Isolated chemotherapeutic perfusion of the pelvis for advanced rectal cancer.

OBJECTIVE: Isolated pelvic perfusion exposes tissue to high doses of drug without the toxicity of high-dose systemic therapy and may benefit patients with advanced malignancy. PATIENTS AND METHODS: There were 32 patients with locally advanced, previously irradiated cancer of the rectum and 5 patients with anal canal cancer. These patients underwent a total of 65 isolated pelvic perfusions using 5-Fu (1500 mg/m2) for 60 min; cisplatinum (100 mg/m2) and mitomycin (10-20 mg/m2) were added to some perfusions. Hospital stay averaged 3-5 days. RESULTS: Palliative perfusion in 15 patients with advanced rectal cancer resulted in symptomatic relief from 1 to 4 months in 11 of 14 with pelvic pain and limited benefit in 6 patients with mass, but no pain. Pre-operative perfusion in 16 rectal cancer patients achieved a complete response (no tumour in pelvis) in 1 patient and significant tumour regression in 8 patients rendering them potentially resectable. Five were resected with clear margins. Three patients with recurrent epidermoid cancer had significant tumour regression and were resected with clear margins. CONCLUSION: Isolated chemotherapeutic perfusion of the pelvis provides excellent palliation for patients with advanced or pelvic recurrence of rectal cancer or epidermoid cancer of anorectum and may potentiate resection in selected patients.

Cytoreduction and intraperitoneal chemotherapy for the management of peritoneal carcinomatosis, sarcomatosis and mesothelioma.

Despite new developments in multi-modality treatments, complete resection remains as an absolute requirement for cure of gastrointestinal cancer. We have reported benefits from combined treatment with complete cytoreduction and intraperitoneal chemotherapy. This has been achieved with low morbidity and mortality. Success in the surgical management of peritoneal surface malignancy depends on the surgeon's ability to complete complex cytoreductive procedures so that only microscopic residual disease remains. This paper describes the current strategy that the surgical oncologist should pursue in the treatment of patients with peritoneal carcinomatosis, sarcomatosis and mesothelioma. Technical details required for this surgery include patient position, incision and exposure, complete lysis of adhesion, electroevaporative dissection with irrigation and suction to preserve the translucent quality of tissues, peritonectomy procedures, proper positioning of tubes and drains for intraperitoneal chemotherapy, and reconstructive surgery. Understanding the treatment and mastery of surgical skills to manage the peritoneal surface spread of cancer has led to long-term survival of selected patients. Combination of this treatment strategy with proper patient selection has reduced the mortality and morbidity. The success of cytoreductive surgery and perioperative intraperitoneal chemotherapy depends on a long-term dedication to achieve the full potential of a curative outcome. Our unit has continued to achieve good results over two decades as improved results of treatment have evolved.

Mesenteric cystic neoformations: report of two cases.

The authors present two case reports of mesenteric cystic neoformations which they themselves observed and, with the help of the literature regarding this pathology, discuss the problems of both diagnosis and treatment.

[The rational use of prosthesis in laparocele]. / L'impiego razionale delle protesi nei laparoceli.

The Authors report their cases of incisional hernias observed from 1990 to 1995 involving 142 patients treated either in emergency or under normal conditions. A guideline in the choice of prosthetic materials of current use, considering the relative chemo-physical characteristics, the biocompatibility and the costs is outlined. Although not entering into the merit of the surgical technique some general criteria that should guide the surgeon facing the incisional hernial pathology are ruled out.