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1.
Anticancer Res ; 40(5): 2865-2869, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366436

RESUMO

BACKGROUND: Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is associated with significant postoperative ileus (POI). This study examined intraoperative gastrointestinal wall thickness (GWT) and its association with patient outcomes. PATIENTS AND METHODS: A prospective study of patients undergoing CRS and HIPEC. Proximal and distal small intestine GWT, before and after HIPEC were recorded. RESULTS: Thirty-four patients (mean age=56.1 years, 61.8% female) were recruited. After HIPEC, the mean proximal (4.5 vs. 3.0 mm, p=0.03) and distal (4.3 vs. 3.4 mm, p<0.01) GWT were increased. Increased GWT was associated with prolonged operative time (10 vs. 8.5 h, p=0.03) and total length of stay (35.71 vs. 21.25 days, p=0.02). Postoperative ileus occurred in 23.5% of patients but differences between GWT groups did not reach significance (28.6% vs. 20%, p=0.56). CONCLUSION: GWT increased significantly during CRS and HIPEC and is reflective of tissue trauma and oedema. This was associated with prolonged operative time, total length of stay and post-operative ileus.


Assuntos
Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Trato Gastrointestinal/cirurgia , Neoplasias Peritoneais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/terapia , Estudos Prospectivos
2.
J Surg Oncol ; 121(8): 1298-1305, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32239529

RESUMO

BACKGROUND: Peritoneal carcinomatosis of colorectal adenocarcinoma (CRC) origin is common and is the second-most frequent cause of death in colorectal cancer. There is survival benefit to surgical resection plus hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with metastatic CRC. However, there remains controversy between oxaliplatin (Oxali) and mitomycin C (MMC), as the agent of choice. METHODS: A review of our 285 patients prospective HIPEC database from July 2007 to May 2018 identified 48 patients who underwent cytoreductive surgery plus HIPEC with MMC or Oxali. Patients were stratified based on preoperative and postoperative peritoneal cancer indices (PCI). The primary outcomes of survival and progression-free survival were compared. RESULTS: Type of HIPEC chemotherapy was not found to be predictive of overall survival. Preoperative PCI (P = .04), preoperative response to chemotherapy (P = .0001), and postoperative PCI (P = .05) were predictive for overall survival. CONCLUSIONS: MMC or Oxali based HIPEC chemotherapy are both safe and effective for the management of peritoneal only metastatic CRC. Both perfusion therapies should be considered with all patients receiving modern induction chemotherapy.


Assuntos
Neoplasias do Colo/terapia , Hipertermia Induzida/métodos , Mitomicina/administração & dosagem , Oxaliplatina/administração & dosagem , Neoplasias Peritoneais/terapia , Antineoplásicos/administração & dosagem , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Estudos Prospectivos , Taxa de Sobrevida
3.
Anticancer Res ; 40(3): 1481-1486, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132047

RESUMO

BACKGROUND/AIM: Peritoneal carcinomatosis is a sign of advanced ovarian cancer. If cytoreductive surgery results in a tumor-free situation with the remaining tumor being less than 0.25 cm, Hyperthermic intraperitoneal chemotherapy (HIPEC) may further improve prognosis. PATIENTS AND METHODS: Patients with ovarian cancer and peritoneal carcinomatosis underwent cytoreductive surgery. In 43 patients with optimal tumor debulking, HIPEC was performed. The peri- and post-operative course was observed. Adverse events were recorded after the Clavien-Dindo classification. RESULTS: The median age of the patients was 56 years, the median peritoneal cancer index (PCI) was 13, and the median operation time was 356 min. There was no postoperative surgery associated death. No adverse events were recorded in 16 (37.2%) of 43 patients, no grade III or IV adverse events were reported for 33 (76.7%) patients, and no grade IV adverse events were reported for 41 (95.3%) patients. Grade III adverse events occured in 19 (44.2%) of the 43 patients. Grade IV adverse events occured in 3 (7.0%) of the 43 patients. CONCLUSION: In ovarian cancer, multiple surgical procedures may be necessary in order to have macroscopically eradicated tumor tissue. The combination with HIPEC, further improves survival of patients with peritoneal carcinomatosis.


Assuntos
Carcinoma Epitelial do Ovário/terapia , Hipertermia Induzida/efeitos adversos , Neoplasias Ovarianas/terapia , Adulto , Idoso , Carcinoma Epitelial do Ovário/patologia , Carcinoma Epitelial do Ovário/cirurgia , Estudos de Coortes , Feminino , Humanos , Hipertermia Induzida/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Neoplasias Peritoneais/terapia
4.
Z Gastroenterol ; 58(2): 146-151, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32050285

RESUMO

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare diagnosis, found more frequently in men than in women. Symptoms are unspecific abdominal disorders making that diagnosis difficult to set. Causes of DMPM are yet to be discovered in entirety. Asbestos exposure is the reason for approximately 7 % of all peritoneal mesotheliomas. Until the evaluation of systematic cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) DMPM was a fatal diagnosis with a median overall survival (OS) of 4-13 months. The prognosis of DMPM dramatically improved with implementation of CRS and HIPEC to an OS of 30-92 month nowadys. CRS and HIPEC were performed in this case.


Assuntos
Antineoplásicos/administração & dosagem , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida/métodos , Mesotelioma/terapia , Neoplasias Peritoneais/terapia , Protocolos de Quimioterapia Combinada Antineoplásica , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Masculino , Mesotelioma/tratamento farmacológico , Mesotelioma/mortalidade , Mesotelioma/cirurgia , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/cirurgia , Prognóstico , Taxa de Sobrevida
5.
Medicine (Baltimore) ; 99(3): e18797, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011482

RESUMO

RATIONALE: Schwannomas are neoplasms that originate from Schwann cells of the peripheral nerve sheath with a low malignant potential. Considering that Schwannomas often occur in the upper extremities, trunk, head, and neck, but in the hepatoduodenal ligament has seldom been reported. PATIENT CONCERNS: A 70-year-old man was referred to our hospital for further evaluation of distension in upper abdomen. Abdominal ultrasonography reported that an anechoic mass was found between the pancreatic head and portal vein, which was measured to be about 5.5 × 4 × 4 cm. No blood flow signal was found within the mass by color doppler ultrasound. Subsequently, abdominal contrast enhanced computed tomography revealed that a well-defined round soft-tissue was above the pancreatic head and adjacent to the common heapatic artery, and it had no obvious enhancement in the arterial phase and portal phase. DIAGNOSES: Schwannomas in the hepatoduodenal ligament. INTERVENTIONS: After the work-up of a multidisciplinary team, a right complete excision was carried out and schwannoma was diagnosed by pathology. OUTCOMES: The patient's postoperative course was uneventful, and he left the hospital 10 days after the operation. Additionally, at the time of writing, recurrence was not observed with a follow-up of 17 months. LESSONS: schwannomas in the hepatoduodenal ligament are extremely rare with benign behavior. Surgical resection is the gateway to cure it; however, accurate preoperative diagnosis of the schwannomas in the hepatoduodenal ligament is a huge challenge because neither the clinical symptoms nor the imaging manifestations are specific.


Assuntos
Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/cirurgia , Idoso , Duodeno , Humanos , Fígado , Masculino , Neurilemoma/patologia , Neoplasias Peritoneais/patologia
7.
Oncology ; 98(4): 230-236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31962336

RESUMO

BACKGROUND: Synchronous colorectal peritoneal carcinomatosis (SCPC) is not a rare entity, and the prognosis is extremely poor compared to other metastatic sites such as the liver and lung. Therefore, optimal treatment based on tumor characteristics is needed. Recently, the tumor sidedness of colorectal cancer has been reported as one of the prognostic factors and also as a key factor for the treatment strategy. The purpose of this study was to assess the clinical impact of tumor sidedness in patients with SCPC. METHODS: A total of 189 cases of SCPC were identified in a retrospective database at Wakayama Medical University Hospital (WMUH) between 1998 and 2014, and were analyzed with a special focus on tumor location. RESULTS: In multivariate analysis, a right-sided location (p = 0.02) and the presence of liver metastases (p < 0.001) were found to be the worst prognostic factors. The median survival time (MST) with right-sided and with left-sided SCPC was 10 and 16 months, respectively. The right-sided SCPC group included more aged patients (p = 0.045) and fewer patients who received postoperative chemotherapy (p = 0.034). When we focused on patients with macroscopically complete resection (n = 39), the MST and disease-free survival in the right-sided SCPC group was significantly shorter than in the left-sided SCPC group (p = 0.030 and p = 0.043, respectively). The MST of the right-sided and the left-sided SCPC patients among the completely resected patients was 24 and 73 months, respectively. CONCLUSION: Tumor sidedness may be a potent prognostic indicator for patients with SCPC. The survival time with right-sided SCPC is dramatically reduced compared to that with left-sided SCPC, especially among completely resected cases. We should change the treatment strategy according to the location of SCPC.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Peritoneais/mortalidade , Adulto , Idoso , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Prognóstico , Estudos Retrospectivos
8.
Am J Surg Pathol ; 44(2): 206-213, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31651523

RESUMO

The chemotherapy response score (CRS) is used to score histopathologic response to neoadjuvant chemotherapy (NACT) of patients with extrauterine high-grade serous carcinoma. This study was undertaken to determine if the CRS in the omentum, adnexa or when combined correlates with (1) progression-free survival (PFS) or overall survival (OS), (2) laparoscopic score of abdominal disease, (3) Cancer antigen 125 levels, (4) BRCA status, and (5) platinum-resistant disease. A total of 158 cases were retrospectively collected that received NACT between April 2013 and February 2018 at a single institution. The 3-tier Böhm CRS system was applied to the omentum and adnexa. Survival outcomes between scored subgroups were analyzed using Cox proportional hazards regression. Spearman rank correlation analyses were used to assess CRS and clinical data. A total of 119 cases were treated only with carboplatin/paclitaxel. Omental CRS was: 1 (23 cases, 19.3%), 2 (65 cases, 54.6%), and 3 (31 cases, 26.1%), whereas adnexal CRS was: 1 (50 cases, 42%), 2 (48 cases, 40.3%) and 3 (21 cases, 17.6%). The omental CRS was significantly associated with PFS as a 2-tier score (hazard ratio [HR]=0.612, 95% confidence interval [CI]: 0.378-0.989, P=0.045) but not associated with the PFS using the 3-tier score or with OS using either system. Adnexal CRS was not associated with OS but was significantly associated with PFS using the 3-tier (HR=0.49, 95% CI: 0.263-0.914, P=0.025) and 2-tier scores (HR=0.535, 95% CI: 0.297-0.963, P=0.037). The combined score was not associated with OS but was significantly associated with PFS using the 3-tier (HR=0.348, 95% CI: 0.137-0.88, P=0.026) and 2-tier scores (HR=0.364, 95% CI: 0.148-0.896, P=0.028). No CRS system used associated with laparoscopic assessment of disease. CRS in the omentum had no significant association with platinum resistance; however, the adnexal CRS 1/2 were 3 times as likely to develop platinum resistance compared with CRS 3 (relative risk=3.94, 95% CI: 1.03-15.09, P=0.046). The CRS, when used on the omentum, adnexa, and as a combined score, was significantly associated with PFS but not with OS. Adnexal CRS 1/2 are more likely to develop platinum-resistant disease. Therefore, the use of this pathology parameter may be useful for clinical management.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Regras de Decisão Clínica , Cistadenocarcinoma Seroso/tratamento farmacológico , Neoplasias das Tubas Uterinas/tratamento farmacológico , Terapia Neoadjuvante , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Peritoneais/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Cistadenocarcinoma Seroso/mortalidade , Cistadenocarcinoma Seroso/patologia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias das Tubas Uterinas/mortalidade , Neoplasias das Tubas Uterinas/patologia , Neoplasias das Tubas Uterinas/cirurgia , Feminino , Seguimentos , Humanos , Laparoscopia , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
9.
J Clin Pathol ; 73(4): 220-222, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31611287

RESUMO

INTRODUCTION: Acellular intra-abdominal mucin is associated with a favourable prognosis in pseudomyxoma peritonei. There are no current guidelines on how many blocks are needed to classify the mucin as acellular with confidence. METHODS: Specimens from cytoreductive surgery for mucinous appendiceal neoplasia, in which acellular mucin was found on initial histopathological examination, were prospectively identified. Additional tissue blocks were then taken to include either all residual visible intra-abdominal mucin or a maximum of 30 blocks. We also sent a questionnaire to pathologists in other centres. RESULTS: Twelve patients were identified. In two cases, neoplastic epithelial cells were found on taking additional blocks. The questionnaire results suggested considerable variation in block-taking practice. CONCLUSION: Taking additional tissue identified neoplastic cells in 2 of 12 cases. We recommend that sampling additional material should be considered when only acellular mucin is found on initial histology. Further work to determine the optimum sampling protocol is indicated.


Assuntos
Neoplasias do Apêndice/diagnóstico , Mucina-1/metabolismo , Neoplasias Peritoneais/diagnóstico , Pseudomixoma Peritoneal/diagnóstico , Adolescente , Adulto , Neoplasias do Apêndice/cirurgia , Criança , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Masculino , Neoplasias Peritoneais/cirurgia , Prognóstico , Estudos Prospectivos , Pseudomixoma Peritoneal/cirurgia , Manejo de Espécimes , Adulto Jovem
10.
Trop Doct ; 50(1): 65-68, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735130

RESUMO

Neuroendocrine tumours (NET) are rare. They usually arise from the gastrointestinal or bronchopulmonary systems. Most are discovered incidentally and the small bowel tumours pose special difficulty in detection and treatment. Primary mesenteric involvement is very rare. Here we report such a case with a liver metastasis. This was preoperatively diagnosed and treated by enucleation of the mesenteric tumour together with right hepatectomy in a single sitting.


Assuntos
Neoplasias Hepáticas/secundário , Tumores Neuroendócrinos/secundário , Neoplasias Peritoneais/patologia , Idoso , Feminino , Humanos , Neoplasias Hepáticas/cirurgia , Tumores Neuroendócrinos/cirurgia , Neoplasias Peritoneais/cirurgia , Resultado do Tratamento
11.
Int J Gynecol Cancer ; 30(1): 62-66, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31744887

RESUMO

OBJECTIVE: Prediction of post-operative residual disease after ovarian cancer cytoreductive surgery remains a topic of interest to gynecologic oncologists. The aim of this study was to explore the correlation between serum CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer and their predictive value for post-operative outcome. METHODS: A total of 70 patients with primary epithelial ovarian cancer, who underwent primary cytoreductive surgery at Charité, Berlin between January 2013 and February 2014 were included. In all patients, pre-operative CA125 values, intra-operative peritoneal cancer index, and intra-operative mapping of ovarian cancer were determined. RESULTS: Using a receiver operating characteristic analysis, cut-off values for CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer score could be defined. Patients with pre-operative serum CA125 >600 U/mL had a three times higher risk for residual tumor after primary cytoreductive surgery (p=0.037). A peritoneal cancer index score >20 indicated a nine times increased risk for residual tumor (p=0.003). More than six affected abdominopelvic fields on the intra-operative mapping of ovarian cancer was associated with a 25 times higher risk of residual tumor after primary cytoreductive surgery (p≤0.05). The combination of all three values predicted residual tumor in up to 90% of patients. CONCLUSION: We found that pre-operative CA125 >600 U/mL, peritoneal cancer index >20, and intra-operative mapping of ovarian cancer score >6 could be used as predictors of complete tumor resection. The combination of all these three values predicted the incomplete resection of disease in up to 90% of patients even in experienced centers.


Assuntos
Antígeno Ca-125/sangue , Carcinoma Epitelial do Ovário/sangue , Carcinoma Epitelial do Ovário/cirurgia , Proteínas de Membrana/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Carcinoma Epitelial do Ovário/patologia , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Neoplasia Residual/sangue , Neoplasia Residual/patologia , Neoplasias Peritoneais/sangue , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Curva ROC , Estudos Retrospectivos
12.
Rev. esp. investig. quir ; 23(1): 13-18, 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-FGT-3941

RESUMO

INTRODUCCIÓN: El cáncer de ovario se acompaña de diseminación peritoneal en más de la mitad de los casos al diagnóstico. La afectación ganglionar es un factor añadido de mal pronóstico. La linfadenectomía lumboaórtica representa una opción terapéutica aunque existen discrepancias en la selección de pacientes y su impacto pronóstico. Se pretende evaluar algunos factores de riesgo de infiltración nodal para esta enfermedad y la influencia pronóstica de dicha linfadenectomía. PACIENTES Y MÉTODO: Estudio retrospectivo de 93 pacientes diagnosticadas de cáncer de ovario en estadio III entre 2006 y 2014. Un total de 52 (55,9%) enfermas sometidas a citorreducción completa u óptima se dividieron en dos grupos en ausencia o presencia de adenopatías retroperitoneales durante el diagnóstico preoperatorio, para analizar el objetivos del estudio. RESULTADOS: El análisis estadístico de variables clínicas e histopatológicas determinó relación de la prealbúmina (p = 0'027) y Ca125 (p = 0'048) con el riesgo de infiltración nodal. No se apreció un valor significativo en los parámetros relativos a la extensión peritoneal del cáncer. La linfadenectomía lumboaórtica mejoró la supervivencia libre de enfermedad (25'7±21'4 vs 35'6±22 meses) con relevancia estadística (p = 0'033) pero no presentó grandes variaciones en la supervivencia global (39'7±20'1 vs 41'9±20'8 meses). CONCLUSIONES: Un estado nutricional deteriorado y un Ca125 elevado podrían ser factores predictivos de afectación ganglionar. La linfadenectomía lumboaórtica podría incrementar la supervivencia libre de enfermedad ante una citorreducción adecuada y ausencia de complicaciones postquirúrgicas graves. Se necesitará un mayor reclutamiento de pacientes para conocer con más exactitud el patrón de enfermedad ganglionar a efectos de una indicación de linfadenectomía más selectiva


BACKGROUND: Ovarian cancer peritoneal spread is presented in more than half of the patients at diagnosis. Lymph node involvement is another poor prognostic factor. Lumboaortic lymphadenectomy is a therapeutic option under debate regarding patient selection and prognostic impact. Both possible nodal infiltration risk factors and lymphadenectomy prognostic influence are assessed for this form of disease. PATIENTS AND METHODS: Retrospective assessment of 93 patients diagnosed with stage III ovarian cancer between 2006 and 2014. A total of 52 (55.9%) patients undergoing complete or optimal cytoreduction were divided into two groups in the absence or presence of retroperitoneal adenopathies during preoperative diagnosis, to analyze the aims of the study. RESULTS: A sta-tistical analysis of clinical and histopathological factors showed a relationship from both prealbumin (p = 0.027) and Ca125 (p = 0.048) with respect to the risk of nodal infiltration. No significant value was found in the parameters related to the peritoneal spread of the cancer. Lumboaortic lymphadenectomy improved disease-free survival (25'7 ± 21'4 vs 35'6 ± 22 months) with statistical significance (p = 0.033) although no outstanding variations in overall survival (39'7 ± 20'1 vs 41'9 ± 20'8 months). CONCLUSIONS: A poor nutritional status and high Ca125 level could be predictive factors of lymph node involvement. Lumboaortic lymphadenectomy increases disease-free survival when a properly cytoreduction is possible without severe postoperative complications. A larger recruitment of patients will be needed to know more accurately the pattern of lymph node disease in order to perform a more selective indication for lymphadenectomy


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Peritoneais/cirurgia , Neoplasias Ovarianas/cirurgia , Prognóstico , Excisão de Linfonodo , Fatores de Risco , Estadiamento de Neoplasias , Intervalo Livre de Doença , Resultado do Tratamento
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1115-1117, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874525

RESUMO

Hyperthermic intraperitoneal chemotherapy (HIPEC) has a unique effect on the prevention and treatment of peritoneal metastasis from malignancies. Recently, the first prospective, multicenter, randomized controlled clinical trial of HIPEC to prevent the development of peritoneal metastasis after curative surgery for patients with locally advanced colon cancer was published in the "Lancet Gastroenterol Hepatol" (COLOPEC). Regrettably, no significant difference was observed in 18-month peritoneal metastasis-free survival between postoperative adjuvant HIPEC and standard systemic chemotherapy for patients with T4 stage or perforated colon cancer. However, we wonder whether we might achieve better outcomes by further optimizing the following issues: (1) We propose that the inclusion criteria for that trial may not be entirely reasonable, which included pT4N0-2M0 and perforation. Additionally, we found that 91% of patients underwent HIPEC 5-8 weeks after primary tumor resection. (2) The imbalance in starting time of postoperative systemic chemotherapy between the two groups may have a negative impact.(3) Nine patients with peritoneal metastasis preceding HIPEC might weaken the potential efficacy of HIPEC. (4) We wonder whether HIPEC using high-dese oxaliplatin (460 mg/m(2)) perfusing 30 minutes for one cycle is the optimal regimen. Therefore, we are planning to conduct a randomized controlled trial (HIPEC-06) in accordcance with the characteristics of Chinese patients, to explore the clinical efficacy of curative surgery combined with HIPEC in the treatment of cT4 colorectal cancer.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias Colorretais/terapia , Hipertermia Induzida/métodos , Oxaliplatina/administração & dosagem , Neoplasias Peritoneais/terapia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Terapia Combinada , Humanos , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia
14.
BMC Vet Res ; 15(1): 461, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856795

RESUMO

BACKGROUND: Peritoneal mesothelioma is a rare abdominal disease; that occasionally occurs congenitally in younger calves. Cytologic examination of peritoneal effusion (PE) was utilized to diagnose this disease, and was not diagnostic. Diagnostic accuracy has been elevated by recent use of ultrasonography (US), despite most diagnoses have been obtained post-mortem in slaughter houses or during clinical necropsy. In humans, ante-mortem diagnosis is highly associated with clinical use of computed tomography (CT) and laparoscopy together with imaging-assisted biopsy. The present report evaluates the diagnostic applicability of CT and laparoscopy as well as US via the practical application of these imaging modalities in an affected calf, and compares the cytologic and histologic findings among in PE, and specimens obtained from fine-needle aspiration and core-needle biopsy. In addition, the present results were reviewed in comparison with those of previous bovine and human reports. CASE PRESENTATION: A 58-day-old male Japanese black calf presented first with scrotal swelling, followed by progressive abdominal distention. Abnormalities of the case included: 1) accumulation of anechoic PE inside the swollen scrotum and abdomen; 2) formation of multiple echogenic nodules within the peritoneal membrane based on US images; 3) presence of hyper-dense spots (suspected calcification) along the margins of the nodules; 4) anatomic connections between intra-abdominal nodular lesions and the swollen tunica vaginalis via the inguinal region based on CT images; 5) serosanguineous-colored and less-turbid characteristics of PE; and 6) formation of multiple nodules over all of the serosa of the rumen as well as the peritoneal wall based on laparoscopic views. Fine-needle aspiration and core-needle biopsy were successfully performed under US and laparoscopic observations, respectively. Histology findings of the core-needle biopsy specimen appeared more indicative (characterization of tubular structures comprised of cubical or columnar abnormal mesothelial cell linings) diagnostically of peritoneal mesothelioma than did findings of the fine-needle aspiration specimen. CONCLUSIONS: To the best of our knowledge, this report is the first description of clinical applications of CT and laparoscopy to diagnose peritoneal mesothelioma in a calf. Laparoscopy enhanced the diagnostic accuracy due to clear gross visualization of the intra-abdominal abnormalities and applicability to imaging-guided core-needle biopsy.


Assuntos
Biópsia Guiada por Imagem/veterinária , Neoplasias Pulmonares/veterinária , Mesotelioma/veterinária , Neoplasias Peritoneais/veterinária , Tomografia Computadorizada por Raios X/veterinária , Animais , Líquido Ascítico/citologia , Bovinos , Laparoscopia/veterinária , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Mesotelioma/diagnóstico por imagem , Mesotelioma/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia
15.
World J Surg Oncol ; 17(1): 230, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31878943

RESUMO

BACKGROUND: Urinary system resections are performed during the cytoreductive surgery with hypertermic intraperitoneal chemotherapy (CRS-HIPEC). However, isolated ureter resection and reconstruction results are uncertain. The aim of this study was to evaluate the postoperative outcomes of isolated ureteral resection and reconstructions in patients who underwent CRC and HIPEC procedure. METHODS: A total of 257 patients that underwent CRC and HIPEC between 2015 and 2017 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University, were retrospectively analyzed. Twenty patients that had undergone isolated ureteral resection and reconstruction were included in the study. Predisposing factors were investigated in patients who developed postoperative complications. RESULTS: The mean age of the patients was 55.1 years. The mean follow-up time of all the patients was 11.6 months. Postoperative mortality occurred in two patients. The mean PCI score was 13.9. Postoperative urologic complications were observed in eight patients after ureter reconstruction. There was no statistically significant difference between the groups in terms of reconstruction techniques and postoperative complications (P = 302). There was no correlation between age (P = 0.571) and gender (P = 0.161) with complications. CRS-HIPEC was performed mostly due to gynecologic malignancy. However, there was no correlation between the primary cancer diagnosis and the development of complications (P = 0.514). The hospital stay duration was higher in the group with complications (16.3 vs 8.8 days, P = 0.208). CONCLUSIONS: Ureteral resections and reconstructions can be performed for R0/1 resections in CRS-HIPEC operations. It leads to an increase in hospital stay. But there is no significant difference in the development of complications. In the management of complications, conservative approach was sufficient.


Assuntos
Hipertermia Induzida/métodos , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/cirurgia , Ureter/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos de Citorredução/mortalidade , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Feminino , Humanos , Hipertermia Induzida/mortalidade , Hipertermia Induzida/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/patologia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/mortalidade , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos
16.
World J Surg Oncol ; 17(1): 192, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718654

RESUMO

PURPOSE: This study aimed to explore the value of preoperative ultrasonography (US) in evaluating the peritoneal cancer index (PCI) of pseudomyxoma peritonei (PMP). METHODS: An ultrasound examination was performed on 59 patients with PMP before surgery, and the ultrasound PCI was evaluated. The accuracy of ultrasound PCI score was evaluated with the surgical PCI score as the gold standard. RESULTS: The preoperative ultrasound PCI was compared with the surgical PCI. The Spearman correlation coefficient of the total PCI score was 0.608 (P < 0.05). The difference in the Spearman correlation coefficient between the preoperative ultrasound PCI and the surgical PCI in areas 0-7 was statistically significant. (1) Among them, the total score and the correlation between 0-3 and 6 were higher. (2) Compared with the surgical PCI, overestimation (> 20%) was concentrated mainly in areas 2 and 4-8 for 2 points, and underestimation (< 20%) was concentrated mainly in areas 1, 3, 4, and 8 for 3 points. (3) The sensitivity and specificity of preoperative ultrasound for predicting the presence or absence of lesions were 85.7% and 50.0%, respectively. The sensitivity of LS 1, LS 2, and LS 3 was 31.7%, 48.2%, and 71.0%, respectively, and the specificity was 44.8%, 55.3%, and 58.8%, respectively. CONCLUSION: The ultrasound examination can be used to score the preoperative PCI, judge the severity, and predict the prognosis in patients with PMP.


Assuntos
Neoplasias Peritoneais/patologia , Cuidados Pré-Operatórios , Pseudomixoma Peritoneal/patologia , Índice de Gravidade de Doença , Ultrassonografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Prognóstico , Pseudomixoma Peritoneal/diagnóstico por imagem , Pseudomixoma Peritoneal/cirurgia
17.
Eur J Radiol ; 121: 108696, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31683251

RESUMO

PURPOSE: Ovarian cancer (OC) is the commonest cause of death by gynaecological cancer in developed countries. Peritoneal carcinomatosis (PC) complete debulking without residual disease of >1 cm is the best prognostic predictor in advanced OC. PC is assessed with Computed tomography (CT). CT accuracy and cytoreduction success predictive ability are limited. PET/CT is not an imaging standard for PC. PC shows high signal foci in Diffusion-weighted magnetic resonance imaging (DWI MRI). We assessed the diagnostic performance (DP) and tumour burden correlation of Whole body DWI with background suppression MRI (WB-DWIBS/MRI) in PC of suspected OC using the Peritoneal Cancer Index (PCI), referring to cytoreduction surgery as the standard reference. METHOD: Fifty patients with suspicion of disseminated OC underwent cytoreduction and WB-DWIBS/MRI. The PCI scores tumour burden (0-3) in 13 anatomical regions (global range of 0-39). Two radiologists (Rad1/Rad2) assessed the PCI preoperatively and with surgical findings. We evaluated regional and global DP, the interobserver agreement (Cohen´s kappa coefficient), statistical differences (McNemar test) and tumour burden (Pearson's test). RESULTS: 72% (36/50) were epithelial OC and 78% (39/50) achieved complete cytoreduction. Global-PCI correlation was 0.762 (Rad1) with DP: Sensitivity 0.84, specificity 0.89, accuracy 0.89, and kappa 0.41. Average global-PCI was 7. The pelvis and right hypochondrium showed the highest positive rate and DP, while the intestinal regions presented the lowest. Previous studies reported higher sensitivity than CT or PET/CT, although only a few used the PCI. CONCLUSIONS: WB-DWIBS/MRI is reliable to depict, quantify and to predict complete cytoreductive surgery in OC PC.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasia Residual , Neoplasias Peritoneais/secundário , Peritônio/diagnóstico por imagem , Peritônio/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1051-1057, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770836

RESUMO

Objective: To explore the short-term efficacy and prognosis of palliative surgical treatment for malignant bowel obstruction (MBO) caused by peritoneal metastasis of colorectal cancer (mCRC). Methods: A retrospective cohort study was conducted. The inclusion criteria for patients were as follows: (1) primary colorectal cancer; (2) massive peritoneal metastasis; (3)obstructive site located below Treitz ligament by imaging; (4) obstruction refractory to conservative treatment; (5) estimated rese survival time more than 2 months; (6) patients and their families had strong willingness for operation; (7) surgical treatment included stoma/bypass and debulking surgery. In accordance with the above criteria, clinicopathological data of 46 patients undergoing palliative surgery at Peking University Gastrointestinal Cancer Center, Unit III from January 2016 to October 2018 were retrospectively collected. Postoperative symptomatic relief rate, morbidity of complication within 30 days, complication classification (Clavien-Dindo classification), mortality and survival after operation were analyzed. Kaplan-Meier method was used to evaluate survival and Cox regression analysis was used to identify prognostic factors. Results: Among 46 patients, 30 were male and 16 were female with median age of 63 (19-87) years; 23 patients received stoma/bypass surgery (stoma/bypass group), and 23 cases received tumor debulking surgery (debulking group). The overall symptom relief rate was 76.1% (35/46), while symptom relief rate in the debulking group was 91.3% (21/23), which was significantly higher than 60.9% (14/23) in the stoma/bypass group (χ(2)=4.301, P=0.038). Postoperative complications occurred in 25 patients. The complication rate was 52.2% (12/23) in the debulking group and 56.5% (13/23) in the stoma/bypass group, without statistically significant difference (χ(2)=0.088, P=0.767). Morbidity of complication beyond grade III was 8.7% (2/23) and 13.0% (3/23) in the debulking group and stoma/bypass group respectively, without statistically significant difference (χ(2)=0.224, P=0.636). Four patients died within 30 days after operation, 2 (8.7%) in each group. Twenty-four patients underwent 1-8 cycles of chemotherapy ± targeting therapy (regimens: CapeOX ± Bevacizumab, FOLFOX/FOLFIRI ± Bevacizumab/Cetuximab), including 10 cases in the stoma/bypass group and 14 cases in the debulking group. Two patients of debulking group received postoperative radiotherapy and chemotherapy (50.6 Gy/22 f, with concurrent oral capecitabine). Till the last follow up of April 2019, 34 patients died (34/46, 73.9%) with a median overall survival time of 6.4 months, and the 6-month and 1-year survival rate was 54.5% and 29.2% respectively. The median survival time in the debulking group was significantly longer than that in the stoma/bypass group (11.5 months vs. 5.2 months, χ(2)=5.117, P=0.024). The median survival time of the 35 patients with symptomatic relief after operation was significant longer than that of 11 patients without relief (7.1 months vs 5.1 months, χ(2)=3.844, P=0.050). Multivariate analysis showed stoma/bypass surgery (HR=2.917, 95%CI:1.357-6.269, P=0.006) and greater omental metastasis (HR=4.060, 95%CI:1.419-11.617, P=0.009) were independent risk factors associated with prognosis of patients with MBO caused by peritoneal mCRC. Conclusions: For patients of MBO caused by peritoneal mCRC, tumor debulking surgery may achieve higher symptom relief rate and prolong survival. Greater omental metastasis indicates poor prognosis.


Assuntos
Neoplasias Colorretais/patologia , Obstrução Intestinal/cirurgia , Cuidados Paliativos , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Omento , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/tratamento farmacológico , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
World J Surg Oncol ; 17(1): 170, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651341

RESUMO

BACKGROUND: Lymphangiomas are uncommon congenital malformations that present mainly in the head, neck, and axillar regions in pediatric patients. Mesenteric cystic lymphangiomas (MCLs), which occasionally present with substantial growth and the invasion of adjacent vital structures, are rarely reported in adults. We report a case of MCL in an adult who was treated with laparoscopic-assisted excision. CASE PRESENTATION: A 40-year-old Japanese man visited his family physician for prolonged periumbilical pain. Plain computed tomography (CT) showed a low-density mass in his left abdomen, and he was referred to our hospital 2 weeks later. His abdomen was flat and soft, and no mass was felt upon palpation. Routine laboratory data showed no abnormalities in the blood cell counts. The levels of tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125), were within normal ranges. Contrast-enhanced CT was performed, and a low-density mass was observed with an irregular outline and poor contrast, as well as involvement of the peripheral mesenteric artery and partial compression of the adjacent jejunum without dilatation of the oral side of the bowel. The patient was diagnosed with lymphatic cysts and observed for 1 month without symptom exacerbation. Follow-up CT showed no increase in the size of the mass but showed apparent invasion of the jejunal wall without bowel obstruction. Magnetic resonance imaging (MRI) showed intermediate intensity on T1-weighted imaging (T1WI) and high intensity on T2-weighted imaging (T2WI). The coronal view on T2WI clearly showed an accumulation of cystic lesions. We performed tumor excision with partial resection of the jejunum in a laparoscopic-assisted manner. Pathological examination showed multicystic lesions with an attenuated endothelial lining, surrounding rich adipose tissue and scattered smooth muscle fibers; the patient was diagnosed with MCL. Immunohistochemical assays supported this diagnosis. CONCLUSIONS: This is rare case of MCL presenting in an adult who underwent successful laparoscopic-assisted resection. Mesenteric lymphangioma (ML) should be considered in the differential diagnosis of patients with intraabdominal cysts. Radical excision is optimal, even when the patient is asymptomatic. Laparoscopic-assisted tumor resection is a suitable surgical method for treating MLs located in the peripheral mesentery.


Assuntos
Neoplasias do Jejuno/cirurgia , Laparoscopia/métodos , Linfangioma Cístico/cirurgia , Neoplasias Peritoneais/cirurgia , Adulto , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/patologia , Linfangioma Cístico/diagnóstico por imagem , Linfangioma Cístico/patologia , Masculino , Mesentério , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/patologia , Tomografia Computadorizada por Raios X
20.
Ann Surg Oncol ; 26(13): 4730-4736, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520212

RESUMO

BACKGROUND: Peritoneal tumor penetration (PP) strongly affects prognosis in gastrointestinal carcinomas. In gastrointestinal stromal tumor (GIST), its significance in the absence of tumor rupture has not been subjected to detailed analysis. METHODS: Patients undergoing complete resection for non-metastatic GIST from 2000 to 2017 were identified in the regional sarcoma database at Oslo University Hospital. Patients with extraperitoneal tumors (esophagus, rectum) or ruptured tumors were excluded from the study. Rupture was defined according to the Oslo criteria, and PP was assessed via routine histopathologic examination by sarcoma pathologists. RESULTS: The study enrolled 341 patients. The median follow-up period was 51 months (range 0-175) months. In 82 (24%) of the 341 patients, PP was recorded. There were 32 recurrences, 9 in patients with PP and 23 in patients without PP. Despite statistically significant associations between PP and established risk factors (size, mitotic index, non-gastric location), the 5-year recurrence-free survival rate did not differ between the patients with PP (86%) and those without PP (90%) (hazard ratio 1.25; 95% confidence interval 0.58-2.70; P = 0.577). Adjuvant imatinib was administered to 53 of 97 patients in the high-risk category. The recurrence rates did not differ between the PP-positive and PP-negative patients in either group. CONCLUSIONS: In GIST, PP without tumor rupture appears not to influence prognosis. This lack of prognostic significance may reflect unexplored differences between epithelial and mesenchymal malignancies.


Assuntos
Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/patologia , Neoplasias Peritoneais/secundário , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/cirurgia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
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