Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): A French multicentric survey.

BACKGROUND: Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. METHODS: A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). RESULTS: Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. CONCLUSION: Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established.

[What do we know about the lymphatic drainage of the rectum?]. / Que savons-nous du drainage lymphatique du rectum ?

Lymph node (LN) involvement is one of the most significant prognostic factors of patients with rectal cancer. However, the distribution of rectal LN is not well known. The rectal LN are mainly located around the rectal arteries. In the mesorectum, the LN are mainly located posteriorly. The number of LN by patient varies considerably. Many reasons can explain this variability. Acquired factors such as infection, inflammation or metastatic involvement facilitate the detection of LN. In contrast, preoperative radiotherapy reduces the number and size of lymph nodes. The procedure of resection affects the number of LN harvested. Extensive lymphadenectomies increase the number of LN harvested. The technique used by pathologist has equally a major influence. The fat clearing method allows detection of a greater number of LN than manual dissection particularly for small LN. Toxicity of these solutions and a time-consuming process explain that fat clearing method is rarely used in clinical practice. Detection of rectal lymph nodes is difficult and tedious but is necessary for an accurate staging of patients with rectal cancer.

[Perineal gangrene: new bacteriologic approach. Results of medico-surgical treatment (81 cases)]. / Gangrènes périnéales: nouvelle approche bactériologique. Résultats du traitement médicochirurgical (81 cas).

STUDY OBJECTIVE: The objective of this retrospective study was to report the results of a series of 81 cases of perineal gangrene treated in the same center. PATIENTS AND METHODS: From 1988 to 1998, 81 patients (64 males, 17 females, mean age: 58 years) with perineal gangrene were treated by a medico-surgical team, by means of a protocol combining appropriate intensive care measures based on a new bacteriologic concept of infectious agents, extensive excisions and drainage of the infraperitoneal region and hyperbaric oxygen therapy. RESULTS: The mortality rate was 24.7%. Mean duration of intensive care stay was 19 days, mean duration of hospital stay was 31 +/- 4 days (range: 6 to 60 days). Risk factors were: age > 68 years (p = 0.001), shock (p = 0.83), subcutaneous crepitation (p = 0.25) and severity index > 10 (p = 0.003). Sequelae were anal incontinence (n = 3) and permanent colostomy (n = 5). Secondary plastic reconstruction was necessary in four patients. There were no urologic or genital sequelae. CONCLUSION: Perineal gangrene is still a very serious disease. The time to treatment, the simplified severity index and consideration of bacteriologic combinations are the main prognostic factors.