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PURPOSE: CO₂ leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasis after laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis between B-ultrasound-guided and laparoscopically-assisted hyperthermic intraperitoneal perfusion chemotherapy (HIPPC). MATERIALS AND METHODS: Sixty-two patients with malignant ascites induced by gastrointestinal or ovarian cancer were divided into two groups to receive either B-ultrasound-guided or laparoscopically-assisted HIPPC. Clinical efficacy was assessed from the objective remission rate (ORR), the Karnofsky Performance Status (KPS) score, and overall survival. The incidence of port-site metastasis was compared between the two groups. RESULTS: Patients in the B-ultrasound (n=32) and laparoscopy (n=30) groups were comparable in terms of age, sex, primary disease type, volume of ascites, and free cancer cell (FCC)-positive ascites. After HIPPC, there were no significant differences between the B-ultrasound and laparoscopy groups in the KPS score change, ORR, and median survival time. The incidence of port-site metastasis after HIPPC was not significantly different between the B-ultrasound (3 of 32, 9.36%) and laparoscopy (3 of 30, 10%) groups, but significantly different among pancreatic, gastric, ovarian, and colorectal cancer (33.33, 15.79, 10.00, and 0.00%, p<0.001). CONCLUSION: The chimney effect may not be the key reason for port-site metastasis after laparoscopy. Other factors may play a role, including the local microenvironment at the trocar site and the delivery of viable FCCs (from the tumor or malignant ascites) to the trauma site during laparoscopic surgery.
Тема - темы
Humans , Ascites , Colorectal Neoplasms , Drug Therapy , Incidence , Karnofsky Performance Status , Laparoscopy , Neoplasm Metastasis , Ovarian Neoplasms , Perfusion , Surgical Instruments , Treatment OutcomeРеферат
A 33-year-old woman with very poor health status was admitted to our hospital because she had experienced increasing abdominal distention for three months, CT examination showed a right ovarian tumor together with massive abdominal and pelvic fluid. The patient was first treated by continuous circulatory hypothermic intraperitoneal perfusion chemotherapy [HIPC] guided by B-mode ultrasound, followed by cytoreductive surgery [CRS] after her ascites was controlled and her health condition improved. She was diagnosed with gestational choriocarcinoma [GC] based on the pathological examination of the hysterectomy specimen. She is still alive with very good health today. We think it may be a good choice for a patient in very poor health with GC accompanied by massive ascites to perform HIPC guided by B-mode ultrasound firstly, followed by CRS when the ascites has relieved and the patient's health has improved
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<p><b>OBJECTIVE</b>To evaluated the safety and efficacy of hyperthermic intraperitoneal perfusion chemotherapy(HIPC) in the prevention and treatment of pseudomyxoma peritonei (PMP) recurrence after cytoreductive surgery(CRS).</p><p><b>METHODS</b>Studies published in English before 2010 on HIPC after CRS for PMP were searched in PubMed database. Each study was carefully evaluated based on pre-determined criteria. Study results were comprehensively displayed in a form. A descriptive systematic review was performed.</p><p><b>RESULTS</b>A total of 11 studies were included. The median survival time of patients in these studies ranged from 25.6 months to 156 months. The ranges of 1-year, 2-year, 3-year, 5-year, and 10-year survival rates were 72%-100%, 55%-96%, 59%-96%, 52%-96%, and 55%-96%, respectively. The overall complication rate ranged from 2%-15%, and the total perioperative mortality were from 0 to 7%.</p><p><b>CONCLUSION</b>HIPC after CRS is effective and safe for patients with PMP.</p>
Тема - темы
Humans , Chemotherapy, Cancer, Regional Perfusion , Methods , Peritoneal Neoplasms , Drug Therapy , General Surgery , Postoperative Care , Pseudomyxoma Peritonei , Drug Therapy , General Surgery , Treatment OutcomeРеферат
<p><b>OBJECTIVE</b>To evaluate the inhibitory of profrin II nanoparticles photodynamic therapy on Lovo human colon cancer xenografts in athymic mice.</p><p><b>METHODS</b>Profrin II nanoparticles were obtained from hypersound emulsification method. LOVO human colon cancer xenograft were established in athymic mice. Athymic mice were divided into four groups:normal control group, profrin II nanoparticles control group, profrin II PDT group and profrin II nanoparticles PDT group. The animals bearing xenografts were treated 30 mg/kg body weight profrin II nanoparticles and 3 h later were irradiated with 9 J/cm(2) light from a diode laser. After Profrin II nanoparticles PDT, the anti-tumor effect was assessed by measuring tumor volume over a 3-4 weeks period, the morphologic changes were observed by microscopy and microscopy via the histological examination.</p><p><b>RESULTS</b>Compared with the control groups, profrin II nanoparticles control group, profrin II PDT group and profrin II nanoparticles-PDT treated tumors had regressed significantly in earlier period with the inhibiting rate being 87.9% (P<0.05), 87.5% (P<0.05) and 56.0% respectively (P<0.05). In the later period post-PDT, tumors growth resumed with a slower rate. Profrin II nanoparticles-PDT prolonged the survival time in the treated group with (38.0+/-6.0) days (P<0.05). Extensive damage to tumor tissue was found in the earlier period (7d) post-PDT, whereas in the later period (21d) post-PDT, islands of vital-looking tumor cells were observed around the damaged tissue.</p><p><b>CONCLUSION</b>Profrin II nanoparticles-PDT results in inhibition Lovo colon carcinoma growth in post-PDT earlier period in vivo, and can prolong the survival time of nude mice bearing xenografts significantly, whereas profrin II-PDT could not inhibit the growth of colon tumor completely.</p>