, but independent confirmation is needed. A single-center cohort was analyzed one year after implementation for feasibility and safety. Methods. PIPAC was started in January 2015, and every patient was entered into a prospective database. This retrospective analysis included all consecutive patients operated until April 2016 with emphasis on surgical feasibility and early postoperative outcomes...
2017: Gastroenterology Research and Practice
Woo Ram Kim, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim
PURPOSE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed for controlling peritoneal seeding metastasis in some kinds of cancers, including those of colorectal origin, but their safety and oncological benefits are subjects of debate. We present our early experience with those procedures. METHODS: Data were retrospectively collected from all patients with peritoneal carcinomatosis (PC) and pseudomyxoma peritonei (PMP) treated using CRS and HIPEC at Yonsei Cancer Center between July 2014 and July 2015...
February 2017: Annals of Coloproctology
Yeqian Huang, Nayef A Alzahrani, Terence C Chua, David L Morris
BACKGROUND: It has been increasingly recognized that appendiceal mucinous neoplasm with peritoneal dissemination is not a homogenous disease. OBJECTIVE: This study aimed to examine the impact of different histological subtypes on survival of a large cohort of patients with appendiceal mucinous neoplasms uniformly treated by cytoreductive surgery and intraperitoneal chemotherapy. DESIGN: This was a retrospective study of prospectively collected data of patients with peritoneal dissemination of appendiceal neoplasm who underwent cytoreductive surgery and intraperitoneal chemotherapy...
April 2017: Diseases of the Colon and Rectum
Lee S Kyang, Nayef A Alzahrani, Jing Zhao, David L Morris
BACKGROUND: Incidence of gastric perforation following cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) is not widely reported. METHODS: Suitable patients were identified from our database of 1028 procedures. Relevant information was then gathered via medical records and operation reports for these patients. RESULTS: Six patients suffered early postoperative gastric perforation following the procedure (0.58%), all of whom received heated intraoperative intraperitoneal chemotherapy (HIPEC)...
February 10, 2017: World Journal of Surgical Oncology
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...
January 2017: Annals of Surgical Oncology
K Karadayi, C Yildiz, S Karakus, O Bozoklu Akkar, G Pakay Ugurlu, A Kurt, A Yanik
INTRODUCTION: The objective of this study was to assess the outcome of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) plus early postoperative intraperitoneal chemotherapy (EPIC) in patients with advanced gynecological malignancies. MATERIALS AND METHODS: A retrospective series of 51 patients with advanced gynecologic cancer, evaluated between May 2008 to February 2014. Peritoneal Cancer Index (PCI) and Completeness of Cytoreduction (CCR) score were used in the study group...
2016: European Journal of Gynaecological Oncology
N Ansari, K Chandrakumaran, S Dayal, F Mohamed, T D Cecil, B J Moran
PURPOSE: To report early and long term outcomes following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in 1000 patients with perforated appendiceal epithelial tumours, predominantly with pseudomyxoma peritonei (PMP). METHODS: Retrospective analysis of a prospective database of 1000 consecutive patients undergoing CRS and HIPEC for perforated appendiceal tumours between 1994 and 2014 in a UK National Peritoneal Malignancy unit...
July 2016: European Journal of Surgical Oncology
Aditi Bhatt, Sourabh Mittal, K S Gopinath
The combined modality treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained worldwide acceptance for management of selected patients with peritoneal metastases from various cancers. Cytoreductive surgery is performed with the goal of removing all macroscopic disease and is coupled with perioperative chemotherapy (POC) in the form of HIPEC with or without EPIC (early postoperative intraperitoneal chemotherapy) to deal with the microscopic residual disease. These treatments entail the use of cytotoxic drugs in the operation theatre or in the intensive care unit where they are not commonly used and put the healthcare workers participating in the treatment at risk of exposure...
June 2016: Indian Journal of Surgical Oncology
S J Valle, N A Alzahrani, W Liauw, P H Sugarbaker, A Bhatt, D L Morris
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combined have been recognized as standard of care for treatment of a subset of patients with peritoneal carcinomatosis (PC). The aim of CRS is to eliminate all macroscopic disease through a series of visceral resections followed by targeting any residual microscopic disease with intraperitoneal chemotherapy, exposing the peritoneal surfaces to a high concentration of chemotherapy with a lower systemic toxicity. Different regimes of intraperitoneal chemotherapy include HIPEC, early postoperative intraperitoneal chemotherapy (EPIC) and bidirectional chemotherapy...
June 2016: Indian Journal of Surgical Oncology
Soo Yeun Park, Gyu-Seog Choi, Jun Seok Park, Hye Jin Kim, Chun-Seok Yang, Jong Gwang Kim, Byung Woog Kang
BACKGROUND: Early postoperative intraperitoneal chemotherapy (EPIC) is a type of intraperitoneal chemotherapy for patients with colorectal cancer and peritoneal metastasis. However, there is a paucity of clinical studies evaluating the efficacy of EPIC after complete cytoreductive surgery. This study was designed to evaluate the efficacy of EPIC in patients who underwent complete surgical resection of peritoneal metastasis from colorectal cancer. METHODS: A 1:2 matched case-control study was conducted in patients undergoing complete surgical resection of peritoneal metastases from colorectal cancer at our institution between January 2000 and November 2013...
July 2016: Annals of Surgical Oncology
A Arjona-Sánchez, A Cadenas-Febres, J Cabrera-Bermon, F C Muñoz-Casares, A Casado-Adam, J M Sánchez-Hidalgo, M López-Andreu, J Briceño-Delgado, S Rufián-Peña
BACKGROUND: The acute renal dysfunction (ARD) is a common complication in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Our aim is evaluate the ARD post-HIPEC procedures using the RIFLE and AKIN criteria. Evaluate the risk factors and analyze ARD's impact on postoperative course. METHODS: From 2011 to 2014, in a retrospective way using a prospective database were operated by HIPEC procedure. The ARD was analyzed by RIFLE and AKIN criteria...
June 2016: European Journal of Surgical Oncology
Paul Sugarbaker, Chukwuemeka Ihemelandu, Lana Bijelic
BACKGROUND: A new and frequently utilized treatment option for symptomatic uterine leiomyoma is laparoscopic resection with morcellation so the specimen can be extracted through a small abdominal incision or through the vagina. Some of these tumors (approximately 0.2 %) have malignant foci of uterine leiomyosarcoma (ULMS) that is widely disseminated in the process of resection. These patients are in need of effective additional treatments. METHODS: Patients with ULMS were treated with a standardized cytoreductive surgery (CRS), hyperthermic perioperative chemotherapy (HIPEC), and early postoperative intraperitoneal chemotherapy (EPIC) specifically designed for sarcomatosis...
May 2016: Annals of Surgical Oncology
Anton Oseledchyk, Oliver Zivanovic
Ovarian cancer, because it is largely confined to the peritoneal cavity, has a unique tumor biology and metastatic spread pattern. Its metastatic potential comes from detached tumor cells in the peritoneal cavity that re-attach to the mesothelial lining of the peritoneal surface. It is proposed that these micrometastases without neovasculature, as well as floating malignant cells, are drivers of early recurrence, since they can be neither resected nor adequately treated by systemic chemotherapy. This represents the major rationale for local treatment by means of postoperative intraperitoneal (IP) chemotherapy, which is the standard of care in the United States in patients with advanced-stage ovarian cancer who have minimal residual disease following cytoreductive surgery...
September 2015: Oncology (Williston Park, NY)
C Hubert, C Dahrenmoller, L Marique, N Jabbour, P Gianello, I Leclercq
PURPOSE: Administering Oxaliplatin prior to resection of colorectal liver metastases often induces a Sinusoidal Obstruction Syndrome (SOS), which can affect postoperative patient outcome. Bevacizumab (Anti-VEGF-A) can decrease the severity of SOS and the associated risk of postoperative liver failure. We investigated the impact of both Oxaliplatin (Oxali) and Bevacizumab on liver regeneration in a rat model. MATERIAL AND METHODS: Male Wistar rats underwent a 70% partial hepatectomy (PH) 3 days after a 2 ml intraperitoneal injection of either saline (controls, n = 17), or Oxaliplatin 10, 20 or 50 mg/kg, 5-Fluorouracil 100 mg/kg (5-FU) and Bevacizumab 5 or 10 mg/kg in various combinations (total 98 rats, 11 groups, n = 5-18/group)...
November 2015: European Journal of Surgical Oncology
Terry P Nickerson, Aodhnait S Fahy, Juliane Bingener
INTRODUCTION: Hemangiopericytoma (HPC) is a rare mesenchymal tumor derived from capillary and postcapillary pericytes that often has an indolent course and occasionally presents with abdominal metastasis. PRESENTATION OF CASE: Twenty-three years after the initial resection of an intracranial HPC located in the right frontoparietal region and left lateral ventricle, a 63-year-old man experienced dull abdominal pain and early satiety and had a palpable epigastric mass...
2015: International Journal of Surgery Case Reports
Daniele Marrelli, Karol Polom, Giovanni de Manzoni, Paolo Morgagni, Gian Luca Baiocchi, Franco Roviello
The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (III and IV), for which additional treatments could provide a survival benefit...
July 14, 2015: World Journal of Gastroenterology: WJG
Geert A Simkens, Thijs R van Oudheusden, Hidde J Braam, Misha D Luyer, Marinus J Wiezer, Bert van Ramshorst, Simon W Nienhuijs, Ignace H de Hingh
BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as treatment for patients with colorectal peritoneal carcinomatosis (PC) is regarded as an extensive procedure. The risk of postoperative mortality after major abdominal surgery might be substantially higher than described by the 30-day mortality. This study aims to identify causes of 1-year mortality, thereby assessing a more accurate treatment-related mortality rate after CRS + HIPEC. METHODS: All subsequent patients with colorectal PC treated with CRS + HIPEC with complete macroscopic cytoreduction in two tertiary hospitals between April 2005 and April 2013 were included in this study...
January 2016: Annals of Surgical Oncology
Jennifer Y Lam, Yarrow J McConnell, Justin D Rivard, Walley J Temple, Lloyd A Mack
BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved survival for colorectal and high-grade appendiceal carcinomatosis. We compared the overall and recurrence-free survival (OS and RFS) of patients treated with HIPEC with mitomycin c and early postoperative intraperitoneal chemotherapy (EPIC) with fluorouracil versus HIPEC alone using oxaliplatin and simultaneous IV infusion of fluorouracil. METHODS: Ninety-three patients with colorectal or high-grade appendiceal carcinomatosis were treated with CRS and HIPEC + EPIC or HIPEC alone...
September 2015: American Journal of Surgery
Paul H Sugarbaker
Despite the fact that cytoreductive surgery (CRS) and hyperthermic perioperative chemotherapy (HIPEC) is conceptually simplistic, optimal implementation of this combined treatment remains complex. Multiple patient-related variables, methodologic variables, and pharmacologic variables need to be considered in devising an optimal treatment strategy. Working through these variables considering the pathophysiology of peritoneal metastases and their possible treatments is more likely to provide guidance in terms of successful management than multiple randomized controlled trials...
May 2015: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
Charlotte E L Klaver, Gijsbert D Musters, Willem A Bemelman, Cornelis J A Punt, Victor J Verwaal, Marcel G W Dijkgraaf, Arend G J Aalbers, Jarmila D W van der Bilt, Djamila Boerma, Andre J A Bremers, Jacobus W A Burger, Christianne J Buskens, Pauline Evers, Robert J van Ginkel, Wilhelmina M U van Grevenstein, Patrick H J Hemmer, Ignace H J T de Hingh, Laureen A Lammers, Barbara L van Leeuwen, Wilhelmus J H J Meijerink, Simon W Nienhuijs, Jolien Pon, Sandra A Radema, Bert van Ramshorst, Petur Snaebjornsson, Jurriaan B Tuynman, Elisabeth A Te Velde, Marinus J Wiezer, Johannes H W de Wilt, Pieter J Tanis
BACKGROUND: The peritoneum is the second most common site of recurrence in colorectal cancer. Early detection of peritoneal carcinomatosis (PC) by imaging is difficult. Patients eventually presenting with clinically apparent PC have a poor prognosis. Median survival is only about five months if untreated and the benefit of palliative systemic chemotherapy is limited. Only a quarter of patients are eligible for curative treatment, consisting of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CR/HIPEC)...
May 24, 2015: BMC Cancer
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