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.

[Clinical and metabolic effectiveness of a new motivational therapy for the treatment of obesity in adolescents (OBEMAT)]. / Eficacia clínica y metabólica de una nueva terapia motivacional (OBEMAT) para el tratamiento de la obesidad en la adolescencia.

INTRODUCTION: The mainstay of the treatment of childhood obesity is the promotion of behavioural changes, which are especially difficult during adolescence. This paper proposes and evaluates a new motivation-based therapeutic protocol, structured in objectives, which is applicable from paediatric practice. PATIENTS AND METHODS: A total of 110 obese adolescents were studied. The therapeutic protocol consisted of 12 monthly visits, in two phases: Motivational and Interventional, in which changes were proposed and objectives were agreed, and later evaluated taking into account the difficulties and achievements. Weight and height was measured in each visit, and blood pressure, waist circumference, glucose, insulin and lipid profile were measured at the beginning and at the end. RESULTS: There was a mean decrease of 0.5 SDS in BMI z-score in the adolescents who completed the intervention (78.2%), with this decrease being 0.8 SDS in the group of patients with good response to treatment (75.6%). This group had a significantly lower total cholesterol, LDL, triglycerides, insulin and HOMA index. The main predictor of good response was the success of the motivational phase, with a positive predictive value of 95% (83-98%). CONCLUSIONS: BMI z-score decreases and the control of anthropometric and biochemical parameters, show that OBEMAT is a highly effective method compared to those published previously. The response to the motivational phase largely determines the success or failure of the intervention.

The cost of cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of peritoneal malignancy in one Greek institute.

PURPOSE: Cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of patients with peritoneal malignancy is expensive. The purpose of this study was to estimate the current cost of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy and identify the most significant related parameters in one center in Greece. METHODS: A retrospective economic study was carried out on 105 patients that underwent 108 cytoreductive operations and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) from 2006-2011 for peritoneal malignancy. The economic cost included the daily cost of hospital bed occupancy, the daily cost of occupancy in the intensive care unit (ICU), the expenditures (materials and drugs), and the preoperative, intraoperative, and postoperative examinations. RESULTS: The mean length of stay in the ICU and the mean hospitalization time was 5 and 23 days, respectively. The hospital mortality and morbidity was 5.6% (6 patients) and 48.17percnt; respectively. The mean cost of treatment was 15677.3±11910.6 euros (range=4258,47-95990,87) per patient. Morbidity (p=0.009), and prolonged stay in the ICU (p<0.001) were the parameters that influenced independently the cost of treatment. CONCLUSION: Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy is an expensive treatment. The economic cost is largely influenced by morbidity and the length of stay in the ICU.

Abdominal wall endometriosis: report of two cases.

Endometriosis is the abnormal existence of functional uterine mucosal tissue outside the uterus. It is a usual disorder of women in reproductive age, which is mainly located in the female genital tract. We report the cases of two women with endometriosis of the abdominal wall; the first one in the rectus abdominis muscle and the second one in the surgical scar of previous caesarian incision. The diagnosis was made by the histopathological analysis of the surgical specimens.