Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered via a modified perfusion system for peritoneal carcinomatosis of colorectal origin.

BACKGROUND AND PURPOSE: The long-term survival of patients with peritoneal carcinomatosis of colorectal origin has been achieved with cytoreductive surgery, which removes all macroscopic implants, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The current technology for administering intraperitoneal heated chemotherapy is expensive and, for some institutions, unaffordable. We conducted this study to assess the temperature stability provided by a modified, inexpensive system, to offer a simple and low cost alternative to the standard HIPEC delivery equipment. METHODS: Ten patients with histologically diagnosed peritoneal metastases of adenocarcinoma or pseudomyxoma peritonei underwent cytoreductive surgery and received HIPEC with 5-fluorouracil for 90 min, delivered via our modified system. The temperature was recorded from two probes: one in the inflow catheter and one in the outflow catheter. The intra-abdominal temperature was monitored meticulously to maintain it at between 41 and 42 °C. RESULTS: All patients underwent cytoreductive surgery and HIPEC using our modified delivery system. Temperature stability was achieved in all patients, with a mean of 41.4°. There were no thermal injuries associated with any of the ten perfusions. The mean hospital stay was 15 days and the median survival was 30 months. CONCLUSION: Analysis of this data demonstrates that the uniform delivery of HIPEC at 41° with this modified system is feasible and safe. The outcome of the patients treated with cytoreductive surgery and HIPEC with this modified system compares favorably to other published series. Its low cost and simple design will give more patients with peritoneal carcinomatosis access to this treatment.

[Experience of cytoreduction with peritonectomy and hyperthermic intraperitoneal chemotherapy in ovarian cancer]. / Experiencia de la citorreducción con peritonectomía y quimioterapia intraperitoneal hipertérmica en cáncer de ovario.

Background: Currently, epithelial ovarian cancer is diagnosed in advanced stages (EC IIIC) in 75-80% of cases worldwide. In this group of patients treatment with neoadjuvant chemotherapy is started, followed by interval cytoreduction of residual disease and even require peritonectomy with application of hyperthermic intraperitoneal chemotherapy (HIPEC). Objective: To identify the overall survival and progression-free survival associated with peritonectomy, in patients with peritoneal carcinomatosis secondary to ovarian cancer treated in the oncology gynecology service from January 2009 to January 2019 at the UMAE Hospital de Oncología Centro Médico Nacional Siglo XXI. Material and methods: Observational, descriptive, cross-sectional, retrospective study, information was obtained from the clinical file of patients treated with peritonectomy with the use of hyperthermic intraperitoneal chemotherapy in the gynecological oncology service from January 2009 to January 2019 at the UMAE Hospital de Oncología Centro Médico Nacional Siglo XXI. Results: Information was obtained from a total of 36 patients (n=100%), 36.1% received intraperitoneal chemotherapy and 63.8% underwent cytoreduction without the application of intraoperative chemotherapy. The most frequently used drug was cisplatin followed by mitomycin. There was no statistical significance when comparing both groups, however there was a trend in favor of the use of intraoperative chemotherapy by obtaining a greater number of months in terms of overall survival. Conclusion: Peritonectomy with hyperthermic intraperitoneal chemotherapy is an option in selected patients with advanced stage ovarian cancer in primary and recurrent surgery, as well as in patients with platinum-resistant ovarian cancer.

Introducción: en la actualidad, el cáncer de ovario epitelial se diagnostica en etapas avanzadas (EC IIIC) en 75-80% de los casos a nivel mundial. En este grupo de pacientes se inicia el tratamiento con quimioterapia neoadyuvante, seguida de citorreducción de intervalo de la enfermedad residual e incluso requieren de peritonectomía con aplicación de quimioterapia intraperitoneal hipertérmica (HIPEC). Objetivo: identificar la sobrevida global y sobrevida libre de progresión asociada a la realización de peritonectomía, en pacientes con carcinomatosis peritoneal secundario a cáncer de ovario tratadas en el servicio de Ginecología Oncológica de enero de 2009 a enero de 2019 en el Hospital de Oncología Centro Médico Nacional Siglo XXI (CMN SXXI). Material y métodos: estudio observacional, descriptivo, transversal, retrospectivo, se obtuvo información del expediente clínico de pacientes tratados con peritonectomía con uso de quimioterapia intraperitoneal hipertérmica en el servicio de Ginecología Oncológica de enero de 2009 a enero de 2019 en el Hospital de Oncología CMN SXXI. Resultados: se obtuvo información de un total de 36 pacientes (n = 100%), el 36.1% recibió quimioterapia intraperitoneal y al 63.8% se les realizó citorreducción sin la aplicación de quimioterapia intraoperatoria. El fármaco utilizado con mayor frecuencia fue el cisplatino seguido por mitomicina. No hubo significancia estadística al comparar ambos grupos, sin embargo hubo una tendencia a favor del uso de quimioterapia intraoperatoria al obtener un mayor número de meses en cuanto a sobrevida global. Conclusión: la peritonectomía con quimioterapia intraperitoneal hipertérmica es una opción en pacientes seleccionados de cáncer de ovario en etapa avanzada en cirugía primaria y recurrente, así mismo en paciente con cáncer de ovario platino-resistentes.

[Mature teratoma with malignant differentiation treated with peritonectomy with HIPEC]. / Teratoma maduro con diferenciación maligna tratado con peritonectomía con HIPEC.

Background: Mature teratomas belong to the group of germ line ovarian tumors; they generally have benign behavior. Malignant transformation occurs in 0.2% to 1% of tumors. The objective is to show the results of peritonectomy with HIPEC in the treatment of a mature teratoma with malignant differentiation with signet ring cells. Clinical case: 43-year-old woman diagnosed with mature malignant teratoma with signet ring cells. It was performed optimal primary cytoreduction surgery, total hysterectomy, bilateral salpingo-oophorectomy, peritonectomy, appendectomy, cholecystectomy and splenectomy adding intraoperative hyperthermic chemotherapy (HIPEC). Conclusions: Malignant transformation of a mature teratoma of the ovary is a rare event, but not exceptional. HIPEC was used after optimal cytoreduction, with good results, since the patient is in a disease-free period of 36 months. It is necessary to report cases in order to compare different types of treatment to improve oncological results.

Introducción: los teratomas maduros pertenecen al grupo de los tumores de ovario de estirpe germinal; por lo general, tienen un comportamiento benigno. La transformación maligna ocurre en un rango de 0.2 a 1% de los tumores. El objetivo es mostrar los resultados de peritonectomía con HIPEC en el tratamiento de un teratoma maduro con diferenciación maligna con células en anillo de sello. Caso clínico: mujer de 43 años de edad, con diagnóstico de teratoma maduro maligno con células en anillo de sello. Se realizó cirugía de citorreducción primaria optima; histerectomía total, salpingooforectomía bilateral, peritonectomía, apendicectomía, colecistectomía y esplenectomía, además de quimioterapia hipertérmica intraoperatoria (HIPEC). Conclusiones: la transformación maligna de un teratoma maduro del ovario es un evento raro, pero no excepcional. Se utilizó HIPEC posterior a la citorredución óptima y hubo buenos resultados, ya que la paciente lleva un periodo libre de enfermedad de 36 meses. Es necesario el reporte de casos a fin de comparar diversos tipos de tratamiento para mejorar resultados oncológicos.

[Mature mesenteric teratoma in an adult male. A case report]. / Teratoma maduro del mesenterio en un hombre adulto. Informe de un caso.

Mesenteric teratoma matures in adulthood are extremely rare. The spectrum of differential diagnosis for intra-abdominal cystic lesions in male patients is limited and its occurrence is less than in female counterparts, being so a diagnostic problem for daily medical practice. The purpose of this study is to present this entity as an infrequent tumor, which can become a diagnostic challenge. Here we present a case of a mature teratoma occurring in the mesenteric root in a 50 year old man.

Estrategias en braquioplastia: incisión en T, anclaje dérmico y liposucción asociada. Cinco años de experiencia / Strategies in brachioplasty: T incision, dermal anchorage and associated liposuction. Five-year experience

INTRODUCCIÓN Y OBJETIVO: El aumento constante de las consultas por flacidez braquial genera interés creciente en el perfeccionamiento de las técnicas para evitar las frecuentes complicaciones y los resultados insatisfactorios. El objetivo de este estudio es describir una variante de la tecnica de braquioplastia en T basada en un anclaje profundo y resistente como alternativa para disminuir complicaciones cicatriciales y analizar los resultados obtenidos con la misma. MATERIAL Y MÉTODO: Estudio observacional, descriptivo y retrospectivo sobre 15 pacientes con flacidez braquial grados IIIA, IIIB y IIIC de la clasificación de Appelt entre junio 2015 y junio 2019. El diseño de la variante incluye incisión en T con área de desepidermización extensa, no menor a 1 cm de ancho, alredor de la incisión que servirá de anclaje dérmico en el cierre, facilitándolo y aportando un plano de resistencia superior a los ya descritos, y disminuyendo la tasa de complicaciones cicatriciales posteriores (dehiscencias posoperatorias y cicatrices inesteticas). RESULTADOS: Todas las pacientes fueron mujeres, con edad media de 47 años. La causa más frecuente de flacidez fue el envejecimiento (60%) y la pérdida de peso posobesidad (40%); el grado de flacidez IIIA fue del 66% (10 casos), grado IIIB del 13% (2 casos) y grado IIIC del 20% (3 casos). En todos los casos realizamos desepidermización de un área alrededor de la incisión no menor de 1 cm que sirvió de anclaje dérmico en el cierre. El procedimiento fue bien tolerado en todos los casos. La tasa general de complicaciones fue del 20% (3 pacientes), 13.3% (2 pacientes) por dehiscencia en el punto de unión central y 6.6% (1 paciente) por cicatrices hipertróficas. Una paciente (6.6%) requirió revisión posterior. CONCLUSIONES: El anclaje dérmico se convierte en una herramienta de gran valor en la braquioplastia para soporte en un área que carece de estructuras que cumplan dicha función. Recomendamos su uso siempre que sea posible ya que es de fácil ejecución, no incrementa el tiempo operatorio, facilita el cierre y disminuye la tasa de complicaciones cicatriciales

BACKGROUND AND OBJECTIVE: The constant rise in consultations for brachial flaccidity has generated a growing interest in perfecting the technique to avoid the frequent complications and unsatisfactory results. Our objective is to describe a variant of the of T-brachioplasty surgical technique based on a deep and resistant anchorage as an alternative to diminish scar complications and to analyze outcomes. METHODS: Retrospective, observational and descriptive study that included 15 patients with brachial flaccidity grades IIIA, IIIB and IIIC according to the Appelt's classification from June 2015 to June 2019. The design of this surgical variant includes a T-shaped incision with an area of deep de-epidermization of at least 1 cm width surrounding the incision that will act as dermal anchorage, facilitating closure and providing a better plane of resistance than the techniques previously described, which will decrease the rate of subsequent scar complications (postoperative dehiscence and non-esthetic scars). RESULTS: All patients were female patients, 47 years old average. The most frequent cause of flaccidity was aging (60%) and post-obesity weight loss (40%); the IIIA grade of flaccidity was 66% (10 cases), the IIIB grade was 13% (2 cases), and the IIIC grade was 20% (3 cases). Surgical technique used in every case included a de-epidermization area of at least 1 cm surrounding the incision that acted as dermal anchorage at the time of closure. The procedure was well tolerated in every case. General complication rate was 20% (3 patients): 13% (2 patients) presented a dehiscence at the central T stitch and 6.6% (1 patient) developed hypertrophic scars. One patient (6.6%) required a surgical revision. CONCLUSIONS: Dermal anchorage is a tool of great value at the time of providing support in an area that lacks support structures. We recommend using this tool whenever possible considering it is easy to perform, does not demand longer surgical time, facilitates closure and reduces scar complications

Carcinoma linfoepitelial de cuello uterino con recurrencia a distancia / Lymphoepithelioma-like carcinoma of the cervix with distant recurrence

Resumen El carcinoma similar al linfoepitelioma (LELC) del cuello uterino es una variante infrecuente del carcinoma de células escamosas. Se presenta el caso de una mujer con un tumor exofítico en el cuello uterino de consistencia aumentada, sangrado al tacto y parametrios libres de tumor clasificándose como etapa clínica IBI; el estudio histopatológico reportó LELC con recurrencia a distancia al año de seguimiento. Debido a su buen pronóstico existen pocos casos reportados de recurrencia posterior al tratamiento inicial.

Abstract Lymphoepithelioma-like carcinoma (LELC) of the cervix is an uncommon variant of squamous cell carcinoma. We present the case of a woman with an exophytic tumor on the cervix of increased consistency, bleeding to the touch and tumor-free parametriums classified as clinical stage IBI; the histopathological study reported LELC with distant recurrence at one year of follow-up. Due to its good prognosis, there are few reported cases of recurrence after initial treatment.

Thrombocytosis as a predictor of distant recurrence in patients with rectal cancer.

BACKGROUND AND AIMS: Thrombocytosis is frequently observed in patients with malignancy. We undertook this study to determine the prognostic value of thrombocytosis in patients with rectal cancer. METHODS: We performed a retrospective study of patients undergoing low anterior resection for rectal cancer between January 2000 and March 2007. Preoperative platelet count was measured before surgery. Postoperative platelets were determined 1 month after surgery. Two-tailed p values <0.05 were considered statistically significant. RESULTS: One hundred sixty three patients with rectal cancer were included in the study. Preoperative platelet count >350,000 was found in 8% of patients. Postoperative platelet count >350,000 was found in 6% of patients. Distant metastases were found in 17 patients (10.4%). Significant variables in the multivariate analyses were preoperative platelets >350,000 (p = 0.001), postoperative platelets >350,000 (p = 0.002), carcinoembryonic antigen >13 ng/dL (p = 0.003). Patients with preoperative platelet count <350,000 showed a 5-year survival rate of 81%, whereas patients with platelet count >350,000 had a 25-month survival [95% confidence interval (CI): 20-26]; p <0.001. Patients with postoperative platelets <350,000 showed a 5-year survival rate of 80%, whereas patients with platelets >350,000 showed a 3-year survival rate of 37.5% (p <0.05). CONCLUSIONS: Pre- or postoperative platelet count >350,000 is associated with poor survival in patients with rectal cancer. The measurement of platelets is a clinical marker useful to define the prognosis for patients with rectal cancer.