Treatment of peritoneal carcinomatosis from ovarian cancer. Present, future directions and proposals.

Peritoneal carcinomatosis, considered years ago as a final stage of unresectable cancer, can now be managed with curative intention by means of a radical cytoreductive surgical procedure with associated peritonectomy and intraperitoneal chemotherapy, as described by Sugarbaker. Malignant neoplasms such as mesothelioma and pseudomyxoma peritonei, ovarian and colon cancer nowadays are experiencing some new therapeutical approaches. Higher survival rates can be reached in ovarian cancer, which is commonly diagnosed in the presence of peritoneal carcinomatosis, using an optimal cytoreductive radical surgery with intraperitoneal chemotherapy. An actualised review of the treatment of advanced ovarian cancer and a proposal of a national multicentre protocol for the treatment of peritoneal carcinomatosis from ovarian cancer has been performed by a group of Spanish surgeons and oncologists dedicated to a therapeutical approach to this pathology.

Treatment of peritoneal carcinomatosis from ovarian cancer. Present, future directions and proposals

Peritoneal carcinomatosis, considered years ago as a final stage of unresectable cancer, can now be managed with curative intention by means of a radical cytoreductive surgical procedure with associated peritonectomy and intraperitoneal chemotherapy, as described by Sugarbaker. Malignant neoplasms such as mesothelioma and pseudomyxoma peritonei, ovarian and colon cancer nowadays are experiencing some new therapeutical approaches. Higher survival rates can be reached in ovarian cancer, which is commonly diagnosed in the presence of peritoneal carcinomatosis, using an optimal cytoreductive radical surgery with intraperitoneal chemotherapy. An actualised review of the treatment of advanced ovarian cancer and a proposal of a national multicentre protocol for the treatment of peritoneal carcinomatosis from ovarian cancer has been performed by a group of Spanish surgeons and oncologists dedicated to a therapeutical approach to this pathology (AU)

Management of peritoneal surface malignancy with cytoreductive surgery and perioperative intraperitoneal chemotherapy.

AIMS: A new treatment strategy combining maximal cytoreductive surgery for treatment of macroscopic disease and maximal perioperative intraperitoneal chemotherapy for residual microscopic disease, suggests that in a selected group of patients benefit is possible. The purpose of this study was to report our experience with this combined treatment and to identify the principal prognostic factors. METHODS: The study included 266 patients from 9 institutions operated on between July 1990 and July 2004. The median age was 55 years. RESULTS: The mortality rate was 7.8% and the morbidity rate 37.5%. The overall median survival was 13.7 months. Positive independent prognostic factors by multivariate analysis were gender, perioperative intraperitoneal chemotherapy and treatment by the second-look procedure. CONCLUSIONS: The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with an acceptable morbidity and mortality.

Seudomixoma peritoneal de origen apendicular / Pseudomyxoma peritonei of appendiceal origin

Introducción. El seudomixoma peritoneal constituye una afección inusual desencadenada a partir de tumoraciones mucinosas, cuyo origen más frecuente suele ser el apéndice cecal y el ovario. Desde que fue descrita por primera vez hace algo más de 100 años, esta entidad clínica ha planteado importantes controversias conceptuales, terapéuticas y pronósticas. Objetivo. Revisar nuestra experiencia en el tratamiento del seudomixoma peritoneal de origen apendicular. Pacientes y método. Se presenta una serie consecutiva de 11 casos de seudomixoma peritoneal de origen apendicular diagnosticados, tratados y seguidos en nuestro centro desde enero de 1982 hasta junio de 1997. En 6 casos se trató de mujeres y en cinco de varones, con una edad media de 65 años (rango, 31-93). Se analizan la sintomatología, el tratamiento y el pronóstico. El estudio de supervivencia se ha efectuado según el método de Kaplan-Meier. Resultados. No ha habido mortalidad postoperatoria. La supervivencia global ha sido del 57 por ciento a los 5 años. La causa del fallecimiento atribuible al seudomixoma peritoneal ha sido la oclusión intestinal intratable. En ningún caso se ha podido constatar enfermedad extraabdominal. Conclusiones. A pesar de ser una afección generalmente de bajo grado de malignidad, que se limita característicamente a la cavidad abdominal, el seudomixoma peritoneal de origen apendicular comporta una mortalidad importante (AU)

Must ERCP Be routinely performed if choledocholithiasis is suspected?

OBJECTIVE: To evaluate the results of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of those patients suspected of harboring bile duct stones before laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: A total of 1,235 consecutive LCs performed between 1991 and 1997 were studied prospectively. ERCP was performed to explore the common bile duct (CBD) preoperatively when choledocholithiasis was suspected on the basis of clinical, analytical or echographical data. RESULTS: ERCPs were performed in 268 patients: unsuccessful CBD evaluation in 3%; dilated CBD without lithiasis in 13%, and normal exploration in 37% (99 patients). CBD stones were found in 46% (124 patients), and endoscopic sphincterotomy was then performed and stone extraction attempted. Endoscopic therapy achieved 92.8% successful removal of CBD stones (115 patients). There was no ERCP-related mortality and the morbidity rate was 6%. Retained CBD stones have been observed in 7 cases after ERCP-LC; all of them have been successfully treated by ERCP. CONCLUSIONS: A combined approach to bile duct stones with selective use of ERCP followed by LC is a good therapeutical alternative. Nevertheless, the usual selection criteria for ERCP may lead to unnecessary exploration. It appears to be necessary to modify the current diagnostic and therapeutic strategy.

[Survival after resection of lung metastasis from colorectal cancer]. / Supervivencia tras resección de metástasis pulmonares de cáncer colorrectal.

OBJECTIVE: To analyze the results of resection of lung metastases from colorectal adenocarcinoma in selected patients, evaluating type of resection, morbidity and mortality associated with the procedure, and overall actuarial survival rates after surgery. PATIENTS AND METHODS: Between 1988 and 1996, 811 patients were treated surgically for colorectal adenocarcinoma. Recurrent chronic lung metastases were resected, presumably with the intention to cure, in 15 patients in the series. One patient underwent surgery for pelvic recurrence and another seven for liver metastases, before resection of the lung metastases. RESULTS: Twenty-seven wedge resections were performed, two being non-malignant and one patient requiring re-resection of new lung metastases. Unsuspected locations of lung metastasis were found in three patients during surgery. Perioperative mortality was zero. Mean follow-up was 50 months (range 28 to 99). Seven patients presented new occurrences of metastasis or tumor recurrence and died as a result. The actuarial survival rate was 48% at 5 years. CONCLUSIONS: In selected patients, surgical resection of lung metastasis from colorectal cancer, with the assumed intention of cure, has yielded a good survival rate and zero perioperative mortality. It appears advisable to use an approach that permits exhaustive palpation of the pulmonary parenchyma, due to the risk of finding unsuspected metastases.

Retroperitoneal liposarcomas. Study of 10 cases.

INTRODUCTION: Retroperitoneal liposarcomas are unusual tumors. Their biological and clinical features different from other retroperitoneal sarcomas. AIM: To analyze our series of retroperitoneal liposarcomas. PATIENTS AND METHODS: Retrospective study of 10 patients with retroperitoneal liposarcoma diagnosed in the last 16 years at our institution. Symptoms, diagnosis, treatment and prognosis were analyzed. RESULTS: Radical resection was done in all cases. Postoperative mortality was 10%. Complementary treatment was considered in each patient. Recurrent disease occurred in 8 patients (14 recurrences), during follow up. In 42% of them recurrences were resected. Actuarial 5-year survival rate was 44%. CONCLUSION: Poor prognosis of retroperitoneal liposarcoma is due to its high recurrence rate.

[Aneurysm of the antero-inferior pancreatoduodenal artery as a cause of massive digestive hemorrhage]. / Aneurisma de la arteria pancreatoduodenal ántero-inferior como causa de hemorragia digestiva masiva.

We report a case of anterior inferior pancreaticoduodenal artery aneurysm fissured to the duodenum, which obliged to an emergency operation. This is an infrequent cause of upper gastrointestinal bleeding. Diagnosis, therapeutic options and prognosis of this pathology are discussed.