Urinary and fecal incontinence in patients with advanced ovarian cancer treated with CRS + HIPEC.

PURPOSE: The objective of this work was to analyze the long-term prevalence of urinary and fecal incontinence and their impact on quality of life in patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (CRS + HIPEC). METHODS: This cross-sectional study included a series of patients with advanced and recurrent ovarian cancer treated by CRS + HIPEC, with a disease-free period of at least 12 months after the procedure. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), fecal incontinence using the Wexner test and the Fecal Incontinence Quality of Life (FIQL) questionnaire and global quality of life using the Short Form 36 (SF-36) survey. RESULTS: A total of 64 patients were included in the study, with a median age of 55 years (range 28-78). The urinary incontinence rate was 45% and the fecal incontinence rate was 20%. Up to 14% of the patients presented both types of incontinence. The presence of urinary or fecal incontinence generated a significant negative impact on quality of life in relation to patients without incontinence. DISCUSSION: Urinary and fecal incontinence is frequent in the follow-up of ovarian cancer patients treated with CRS + HIPEC. Reconsidering the approach to the pelvis without peritoneal metastases in the peritoneum could modify the incidence of these pelvic floor dysfunctions.

Risk factors and management of incisional hernia after cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal surface malignancies.

BACKGROUND: The incidence of incisional hernia in patients with peritoneal surface malignancies treated by cytoreduction plus hyperthermic intraperitoneal chemotherapy (HIPEC) remains unclear, and the criteria commonly used to indicate their repair cannot be applied in these patients. The objective of this work was to analyze the incidence of incisional hernias in these patients, identify the risk factors associated with their appearance, and propose an algorithm for their management. METHODS: We analyzed a series of patients with malignant pathologies of the peritoneal surface treated by cytoreduction with peritonectomy and HIPEC procedures between January 2008 and June 2017. Only patients with a minimum postoperative follow-up period of 12 months were included. RESULTS: Our series included 282 patients, 28 (10%) of whom developed an incisional hernia during the follow-up period. Fifty-one patients, all with ovarian cancer with peritoneal dissemination, did not receive HIPEC after cytoreduction as they were part of the control arm of the CARCINOHIPEC clinical trial (NCT02328716) or because they did not provide specific informed consent. In the multivariate analysis, treatment with HIPEC (OR 2.56, 95% CI [1.57, 4.31], p = 0.032) and the administration of preoperative systemic chemotherapy (OR = 1.59, 95% CI [1.26, 3.58], p = 0.041) were found to be independent factors related to the appearance of an incisional hernia. CONCLUSIONS: The incidence of incisional hernia after cytoreduction and HIPEC is within the ranges described in the literature for other abdominal surgery procedures. The use of systemic chemotherapy and treatment with HIPEC, in particular, were identified as factors related to their occurrence.

Endometriosis sobre ligamento redondo extrapélvico / Endometriosis affecting the extrapelvic round ligament

La afectación del ligamento redondo por endometriosis es infrecuente, oscilando según la bibliografía entre un 0,3 a un 14 % de las pacientes afectadas por endometriosis. Se localiza mas frecuentemente en el lado derecho y en su porción extrapélvica. Produce efecto masa y dolor variable con el ciclo. Generalmente hay afectación del compartimento posterior pélvico. La sospecha diagnóstica se basa en la anamnesis y exploración física, donde se objetiva una masa en región inguinal dolorosa. El diagnóstico por imagen a través de ecografía y resonancia magnética presenta una lesión ocupante de espacio con las mismas características que las lesiones endometrió-sicas pélvicas. Su manejo en la mayoría de las veces implica cirugía para su exéresis. Presentamos un caso de endometriosis sobre el ligamento redondo extrapélvico en el contexto de una endometriosis compleja en una paciente de 23 años con uropatía obstructiva

Endometriosis of the round ligament is a rare entity, it accounts for 0.3 to 14 % of patients affected by endome-triosis. The right side at extrapelvic slice is the most usual affected area. It cause swelling and changing mens-trual pain. Inguinal endometriosis is usually associated with posterior compartment of pelvis affectation. The diagnostic approach is base on accurate anamnesis and physical examination with a painful groin swelling. An space occupying lesion with the same properties as endometriosis pelvics injuries is show in Ultrasonography and Nuclear Magnetic Resonance. En-bloc resection surgery is the treatment of choice almost always. We report on a case of endometriosis of extrapelvic round ligament in a complex endometriosis 23 years-old patient, with obstructive uropathy context

[Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy associated toxicity in treatment of peritoneal carcinomatosis]. / Toxicidad asociada a la cirugía citorreductora y quimioterapia intraperitoneal hipertérmica en el tratamiento de la carcinomatosis peritoneal.

INTRODUCTION: Peritoneal carcinomatosis is a form of intra-abdominal dissemination of several tumours, which is associated with a poor prognosis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is an alternative treatment. The aim of this study is to describe the toxicity associated with this procedure in patients with peritoneal carcinomatosis. METHOD: We conducted a descriptive, retrospective, single-centre study, including all patients undergoing this procedure between December 2007 and January 2010. The following data were recorded: anthropometric data, personal and surgical events, indication, previous treatments, extent of carcinomatosis, intervention duration, hospital stay, and type of complications and/or adverse events following application of the multidisciplinary treatment. RESULTS: We performed 46 interventions on 45 patients diagnosed with peritoneal carcinomatosis from different causes, mainly ovarian cancer (83%). Paclitaxel was the most-used drug (35 interventions). There was no associated mortality, the average intervention time was 6.4 hours and the average hospital stay 7 days. We recorded adverse effects for 42 procedures, being grade 3-4 in 28.3% of the patients. The severe adverse events were: 10.9% gastrointestinal, 10.9% infectious, 6.5% haemorrhage or bleeding, 6.5% medullary toxicity, 4.4% respiratory, 2.2% coagulation and 2.2% hepatobiliary disorders. One patient developed grade III neutropaenia, probably associated with cisplatin. CONCLUSION: The morbidity and mortality is in line with the average of published studies, and has mainly been attributed to surgical complications. Toxicity data lower than other studies can be due to using more tolerable chemotherapy regimens, not including drug combinations and given that paclitaxel was the main drug.

Perioperative fast track program in intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery in advanced ovarian cancer.

INTRODUCTION: Diffuse peritoneal dissemination in advanced ovarian cancer can be treated using optimal effort surgery involving peritonectomy procedures and the administration of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC). OBJECTIVE: To report on our experience in the treatment of advanced ovarian cancer using peritonectomy procedures and HIPEC through the fast track program. PATIENTS AND METHOD: From September 2008 until May 2010, forty-six patients with primary advanced (stage III-C) or recurrent ovarian cancer have been included in the fast track protocol if they had optimal cytoreduction CC-0 or CC-1 accompanied by HIPEC and there had no more than one digestive anastomosis. RESULTS: The mean peritoneal cancer index (PCI) was 12.35 (3-21). The median operation time was 380 min (200-540). Optimal surgery CC-0 was achieved in 38 of the 46 patients and CC-1 in the remaining 8. Mean postoperative hospital stay was 6.94 ± 1.56 days (3-11). Major morbidity rates were 15.3%. Paralytic ileus was the most frequent of these. There was no mortality related to the procedure. CONCLUSION: Surgery with peritonectomy procedures and HIPEC in advanced ovarian carcinoma is possible under fast track surgery programs in patients with low volume peritoneal carcinomatosis. Prospective and randomized studies are needed.

Úlcera rectal penetrada a espacio presacro / No disponible

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Toxicidad asociada a la cirugía citorreductora y quimioterapia intraperitoneal hipertérmica en el tratamiento de la carcinomatosis peritoneal / Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy associated toxicity in treatment of peritoneal carcinomatosis

Introducción La carcinomatosis peritoneal es una forma de diseminación intraabdominal de diversos tumores, asociada con mal pronóstico. La realización de cirugia citorreductora y administración de quimioterapia intraperitoneal hipertérmica constituye una alternativa para su tratamiento. El objetivo del estudio es describir la toxicidad derivada del procedimiento en pacientes diagnosticados de carcinomatosis peritoneal. Métodos Estudio descriptivo, retrospectivo, unicéntrico, incluyendo todos los pacientes sometidos al procedimiento, entre diciembre de 2007 y enero de 2010. Se registraron: datos antropométricos, antecedentes personales y quirúrgicos, indicación, tratamientos previos, grado de carcinomatosis, duración de la intervención, estancia hospitalaria, así como el tipo de complicaciones y/o eventos adversos tras la aplicación del tratamiento multidisciplinario. Resultados: Se realizaron 46 intervenciones en 45 pacientes diagnosticados de carcinomatosis peritoneal de diferentes etiologías, mayoritariamente cáncer de ovario (83%). El fármaco más utilizado fue paclitaxel (35 intervenciones). No hubo mortalidad asociada, el tiempo medio de intervención fue 6,4h y la estancia media hospitalaria 7 días. Se registraron eventos adversos en 42 procedimientos, siendo de grado 3-4 en un 28,3% de los pacientes. Las incidencias de reacciones severas fueron: 10,9% gastrointestinales, 10,9% (..) (AU)

Introduction Peritoneal carcinomatosis is a form of intra-abdominal dissemination of several tumours, which is associated with a poor prognosis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is an alternative treatment. The aim of this study is to describe the toxicity associated with this procedure in patients with peritoneal carcinomatosis. Method We conducted a descriptive, retrospective, single-centre study, including all patients undergoing this procedure between December 2007 and January 2010. The following data were recorded: anthropometric data, personal and surgical events, indication, previous treatments, extent of carcinomatosis, intervention duration, hospital stay, and type of complications and/or adverse events following application of the multidisciplinary treatment. Results We performed 46 interventions on 45 patients diagnosed with peritoneal carcinomatosis from different causes, mainly ovarian cancer (83%). Paclitaxel was the most-used drug (35 interventions). There was no associated mortality, the average intervention time was 6.4hours and the average hospital stay 7days. We recorded adverse effects for 42 procedures, being grade 3-4 in 28.3% of the patients. The severe adverse events were: 10.9% gastrointestinal, 10.9% infectious, 6.5% haemorrhage or bleeding, 6.5% medullary toxicity, 4.4% respiratory, 2.2% coagulation and 2.2% hepatobiliary disorders. One patient developed grade III neutropaenia, probably associated with cisplatin. Conclusion The morbidity and mortality is in line with the average of published studies, and has mainly been attributed to surgical complications. Toxicity data lower than other studies can be due to using more tolerable chemotherapy regimens, not including drug combinations and given that paclitaxel was the main drug (AU)