Prior Surgical Score: An Analysis of the Prognostic Significance of an Initial Nondefinitive Surgical Intervention in Patients With Peritoneal Carcinomatosis of a Colorectal Origin Undergoing Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy.

BACKGROUND: The prior surgical score estimates the extent of previous surgical intervention by quantitating surgical dissection within 9 abdominopelvic regions. OBJECTIVE: Our aim was to analyze the prognostic significance of the prior surgical score in our cohort of patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of a colorectal origin. DESIGN: This was a retrospective analysis of a prospectively maintained database for all patients treated for peritoneal carcinomatosis of a colorectal origin. SETTINGS: The prospectively maintained surgical oncology tumor database was analyzed for the study period 1989-2014. PATIENTS: A total of 407 patients diagnosed with peritoneal carcinomatosis of a colorectal origin and treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy were included in this analysis. MAIN OUTCOME MEASURES: The prognostic significance and clinicopathologic factors associated with an initial nondefinitive surgical intervention in patients with peritoneal carcinomatosis of a colorectal origin undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy was evaluated. RESULTS: There were 210 men (51.6%) and 197 women (48.4%) in the study. Mean age at presentation was 53.7 years (range, 19.0-87.0 y). Data on prior surgical score for 69 patients were missing, leaving us with a study cohort of 338 patients. Grouped by prior surgical score, 46 (13.6%) had a prior surgical score of 0 versus 25 (7.4%), 122 (36.1%), and 145 (42.9%) who had a prior surgical score of 1, 2, or 3. Overall survival was 53.0%. Three- and 5-year survival rates were 75% and 75% for group prior surgical score 0 versus 26% and 13%, 39% and 37%, and 21% and 16% for group prior surgical scores 1, 2, and 3. Median survival time for the various prior surgical score groups were 180.0, 30.4, 30.5, and 21.3 months for prior surgical scores 0, 1, 2, and 3 (p = 0.000). A total of 87.2% of the prior surgical score 0 group had a completeness of cytoreduction score of 0/1 (no residual disease/tumor <0.25 cm) versus 68.0%, 68.1%, and 48.6% for prior surgical scores of 1, 2, or 3 (p = 0.000). Significant independent predictors of a shorter survival in multivariate analysis included a high cytoreduction score status (p < 0.000) and a high prior surgical score (p = 0.05). LIMITATIONS: This study was limited by its retrospective, population-based design. CONCLUSIONS: The extent of a previous nondefinitive surgical intervention contributes to the poor prognosis associated with peritoneal carcinomatosis of a colorectal origin. Independent predictors for an improved overall survival include completeness of cytoreduction and low prior surgical score. See Video Abstract at http://links.lww.com/DCR/A573.

Development of Physiologically Based Pharmacokinetic Model (PBPK) of BMP2 in Mice.

Bone Morphogenetic protein 2 holds great promise for potential applications in the clinic. It is a potent growth factor for the use in the cervical spine surgery (FDA approved 2002) and has been marketed as "Infuse" for treating open tibial shaft fractures (FDA approved 2004). However, its use is limited by several significant side effects that maybe due to its potency and effect on different stem cell populations in the spine. BMP2 is expressed throughout the human body in several tissues and at a very high concentration in the blood. BMP receptors, especially BMP receptor type Ia, is ubiquitously expressed in most tissues. Currently, it is difficult to determine how BMP2 is physiologically distributed in mice or humans and no quantitative models are available. A Physiologically-Based Pharmaco-Kinetic (PBPK) model has been developed to determine steady-state distribution of BMP2 in mice. The multi-compartmental PBPK model represents relevant organ/tissues with physiological accuracy. The organs/tissue compartments chosen were brain, lung, heart, liver, pancreas, kidney, uterus, bone and fat. A blood compartment maintained connectivity among the various organs. Four processes characterized the change in the concentration of the protein in every compartment: blood flow in, blood flow out, protein turnover and receptor binding in the organ. The unique aspects of the model are the determination of elimination using receptor kinetics and generation using protein turnover. The model also predicts steady state concentrations of BMP2 in tissues in mice and may be used for possible scale-up of dosage regimens in humans.

Traumatic injuries to the portal vein: case study.

BACKGROUND: Injuries to the portal vein are rare but devastating. Contemporary studies have debated the most effective management for this injury. The purpose of this case study was to provide an update on portal vein injury and add information regarding its management. METHODS: A retrospective review investigated the 10-year experience with portal vein injury in a level 1 trauma center. RESULTS: Of the 18,900 trauma patients (0.08%) evaluated during a 10-year period, 15 sustained injuries to the portal vein. All the injuries resulted from penetrating trauma, and the overall survival rate was 60% (9 of the 15 patients). Four patients died of exsanguination and two patients died later as a result of multisystem organ failure. Postoperative complications were common. Sepsis and wound infection were the most common postoperative complications, occurring in seven (78%) of the nine survivors. All the patients had associated nonvascular injuries, whereas 9 (60%) of the 15 had associated vascular injuries. Associated injuries to the other structures in the portal triad occurred in 7 (47%) of the 15 patients, and 5 (71%) of these patients survived. Survival rates by procedure were 86% for venorrhaphy and 67% for ligation. CONCLUSIONS: Injuries to the portal vein are rare. In this study, exsanguination was the main cause of death. The key to a favorable outcome is prompt control of hemorrhage with an early decision to proceed with either venorrhaphy or ligation. Ligation can be effective for the management of hemodynamically unstable patients.