Prognostic Value of En-Block Radical Bowel Resection in Advanced Ovarian Cancer Surgery With HIPEC.

PURPOSE: To identify prognostic factors of survival and recurrence in advanced ovarian cancer patients undergoing radical surgery and HIPEC. METHODS: In a single Department of Surgical Oncology, Peritoneal Surface Malignancy Program, and over a 16-year period, from a total of 274 epithelial ovarian cancer patients, retrospectively, we identified 152 patients undergoing complete (CC-0) or near-complete (CC-1) cytoreduction, including at least one colonic resection, and HIPEC. RESULTS: Mean age of patients was 58.8 years and CC-0 was possible in 72.4%. Rates of in-hospital mortality and major morbidity were 2.6% and 15.7%. Only 122 (80.3%) patients completed Adjuvant Systemic Chemotherapy (ASCH). Rates of metastatic Total Lymph Nodes (TLN), Para-Aortic and Pelvic Lymph Nodes (PAPLN) and Large Bowel Lymph Nodes (LBLN) were 58.7%, 58.5%, and 51.3%, respectively. Median, 5- and 10-year survival rates were 39 months, 43%, and 36.2%, respectively. The recurrence rate was 35.5%. On univariate analysis, CC-1, high Peritoneal Cancer Index (PCI), in-hospital morbidity, and no adjuvant chemotherapy were adverse factors for survival and recurrence. On multivariate analysis, negative survival indicators were the advanced age of patients, extensive peritoneal dissemination, low total number of TLN and no systemic PAPLN. Metastatic LBLN and segmental resection of the small bowel (SIR) were associated with a high risk for recurrence. CONCLUSION: CC-O is feasible in most advanced ovarian cancer patients and HIPEC may confer a survival benefit. Radical bowel resection, with its entire mesocolon, may be necessary, as its lymph nodes often harbor metastases influencing disease recurrence and survival. The role of metastatic bowel lymph nodes has to be taken into account when assessing the impact of systemic lymphadenectomy in this group of patients.

Adjuvant perioperative intraperitoneal chemotherapy in locally advanced colorectal carcinoma: preliminary results.

Background and Aims. Intraperitoneal chemotherapy is a basic tool in the treatment of peritoneal malignancy. The purpose of the study is to investigate the effect of adjuvant perioperative intraperitoneal chemotherapy in the treatment of locally advanced colorectal cancer. Patients and Methods. Patients with T(3) and T(4) colorectal carcinomas that underwent R(0) resection received either hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC group = 40 patients) or early postoperative intraperitoneal chemotherapy (EPIC group = 67 patients). The survival, the recurrences and the sites of recurrence were assessed. Results. The 3-year survival rate for HIPEC group was 100% and for EPIC group 69% (P = .011). Nodal infiltration was found to be the single prognostic indicator of survival. The incidence of recurrence in EPIC group was higher than in HIPEC group (P = .009). The independent indicators of recurrence were the use of HIPEC and the degree of differentiation (P < .05). Conclusions. Intraperitoneal chemotherapy, particularly HIPEC, as an adjuvant in locally advanced colorectal carcinomas appears to improve survival and decrease the incidence of recurrence.

Long-term results following potentially curative gastrectomy for gastric cancer.

PURPOSE: The purpose of this study was to report the results of gastric cancer surgery in patients who had undergone potentially curative gastrectomy. METHODS: The hospital mortality, morbidity, survival, recurrences and the sites of failure were retrospectively analyzed in D1 group (conventional gastrectomy), and in D2 group (extended lymph node resection). RESULTS: D1 and D2 groups were comparable for age, gender, American Society of Anesthesiologists (ASA) class, type of surgery, and histopathologic characteristics (p>0.05). D2 group patients were in better physical status (p=0.008). The recurrence rate was higher in D1 group (p=0.019). Independent prognostic indicators of morbidity were male gender (p=0.012), and poor ASA class (p<0.001). Poor ASA class was the single independent prognostic indicator of hospital mortality (p=0.001). Ten-year survival for D1 and D2 was 44.1 and 64.8%, respectively (p=0.0433). D2 gastrectomy improved survival in stage IIIA. The independent prognostic indicators of survival were total gastrectomy (p=0.003), lymph node involvement (p<0.0001), and extended lymphadenectomy (p=0.003). The independent prognostic variables of recurrence were stage (p=0.001), and extended lymph node resection (p=0.006). CONCLUSION: D2 gastrectomy improves survival in gastric cancer, particularly in stage IIIA.

Differences between right- and left-sided colon carcinomas.

PURPOSE: Clinical, histopathological, and biological differences between right and left colon carcinomas have been questioned in the literature. The purpose of this retrospective study was to identify possible clinical and histopathological differences between the right and left colon carcinomas. METHODS: From 1987-2007, 109 patients with right colon carcinomas (RC group), and 186 patients with left colon carcinomas (LC group) were treated at a single institution. Clinical, histopathological, and biological variables were correlated to tumor location. The endpoint of the study was to see for any relationship between overall survival, recurrences, and their pattern in regard to tumor location. RESULTS: The incidence of distant metastases at initial diagnosis (p=0.049), and poorly differentiated tumors (p=0.001) was higher in right colon carcinomas. The 10-year survival rate in the RC group was 63% and in the LC group 66% (p >0.05). Recurrences, sites of recurrence, the in-hospital mortality and morbidity were similar in both groups (p >0.05). CONCLUSION: The biological behavior of right and left colon carcinomas is similar despite minor histopathological differences that do not influence survival and development of recurrences.