Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of advanced epithelial and recurrent ovarian carcinoma: a single center experience.

BACKGROUND: With standard treatment of epithelial ovarian cancer (EOC), prognosis is very poor. The aim of this study is to show early and late results in patients who underwent cytoreductive surgery and intraperitoneal chemotherapy. PATIENTS AND METHODS: This was a retrospective single centre study. All patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) or modified early postoperative intraperitoneal chemotherapy (EPIC) were included in the study. RESULTS: In the period 1995-2014, 116 patients were treated, 55 with primary EOC and 61 with recurrent EOC. The mean age was 59 years (26-74). Statistically, median survival time was significantly longer in the group with primary advanced cancer of the ovary (41.3 months) compared to relapsed ovarian cancer (27.3 months). Survival for the primary EOC was 65 and 24% at 3 and 5 years, respectively. Survival for recurrent EOC was 33 and 16% at 3 and 5 years, respectively. Mortality was 1/116 (0.8%). Morbidity was 11/116 (9.5%). Peritoneal cancer index (PCI) was ≤20 in 59 (51%) patients and statistically, their average survival was significantly longer than in the group of 57 (49%) patients with PCI >20 (p = 0.014). CONCLUSIONS: In advanced or recurrent EOC, a curative therapeutic approach was pursued that combined optimal cytoreductive surgery and intraperitoneal chemotherapy. PCI and timing of the intervention (primary or recurrent) were the strongest independent prognostic factors.

Validation and feasibility of ex vivo sentinel lymph node "mapping" by methylene blue in colorectal cancer.

BACKGROUND/AIMS: There are currently divided opinions about the usefulness of sentinel lymph node mapping in colorectal carcinoma. This technique can potentially be useful in determining the volume of resection, reducing the number of analyzed lymph nodes limited to sentinel lymph nodes, and re-staging when metastases are detected in the sentinel lymph node. The aim of this study was to examine the feasibility of postoperative sentinel lymphatic node detection (hereinafter referred to as ex vivo sentinel lymph node mapping) in patients with colorectal carcinoma. METHODOLOGY: The clinical study included a total of 58 patients. Thirteen patients were intraoperatively excluded. Ex vivo sentinel lymph node mapping by methylene blue was used in this study to detect the lymphatic micrometastases. Lymph node preparations were also stained with hematoxylin eosin, followed by immunohistochemical staining of serial sections. RESULTS: Ex vivo sentinel lymph node technique was performed in 45 patients, successfully in 41/45 (91.1%). 22.9 lymph nodes (range: 11 to 43) and 1.7 sentinel lymph node (range: 0 to 4) were resected and stained. Sentinel lymph node staining was negative in 15/45 patients (33, 3% false negative results). CONCLUSIONS: Limited histopathology analysis by ex vivo sentinel lymph node mapping can not replace a complete histological analysis of all resected lymph nodes.

Double-barreled wet colostomy: urinary and fecal diversion.

PURPOSE: Double-barreled wet colostomy represents simultaneous urinary and fecal surgical diversion performed most commonly after pelvic exenteration as a palliative procedure or after actinic damage. We report the structural and functional results of double-barreled wet colostomy with special attention to surgical technique, morbidity and functional results compared to those described in the available literature. MATERIALS AND METHODS: We retrospectively followed 38 patients who underwent double-barreled wet colostomy at our institution from April 2003 to November 2007. The parameters were patient age and gender, the indication for double-barreled wet colostomy, postoperative morbidity and mortality, length of hospital stay and functional assessment by excreting excretory urography. RESULTS: A total of 38 double-barreled wet colostomies were performed at our institution, including 24 following total pelvic exenteration, 14 without resection, 9 in inoperable tumor cases and 5 in actinic damage cases. The postoperative morbidity rate was 15.7% with no treatment related mortality. Two patients had late postoperative complications, including stenosis of the ureterocolonic anastomosis and conduit necrosis, respectively. CONCLUSIONS: In our experience double-barreled wet colostomy has an acceptable morbidity and mortality rate, is performed without technical difficulties and does not require prolonged operative time. Double-barreled wet colostomy represents the procedure of choice in patients who require concurrent urinary and fecal diversion.

Hemodynamic and cardiovascular problems during modified hyperthermic intraperitoneal perioperative chemotherapy.

BACKGROUND/AIMS: Cytoreductive surgery and hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) significantly improves patients survival with peritoneal carcinomatosis especially in low-grade tumor e.g. ovarian and appendiceal adenocarcinoma, peritoneal pseudomyxoma and grade I gastric and colorectal cancer. METHODOLOGY: During a period of nine years, hemodynamic and cardiac functions combined with urinary output during hyperthermic intraoperative intraperitoneal chemotherapy were prospectively measured in 60 patients. RESULTS: Statistically significant hemodynamic and cardiac parameters were characterized by an increased heart rate and cardiac output as well as decreased systemic vascular resistance associated with an increased body temperature and decreased effective circulating volume. The tendency of urinary output was to decrease as the therapy progressed. CONCLUSIONS: HIPEC induces a hyperdynamic circulatory state requiring increased intravenous fluid administration, which avoids changes because of increased intra-abdominal pressure. Documented by normal blood pressure and adequate urinary output hemodynamic and intravenous fluids, titrated to frequent urinary output determination, can achieve cardiac stability.

Bulk agent Plantago ovata after Milligan-Morgan hemorrhoidectomy with Ligasure.

The aim of this study was to determine usefulness of the bulk agent Plantago ovata in reducing postoperative pain and tenesmus after open hemorrhoidectomy (Milligan-Morgan with Ligasure). Ninety-eight patients were randomized into two groups of 49 patients each. In both groups Milligan-Morgan open hemorrhoidectomy with Ligasure was performed. The first group received postoperatively two sachets daily of 3.26 g of the bulk agent, Plantago ovata, for 20 days. The control group was treated postoperatively with glycerin oil. There was no statistically significant difference in age, gender distribution and hemorrhoid grading, between the two groups. The pain score after first defecation (p < 0.001) and after 10 days (p < 0.01) and the global pain score (p < 0.001) was statistically significantly lower in the group treated with Plantago ovata, while there was no statistically significant difference in the pain level after 20 days (p > 0.05). The hospital stay was statistically significantly shorter in the group receiving Plantago ovata (2.6 +/- 0.6 vs 3.9 +/- 0.7 days, p < 0.001). The incidence of tenesmus was higher in the control group (40.8% vs 10.2%, p < 0.01). Treating patients with Plantago ovata after open hemorrhoidectomy, reduces pain, tenesmus rate and shortens postoperative hospital stay.