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1.
M. Bushati K.P. Rovers A. Sommariva P.H. Sugarbaker D.L. Morris Y. Yonemura C.A. Quadros S.P. Somashekhar W. Ceelen P. Dubé Y. Li V.J. Verwaal O. Glehen P. Piso J. Spiliotis M.C.C. Teo S. González-Moreno P.H. Cashin I.H.J.T. de Hingh 《European journal of surgical oncology》2018,44(12):1942-1948
Background
At present, selected patients with resectable colorectal peritoneal metastases (CRC-PM) are increasingly treated with a combination therapy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study was to investigate the current worldwide practice.Methods
HIPEC experts from 19 countries were invited through the Peritoneal Surface Oncology Group International (PSOGI) to complete an online survey concerning their personal expertise and current hospital and countrywide practice.Results
It is estimated that currently more than 3800 patients with CRC-PM (synchronous and metachronous) are annually treated with CRS and HIPEC in 430 centers. Integration of CRS and HIPEC in national guidelines varies, resulting in large treatment disparities between countries. Amongst the experts, there was general agreement on issues related to indication, surgical technique and follow up but less on systemic chemotherapy or proactive strategies.Conclusion
This international survey demonstrates that CRS and HIPEC is now performed on a large scale for CRC-PM patients. Variation in treatment may result in heterogeneity in surgical and oncological outcomes, emphasising the necessity to reach consensus on several issues of this comprehensive procedure. Future initiatives directed at achieving an international consensus statement are needed. 相似文献2.
Paul H. Sugarbaker 《European journal of surgical oncology》2018,44(6):805-809
Background
Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may be of greatest benefit if all visible evidence of disease is resected. In some male patients the peritoneal metastases within the pelvis are invasive into the seminal vesicles and complete cytoreduction requires resection of these structures.Patients and methods
From a prospective database of colorectal and appendiceal cancer patients who had CT evidence of seminal vesicle involvement and then had cytoreduction including resection of the seminal vesicles were reviewed. Their clinical features were tabulated.Results
Five patients were identified between ages 52 and 60. Three of 5 were appendiceal mucinous neoplasms and 4 of 5 had complete cytoreduction. Two of the patients are long-term survivors of 120 and 28 months. All patients are impotent and reported no return of sexual function over time. All five patients report normal micturition.Conclusions
Resection of the seminal vesicles in a patient with invasion of these structures by peritoneal metastases is possible and should be considered in selected patients. This resection causes impotence but normal urination is to be expected. 相似文献3.
Sanket Mehta Lilian Schwarz John Spiliotis Mao-Chih Hsieh Eduardo H. Akaishi Diane Goere Paul H. Sugarbaker Dario Baratti François Quenet David L. Bartlett Laurent Villeneuve Vahan Kepenekian 《European journal of surgical oncology》2018,44(11):1786-1792
Introduction
Peritoneal metastasis (PM) of hepatocellular carcinoma (HCC) without distant spread are rare. The related prognosis is poor without standard treatment available. The role of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is poorly documented.Methods
An international multicentric cohort was constituted by retrospective analysis of 21 patients undergoing CRS/HIPEC for PM of HCC between 1992 and 2016 from 10 reference centers of PSOGI. Data on clinical features, treatment strategies, and survival outcomes were analyzed.Results
The median time interval from the diagnosis of PM to the procedure was 4.5 months. The median peritoneal cancer index was 14. Sixteen patients had complete cytoreduction (CCR0-1). Ten patients had grades 3 to 4 complications. The median duration of follow-up was 52.2 months. The median OS was 46.7 months. The projected 3y-OS and 5y-OS were 88.9 and 49.4% respectively. The median OS for patients with CCR0-1 resection was not reached whereas it was 5.9 months for those with CCR2-3 resection after CRS (p = 0.0005). The median RFS was 26.3 months and projected RFS at 3 years of 36.5 months Three prognostic factors were associated with improved RFS in the univariate analysis: preoperative chemotherapy (p = 0.0156), PCI >15 (p = 0.009), Number of chemotherapy agents used for HIPEC (p = 0.005).Conclusion
CRS/HIPEC is a safe and effective approach in selected patients with PM of HCC. CRS/HIPEC gives the patient a chance for a good relapse free and overall survival and should be considered as an option. 相似文献4.
5.
Aditi Bhatt Suniti Mishra Robin Prabhu Veena Ramaswamy Antony George Sonal Bhandare Mita Shah Sanket Mehta 《European journal of surgical oncology》2018,44(7):1105-1111
Introduction
The pathological classification of PMP of appendiceal origin has prognostic and treatment implications. Our goals were to? Classify low grade mucinous carcinoma peritonei (LGMCP) into prognostically distinct subgroups based on histological features.? Compare the reproducibility of the WHO and the PSOGI classifications for both PMP and the appendiceal primary tumor.Patients and methods
A retrospective analysis of patients undergoing CRS and HIPEC or debulking surgery was done. All the tumors were re-classified according to the PSOGI classification. LGMCP was further classified into three histological subgroups and the impact on survival was evaluated.Results
From Jun 2011 to June 2016, 101 patients underwent CRS with HIPEC (n = 89) or debulking surgery (n=12). The median PCI was 28 (3–39) and 74.1% patients had CC-0/1 resections. Of the 76.2% patients who had LGMCP, 4 patients (5.1%) were classified as group 1, 54 (70.1%) as group 2 and 19 patients (24.6%) as group 3. At a median follow up of 21 months, the disease free survival was not reached, 30 months and 14 months for groups 1, 2 and 3 respectively (p = 0.09). There was no difference in overall survival. Using the WHO classification, there was a discordance in the grade of the primary tumor and the peritoneal lesions in 19.8% and conflicting terminology was used in 62% of patients.Conclusions
The subgroups of LGMCP described here are prognostically different though this needs further prospective evaluation in larger series. The PSOGI classification is more uniformly reproducible and should be preferred to the WHO classification. 相似文献6.
I. Amblard F. Mercier D.L. Bartlett S.A. Ahrendt K.W. Lee H.J. Zeh E.A. Levine D. Baratti M. Deraco P. Piso D.L. Morris B. Rau A.A.K. Tentes J.-J. Tuech F. Quenet E. Akaishi M. Pocard Y. Yonemura H.J. Zeh 《European journal of surgical oncology》2018,44(9):1378-1383
Background
Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy.Objective
To evaluate the impact on survival of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC.Material and methods
A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test.Results
Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the systemic chemotherapy group. In the surgical group, median peritoneal cancer index was 9 (range 3–26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the chemotherapy group (35% vs. 18%, p = 0.001). Median OS was 21.4 and 9.3 months for surgical and chemotherapy group, respectively (p=0.007). Three-year overall survival was 30% and 10% for surgical and chemotherapy group, respectively.Conclusion
Treatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy. 相似文献7.
K.H. Chang M. Kazanowski O. Staunton R.A. Cahill B.J. Moran C. Shields J. Mulsow 《European journal of surgical oncology》2017,43(2):395-400
Background
Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are considered standard of care for pseudomyxoma peritonei (PMP) and selected patients with colorectal peritoneal metastases (CPM) or peritoneal mesothelioma. A National Peritoneal Malignancy programme was established in Ireland (population of 4.5 million) in May 2013 with mentoring and support from the Peritoneal Malignancy Institute, Basingstoke UK. This study reviews the operative and oncological outcomes for the first 50 patients who underwent CRS and HIPEC in Ireland.Methods
This is a retrospective review of all patients referred, and of the subset who underwent CRS and HIPEC, for peritoneal malignancy in Ireland between May 2013 and November 2015.Results
During the study period, 130 patients were referred and 50 patients were selected for CRS and HIPEC. Three patients were found to have unresectable disease at laparotomy. Of the remaining 47 patients, eight had major tumour debulking. In total, 39 underwent complete cytoreduction and 45 received HIPEC. After a median follow-up of 12.7 months, 12 patients had developed further metastatic disease. The rates of complete cytoreduction, major complication (Clavien–Dindo III/IV) and operative mortality were 83%, 0% and 0%, respectively. 32% of patients experienced grade I/II complications.Conclusions
We report the successful establishment of a national peritoneal malignancy programme. Mentoring from an experienced centre may have shortened the known learning curve evident by our encouraging outcomes. The follow-up period is short, however our early results are comparable with internationally reported figures. 相似文献8.
Xin Li Jianping Zhou Ming Dong Lianhe Yang 《European journal of surgical oncology》2018,44(10):1640-1645
Background
Low-grade appendiceal mucinous neoplasms (LAMN) are poorly understood lesions characterized by their potential to spread to the peritoneal cavity as pseudomyxoma peritonei (PMP). The purpose of this study was to investigate the clinical and pathologic features and management of these tumors.Methods
This was a retrospective study of consecutive patients with LAMN who underwent surgery by a surgical team at the First Affiliated Hospital of China Medical University between 2005 and 2016. Subgroup analyses were performed for patients with PMP.Result
The study included 50 LAMN patients, 13 of them with PMP. There were no significant differences in age (p = 0.293) or gender (p = 0.196) at diagnosis between the two groups. There was no significant difference in their presentation (p = 0.700). Although 5 patients with PMP had perforation of the appendiceal mucinous, acute peritonitis was uncommon. Microscopic examination detected that PMP without any obvious perforation in tumors shown mucin and/or mucinous epithelium herniating into the appendiceal wall, or as islands within these tissues. The patients underwent appendectomy, caecectomy and right hemicolectomy according to the intraoperative situation. The median follow-up period was 53 months (range 11–146 months). None of the patients developed clinical progression in either group during the follow-up period.Conclusion
The age of LAMN at presentation was almost 60 years (56.7) and there was no clear gender predilection. When LAMN was treated surgically with resection of the primary site in early stage disease or with pushing invasion, there was an excellent prognosis and expanded surgical procedures were unnecessary. 相似文献9.
Cristina Rihuete Caro Israel Manzanedo Fernando Pereira Lucía Carrion-Alvarez Ángel Serrano Estíbalitz Pérez-Viejo 《European journal of surgical oncology》2018,44(11):1805-1810
Background
Gastric Cancer (GC) with Peritoneal Carcinomatosis (PC) has long been regarded as a terminal disease. Over the past two decades, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed the traditional concept of peritoneal metastases from being a systemic disease, to being considered a locoregional dissemination.Patients and methods
A prospective study was performed at a high-volume Carcinomatosis Center to evaluate survival, morbi-mortality and prognostic factors for survival in a cohort of patients with GC and PC treated with CRS + HIPEC between June 2006 and December 2016.Results
Thirty-five patients were included in the study. Median follow-up was 54 months. Postoperative major complications (>grade IIIa) occurred in 25.7% of patients, including 2 deaths (mortality 5.7%). The median overall survival (OS) was 16 months and the 1-, 3- and 5-year OS rates were 70.8%, 21.3% and 21.3% %, respectively. The median OS for patients with PCI ≤6 was 19 months, in contrast to 12 months for the 19 patients with PCI >6. Three patients were included with only a positive cytology and their median OS was not reached. Perineural invasion was the only factor that had a negative influence in prognosis (HR 18.8) in multivariate analysis.Conclusion
Although GC with PC still has a poor prognosis, survival has improved in selected patients with CRS + HIPEC and perioperative systemic chemotherapy. Patients with isolated positive cytology or peritoneal carcinomatosis with PCI less than 6 had encouraging survival rates. 相似文献10.
Gabriel Glockzin Florian Zeman Roland S. Croner Alfred Königsrainer Jörg Pelz Michael A. Ströhlein Beate Rau Dirk Arnold Michael Koller Hans J. Schlitt Pompiliu Piso 《Clinical colorectal cancer》2018,17(4):285-296
Background
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as parts of an interdisciplinary treatment concept including systemic chemotherapy can improve survival of selected patients with peritoneal metastatic colorectal cancer (pmCRC). Nevertheless, the sequence of the therapeutic options is still a matter of debate. Thus, the COMBATAC (COMBined Anticancer Treatment of Advanced Colorectal cancer) trial was conducted to evaluate a combined treatment regimen consisting of preoperative systemic polychemotherapy + cetuximab followed by CRS + HIPEC and postoperative systemic polychemotherapy + cetuximab.Patients and Methods
The COMBATAC trial is a prospective, multicenter, open-label, single-arm, single-stage phase 2 trial. Twenty-six patients with synchronous or metachronous colorectal or appendiceal peritoneal carcinomatosis were included. Enrollment was terminated prematurely by the sponsor because of slow recruitment. Progression-free survival as primary end point and overall survival were estimated by the Kaplan-Meier method. Also evaluated were morbidity according to Common Terminology Criteria for Adverse Events v4.0 and feasibility of the combined treatment concept.Results
Median progression-free survival for the intention-to-treat population (n = 25) was 14.9 months. Median overall survival was not reached during the study duration. Ninety-two adverse events were documented in 16 patients, including 14 serious adverse events in 9 patients. The overall morbidity rate was 64%, and the grade 3/4 morbidity rate was 44%. Of all grade 3/4 morbidity events, 36.4% were related to systemic chemotherapy and 22.7% to surgery, whereas 40.9% were not directly related. There was no treatment-related mortality.Conclusion
The results of the COMBATAC trial show that the multimodal treatment concept consisting of perioperative systemic chemotherapy and CRS + HIPEC is safe and feasible. Progression-free survival in selected patients with colorectal or appendiceal peritoneal metastasis might be improved. 相似文献11.
Jinning Ye Yufeng Ren Zhewei Wei Jianjun Peng Chuangqi Chen Wu Song Min Tan Yulong He Yujie Yuan 《Surgical oncology》2018,27(3):456-461
Background & purpose
Cytoreductive surgery (CRS) plus Hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective measure for peritoneal carcinomatosis. The cisplatin (CP) applied in HIPEC carries a risk of kidney injury. This study aims to investigate CP-induced nephrotoxicity post HIPEC and to explore its risk factors.Methods
From January 2012 to July 2013, 99 patients undergoing CRS + HIPEC were retrospectively reviewed. Patients were divided into CP and Non-CP HIPEC groups. The RIFLE classification was used to assess the severity of acute kidney injury (AKI). Renal and hepatic function, concentrations of tumor markers, and postoperative outcomes were compared between groups.Results
47 (47.5%) patients were in the CP HIPEC group, with 52 (52.5%) patients in the Non-CP HIPEC group. 11 (11.1%) patients developed AKI, with 10 of them from the CP HIPEC group. Two patients with CP-contained HIPEC developed acute renal failure. Plasma levels of both urea nitrogen and creatinine were significantly increased in the CP HIPEC group compared with the Non-CP HIPEC group (P?<?0.01). However, postoperative pain (scaled score, 4.2 vs. 3.8; P?=?0.279), length of hospital stay (18.1 vs. 20.2 days; P?=?0.285), hospital costs ($1 3182 vs. $12 640; P?=?0.465) and incidence of postoperative complication (25.5% vs. 17.3%; P?=?0.337) were similar in both groups, with comparable 3-year overall survival observed (38.6% vs. 31.8%, P?=?0.319). A multivariate analysis indicated that use of CP was an independent risk factor for AKI (P?=?0.017, 95% CI: 1.277–4.155).Conclusions
Application of CP during HIPEC is associated with an increased risk of nephrotoxicity, without promising long-term survival benefit. 相似文献12.
Armando Sardi Arkadii Sipok Dario Baratti Marcello Deraco Paul Sugarbaker George Salti Yutaka Yonemura Paolo Sammartino Olivier Glehen Naoual Bakrin Teresa P. Díaz-Montes Vadim Gushchin 《European journal of surgical oncology》2017,43(11):2170-2177
Objective
Uterine sarcoma (US) is a rare tumor representing 1% of female genital tract malignancies. Peritoneal sarcomatosis (PS) after US, diminishes median overall survival (OS) and progression-free survival (PFS) with cytoreductive surgery (CRS) alone, with or without systemic chemotherapy is <1 year and 6 months, respectively. A multi-institutional review of PS from US was conducted to evaluate CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) and effects on survival outcomes.Methods
A retrospective review of 36 patients from 7 specialized international centers was performed. Selection criteria included PS of uterine origin with CRS/HIPEC treatment. Clinical data were analyzed. OS and PFS were estimated with Kaplan-Meier method.Results
Thirty-six patients underwent a total 38 HIPEC procedures performed from 2005 to 2014; 35 previous treatment and 1 primary treatment. Twenty-nine (81%) LMS patients, 3 (8%) endometrial stromal sarcoma (ESS), 3 (8%) adeneosarcoma (AS), and 1 (3%) categorized as other. Median PCI was 16 (range: 2–39), 10 patients had PCI ≥20. Thirty-four patients (94%) had complete cytoreduction (CC 0–1), 19 patients recurred. CRS/HIPEC OS at 1, 3, and 5-years was 75%, 53%, and 32% respectively, with median OS of 37 months (CI 95%: 20–54). PFS in 32 patients with CC at 1, 3, and 5-years was 67%, 32% and 32%, respectively with median PFS of 18.9 months (CI 95%: 6.7–31).Conclusions
CRS/HIPEC is a promising treatment modality for patients with PS. Histological subtype may influence survival. A global prospective registry of patients to further assess the efficacy of CRS/HIPEC is needed. 相似文献13.
Malin Enblad Wilhelm Graf Helgi Birgisson 《European journal of surgical oncology》2018,44(7):997-1005
Background
Early diagnosis to target minimal volume disease has received increased attention in the management of appendiceal and colorectal peritoneal metastases (PM). This study aimed to identify risk factors for appendiceal, colon and rectal PM.Methods
Data were retrieved from the Swedish Colorectal Cancer Registry for all patients undergoing bowel resection of appendiceal and colorectal tumours, in Sweden, 2007–2015. Risk factors for synchronous and metachronous PM were analysed with multivariate logistic and Cox proportional hazard regression models.Results
Synchronous PM was most common in appendiceal cancer (23.5%), followed by colon (3.1%) and rectal (0.6%) cancer. The 5-year cumulative incidence was 9.0% for appendiceal, 2.5% for right colon, 1.8% for left colon and 1.2% for rectal cancer. In appendiceal cancer (n = 327), T4, N2, mucinous tumour, and non-radical surgery were associated with PM. In colon cancer (n = 24,399), synchronous PM were primarily associated with T4 (OR 18.37, 95% CI 8.12–41.53), T3 and N2 but also with N1, right-sided tumour, mucinous tumour, vascular and perineural invasion, female gender, age <60 and emergency surgery. These factors were also associated with metachronous PM. In rectal cancer (n = 10,394), T4 (OR 19.12, 95% CI 5.52–66.24), proximal tumour and mucinous tumour were associated with synchronous PM and T4 and mucinous tumour with metachronous PM.Conclusions
This study shows that appendiceal cancer, right-sided colon cancer, advanced tumour and node stages and mucinous histopathology are the main high-risk features for PM and should increase the awareness of current or future PM. 相似文献14.
D. Badrudin L. Sideris F.A. Leblond V. Pichette A.S. Cloutier P. Drolet P. Dubé 《Surgical oncology》2018,27(2):275-279
Background
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (OX) is the standard of care for selected patients with peritoneal carcinomatosis of colorectal origin. Because 5-FU is mandatory to improve efficacy of OX when used by systemic route, several teams now empirically combine intravenous (IV) 5-FU with HIPEC OX, but this practice has yet to be supported by preclinical data. Using a murine model, we studied the impact of IV 5-FU on peritoneal absorption of HIPEC OX.Methods
Under general anesthesia, 24 Sprague-Dawley rats were submitted to 4 different doses of IV 5-FU (0, 100, 400 and 800?mg/m2) and a fixed dose of HIPEC OX (460?mg/m2) perfused at 40?°C during 25?min. At 25?min, samples in different compartments were harvested (peritoneum, portal vein and systemic blood) and the concentrations of 5-FU and OX were measured by high performance liquid chromatography.Results
Peritoneal absorption of OX was significantly higher (17.0, 20.1, 34.9 and 38.1?nmol/g, p?<?0.0001) with increasing doses of 5-FU (0, 100, 400 and 800?mg/m2, respectively). Peritoneal absorption of OX reached a plateau between 400 and 800?mg/m2 of IV 5-FU.Conclusion
IV 5-FU enhances peritoneal absorption of HIPEC OX. The most efficient dose of IV 5-FU to be used in combination with HIPEC OX seems to be 400?mg/m2. 相似文献15.
Gérard Lorimier Valérie Seegers Marie Coudert Denis Dupoiron Emilie Thibaudeau Luc Pouplin Nathalie Lebrec Pierre Yves Dubois Frédéric Dumont Véronique Guérin-Meyer Olivier Capitain Mario Campone Romuald Wernert 《European journal of surgical oncology》2018,44(11):1824-1831
Objective
To assess the effectiveness of prolonged perioperative thoracic epidural analgesia (PEA) on long term survival of patients who underwent a complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases (CPM).Background
Grade III-IV morbidity affects long term outcomes after CRS and HIPEC. As compared with opioid administered via patient-controlled analgesia (PCA), PEA reduces morbidity.Method
From 2005 to 2016, 150 patients underwent CRS plus HIPEC with or without prolonged PEA. Clinical data and outcomes collected from prospective database were analyzed. Survival was assessed in terms of analgesic method using Kaplan-Meier plots and a propensity score.Results
Patients ‘characteristics of 59 patients in PCA group were comparable to those of 91 patients in PEA group, except for age, ASA score and fluid requirements, significantly more important in PEA group. Grade III-IV morbidity was 62.7% in PCA group compared with 36.3% in PEA group (p = 0.0015). Median overall survival (OS) of PEA group was 54.7 months compared to 39.5 months in PCA group (p = 0.0078). When adjusted on the covariates, using the propensity score, the PEA significantly improves OS [HR 0.40 (95% CI: 0.28–0.56)] (p < 0.0001) and disease free survival (DFS) [HR 0.61 (95% CI: 0.45–0.81] (p < 0.0007)Conclusions
In this retrospective study of patients who underwent a complete CRS and HIPEC for colorectal peritoneal metastases, the perioperative thoracic epidural analgesia prolonged for over 72 h reduced significantly the grade III-IV morbidity and may improve OS and DFS. 相似文献16.
Rafael Morales-Soriano Neus Esteve-Pérez Juan José Segura-Sampedro Pedro Cascales-Campos Pedro Barrios 《European journal of surgical oncology》2018,44(2):228-236
Introduction
Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers.Aim of the study
To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC.Patients and methods
All 25 members of the Spanish Surface Peritoneal Malignancy (GECOP), were invited to answer an online survey, to describe their usual practice in different perioperative areas of the CRS-HIPEC.Results
Survey was responded by 100% of centers. This study represents more than 800 patients treated annually. Seventy per cent of respondents perform CRS-HIPEC for more than 5 years. The most frequent technique was Coliseum (88%). Routinely non-invasive monitoring of cardiac output is used by 92% of centers. More than 50% of centers administer oxaliplatin (74%), or mitomycin-C (65%) in colorectal cancer; cisplatin in gastric cancer (73%) and mesothelioma (74%). Ovarian cancer is treated with cisplatin and various combinations, in 64% or paclitaxel in 54.5%. Spillage protocol was available in 100% centers.Conclusions
Data showed an important variability in volume of patients per center, selection of cytostatic agents, professional training and safety measures applied. The standardization of CRS/HIPEC procedures based on the best available evidence, the individualization of patients and the consensus among professionals, constitute an important part of the basis that will allow us to improve results of this complex procedure. 相似文献17.
Mathew A. Kozman Oliver M. Fisher Bree-Anne J. Rebolledo Sarah J. Valle Nayef Alzahrani Winston Liauw David L. Morris 《European journal of surgical oncology》2017,43(12):2299-2307
Background
Serum tumour levels have been shown to be prognostic in patients with epithelial appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei (PMP)). A singular index which incorporates both tumour activity (as depicted by serum tumour marker levels) and tumour volume (as depicted by peritoneal carcinomatosis index (PCI)), may give a more precise surrogate of tumour biological behaviour. The prognostic implication of this index has not yet been reported.Methods
A retrospective cohort study of all patients with PMP managed from 1996 to 2016 with cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) was performed by analysing the survival effect of the ratio of preoperative serum CEA, CA19.9 and CA125 to PCI.Results
Three hundred and eighty-six patients were included. In patients with low-grade PMP, elevated CA19-9/PCI ratio resulted in poorer median overall survival times (104 months vs NR, 95%CI 83 – NR, log-rank p < 0.001) and was an independent predictor of reduced overall survival on multivariable analysis (adjusted HR 5.60, 95%CI 1.60–19.68, p = 0.007). In patients with high-grade PMP, no statistically significant difference in survival was recognised.Conclusion
CA19-9/PCI ratio is an independent prognostic factor for overall survival in patients with low-grade PMP undergoing CRS and IPC. By accounting for both tumour activity and tumour volume simultaneously, this novel index behaves as a surrogate of tumour biology and provides a useful adjunct for decisions regarding treatment allocation in this patient group. 相似文献18.
J.-B. Delhorme C. Honoré L. Benhaim F. Dumont P. Dartigues C. Dromain M. Ducreux D. Elias D. Goéré 《European journal of surgical oncology》2017,43(1):159-167
Introduction
Complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have dramatically changed the prognosis of patients with pseudomyxoma peritonei (PMP). However, recurrences can still occur and no consensus has been reached regarding their optimal treatments. This study aimed to analyze the patterns of recurrence after CCRS plus HIPEC for PMP and potential subsequent treatments of these lesions.Patients and methods
Between 1992 and 2014, patients who had relapsed after treatment of PMP were selected from a prospective database of 251 patients who had undergone CCRS plus HIPEC with a curative intent.Results
After a median follow-up of 85 months, 66 patients (26%) had relapsed with a median free interval of 25 months. The first recurrence was mostly located in the peritoneum, isolated in 50 patients (76%) and associated with extraperitoneal disease in 6 patients. Curatively intended treatment of the relapse, combining surgery and chemotherapy was achievable in 76% of the patients, leading to a 5-year overall survival (OS) rate of 83% from the date of treatment of the first recurrence. In contrast, the 5-year OS rate was only 27% (p < 0.001) for patients treated with non-curative therapy. An isolated peritoneal recurrence was predictive of greater amenability to curative therapy and a better prognosis.Conclusion
After CCRS plus HIPEC, serosal recurrences were more common than their distant counterparts. Distant relapses' emergence has raised the question of their optimal treatments. Very long-term survival can be obtained after further treatment of recurrent PMP for patients with limited disease and good general status. 相似文献19.
Kim Govaerts K. Chandrakumaran Norman J. Carr Thomas D. Cecil Sanjeev Dayal Faheez Mohamed Andrew Thrower Brendan J. Moran 《European journal of surgical oncology》2018,44(9):1371-1377
Aim
Pseudomyxoma peritonei (PMP) is an uncommon malignancy, generally originating from a ruptured epithelial tumour of the appendix. Despite successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), some patients recur. Currently there are no guidelines on the methods, frequency and intensity of follow-up.Methods
Between 1994 and 2016, 1070 patients underwent surgery for a perforated epithelial tumour of the appendix, predominantly with PMP. Overall (OS) and Disease Free Survival (DFS) were documented by annual CT scanning and evaluated according to the Kaplan-Meier method. The influence of histological differentiation was investigated.Results
Overall, 775/1070 (72%) had complete cytoreductive surgery (CCRS) and HIPEC. Histological classification was low grade PMP in 615 (79.4%), high grade PMP in 134 (17.3%) and adenocarcinoma in 26 (3.4%). DFS and OS were significantly worse for high grade disease, with the steepest decline for both in the first three years. DFS curves, for low as well as high grade PMP, levelled off at year 6 at approximately 60% and 20% respectively. Thereafter there were few recurrences in either group.Conclusion
Annual CT of the abdomen and pelvis in the first six years appears to be adequate follow-up for low grade PMP. In high grade PMP, additional imaging of the chest and more frequent surveillance, during the first three years postoperatively, may detect recurrent disease earlier. From year 6 on, reduced frequency of follow-up is proposed, independent of the histology. This long-term follow-up in a large number of patients gives insight into tumour behavior after CCRS and HIPEC for PMP and guides intensity of surveillance. 相似文献20.