Cytoreductive Surgery and Intraperitoneal Chemotherapy in Advanced Serous Epithelial Ovarian Cancer: A 14-Year French Retrospective Single-Center Study of 124 Patients.

INTRODUCTION: Ovarian cancer (OC) is the most lethal gynecological cancer. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy appears to increase survival, and normothermic intraperitoneal chemotherapy (IPC) could improve overall survival (OS). Furthermore, intraperitoneal epinephrine could decrease the toxicity of chemotherapy by decreasing the systemic absorption of chemotherapy. The goal of this study was to assess the effects of CRS and IPC with intraperitoneal epinephrine, as first-line therapy, on the survival of patients with serous epithelial OC (EOC) with peritoneal metastases. METHODS: A prospective monocentric database was retrospectively searched for all patients with advanced serous EOC treated by interval or consolidative CRS plus IPC with intraperitoneal epinephrine after neoadjuvant chemotherapy. OS and disease-free survival (DFS), postoperative complications, and prognostic factors were analyzed. RESULTS: From January 2003 to December 2017, 124 patients with serous EOC were treated with interval (n = 58) or consolidative (n = 66) complete CRS plus IPC with intraperitoneal epinephrine. The median follow-up was 77.8 months, the median OS was 60.8 months, and the median DFS was 21.2 months. In our multivariate analysis, a higher Peritoneal Cancer Index (PCI) and positive lymph node status resulted in worse OS, while higher World Health Organization score, higher PCI score, and positive lymph node status were risk factors for worse DFS. Grade 3 or higher surgical morbidity occurred in 27.42% of cases; only 3.2% had grade 3 renal toxicity and mortality was 0.8%. CONCLUSION: CRS and IPC with intraperitoneal epinephrine in stage III EOC offer good OS and DFS with acceptable morbidity and mortality rates.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment of ovarian cancer.

Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery and maximal regional chemotherapy, has been applied to treat ovarian cancer resulting in long-term survival rates in selected patients. However, the status of HIPEC in ovarian cancer remains an experimental procedure, given the many variables among the data and trials reviewed, to enable us to derive strong conclusions about its role from this overview. In this review we discuss treatment with HIPEC in patients with ovarian cancer and future prospective of its use in clinical setting. HIPEC is an effective tool in the treatment of selected patients with peritoneal carcinomatosis from ovarian cancer. Unfortunately, due to the lack of randomised trials, the evidence of HIPEC is very limited. Future randomised studies are awaited to define the role and clinical impact of HIPEC in ovarian cancer.

Assessing the feasibility of full robotic interaortocaval nodal dissection for locally advanced gastric cancer.

BACKGROUND: The clinical value of super-extended lymph node dissection (D2(+) ) is still debated. This procedure has not been reported using the laparoscopic or robotic approach. Although this technique, in low-volume centres, could lead to an increased risk of morbidity, in high-volume centres morbidity and mortality are similar to those of the standard D2 lymphadenectomy. Robotic surgery could overcome the limitations of laparoscopic surgery, especially in the removal of posterior nodal stations. In this report we describe the feasibility of fully robotic interaortocaval lymphadenectomy, following similar steps to those of the traditional open approach. METHODS: The procedure was a total gastrectomy with oesophago-jejunal Roux-en-Y reconstruction in a 73 year-old male patient with clinically advanced (cT3) gastric adenocarcinoma, located in the lesser curvature (middle-upper third). The da Vinci® Si HD with a double-docking robot set-up was employed. RESULTS: The histological specimen examination showed a pT4aN3bM0, Borrmann type III, intestinal histotype, G3 gastric adenocarcinoma. No involvement of resection margins was found (R0 resection). The numbers of total harvested and positive nodes were 57 and 41, respectively; the number of harvested interaortocaval nodes was 14, and all of them were negative for tumour involvement. Operative time for lymphadenectomy was comparable with that of the traditional open approach. The postoperative period was uneventful and hospital stay was 11 days. CONCLUSIONS: Robotic-assisted interaortocaval lymphadenectomy is a feasible technique in high-volume centres for gastric cancer surgery, and should be considered in curative surgery for selected advanced cases, especially for the high-risk group of lymph node metastases in the posterior area.

[Acute abdomen by anisakiasis and globalization]. / Addome acuto da anisakiasi e globalizzazione.

OBJECTIVES: The AA report a case of a patient with acute abdomen caused by intestinal Anisakiasis, a fish-transmitted infection that results from ingestion of raw or improperly cooked fish contaminated by live larvae of Anisakis Simplex, a round worm from the order of Ascaridida. MATERIAL AND METHODS: A 33-year-old man, presented to the emergency room with severe upper abdominal pain, nausea and vomiting, without fever. The patient revealed that he had eaten pickled anchovies a few days before. RESULTS: On the exploratory laparotomy an edematous and stenotic tract of 15 cm of jejunum was found, and a segmental resection was performed. Histologically, the resected jejunum showed a conspicuous and diffuse inflammatory infiltration, predominantly made up of eosinophil granulocytes, numerous mucosal erosions and the presence in the submucosa of sections of parasites which were identified as Anisakis Simplex larvae. DISCUSSION: The ingestion of fish contaminated by Anisakis larva is often followed by the appearance of systemic or gastrointestinal symptoms due respectively to the direct larva localization and the allergic reaction to some parasite components. Diagnosis is made frequently difficult by clinical manifestations that could mimic symptoms of other diseases more common in Italy. CONCLUSIONS: Globalization has made Anisakiasis a more and more frequent disease worldwide, as increased mixture of different cultures and international travelling has allowed the spreading of risky feeding habits. That's why Anisakiasis should be considered in differential diagnosis of intestinal obstruction in patients with positive anamnesis for suspiciously cooked or conserved seafood eating.

[Intestinal occlusion by ileal carcinoid]. / Occlusione intestinale da carcinoide ileale.

OBJECTIVE: Ileal carcinoids diagnosis, generally, is late because patients have aspecific symptoms. MATERIAL OF STUDY: The two cases described presented for a long time peristaltic abdominal pains, vomit episodes and reduction of weight, with negativity of radiologic reports. The first diagnosis was adhesion syndrome produced by previous abdominal surgical operation; just emergency surgical operation executed for intestinal occlusion noticed carcinoids, located into the distal ileum, which infiltrated muscular wall and interested regional lymph nodes. RESULTS: Ileal carcinoids diagnosis, generally, takes place during emergency laparotomy for intestinal occlusion which is the most frequent complication of this tumor. At the moment of diagnosis the tumor presents an advanced stage of evolution. DISCUSSION: Ileal carcinoids behave malignant because of their biologic aggressiveness and because of at the moment of diagnosis they present an advanced stage of evolution. Symptomatology is aspecific, just a carcinoid syndrome could addressed clinical diagnosis, but this is an rare event and however it needs of liver metastases to appear. In case there is an clinical suspect scintigraphy with Octreoscan can locate tumor and metastases. CONCLUSIONS: Surgical treatment of ileal carcinoids is based on large resections en bloc. Ileal carcinoids survival to 5 years is estimated inferior to 60% after surgical treatment.