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Recent technological advances coupled with our improved understanding of the molecular and cellular mechanisms associated with cancer development have enabled better overall patient care. Among the newly identified biomarkers such as circulating tumor DNA or circulating tumor cells, hPG

International audience; Background: The French Society of Surgery has endorsed a cohort aiming to prospectively assess the frequency of recurrence after incisional hernia repair and to identify the risk factors.Methods: Consecutive patients undergoing incisional hernia repair in the participating centers were included in the prospective French Society of Surgery cohort over a 6-month period. Patients were followed up with a computed tomography scan at 1 y and a clinical assessment by the surgeon at 2 years.Results: A total of 1,075 patients undergoing incisional hernia repair were included in 61 participating centers. The median follow-up was 24.0 months (interquartile range: 14.0-25.3). The follow-up rates were 83.0% and 68.5% at 1 and 2 years, respectively. The recurrence rates were 18.1% at 1 year and 27.7% at 2 years. Recurrence risk factors at 2 years were a history of hernia (odds ratio = 1.57, 95% confidence interval = 1.05-2.35, P = .028), a lateral hernia (odds ratio = 1.84, 95% confidence interval = 1.19-2.86, P = .007), a concomitant digestive operation (odds ratio = 1.97, 95% confidence interval = 1.20-3.22, P = .007), and the occurrence of early surgical site complications (odds ratio = 1,90, 95% confidence interval = 1.06-3.38, P = .030). The use of surgical mesh was strongly associated with a lower risk of recurrence at 2 years (P < .001).Conclusion: After incisional hernia repair, the 2-year recurrence rate is as high as 27.7%. History of hernia, lateral hernia, concomitant digestive operation, the onset of surgical site complications, and the absence of mesh are strong risk factors for recurrence.

Resume La pandemie de COVID-19 modifie profondement l’organisation et l’acces aux soins, en particulier pour les pathologies neoplasiques peritoneales, dont la prise en charge curative mobilise des moyens importants en personnel, bloc operatoire et reanimation. Les groupes BIG-RENAPE et RENAPE proposent des pistes de reflexion et de priorisation pour leur prise en charge. Un renforcement des criteres habituels de selection est necessaire pour une prise en charge a visee curative : patients jeunes, avec peu de co-morbidites et une extension peritoneale limitee. Il est souhaitable de prioriser les pathologies pour lesquelles la chirurgie de cytoreduction associee ou non a une chimiohyperthermie intraperitoneale (CHIP) est le traitement de reference et celles pour lesquelles la chimiotherapie systemique ne peut etre une alternative temporaire ou prolongee : pseudomyxomes peritoneaux ; mesotheliomes peritoneaux malins resecables ; metastases peritoneales d’origine colorectale si resecables, non repondeuses a la chimiotherapie systemique et/ou apres 12 cures, carcinoses ovariennes en 1re intention si resecables et limitees ou en situation intervallaire apres un maximum de 6 cycles de chimiotherapie systemique. L’adjonction d’une CHIP devra etre discutee au cas par cas, en centre expert. La priorisation des indications devra prendre en consideration les conditions locales et la phase de la periode epidemique pour permettre une prise en charge peri-operatoire optimale.

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Pseudomyxoma peritonei is a clinical entity characterized by a gelatinous ascite associated with mucinous tumor deposits spreading on peritoneal surface and potentially invading abdominal organs. It is considered as a tumor process linked, in most of cases, to a mucinous appendiceal neoplasm. Pseudomyxoma peritonei may benefit from a therapeutic strategy combining cytoreductive surgery and intra-peritoneal chemotherapy, which has led to a major prognosis improvement. Different classifications are available and the last one corresponds to the WHO 2010 version, which individualizes pseudomyxoma peritonei in two classes: low grade and high grade mucinous carcinoma. The very low frequency of this entity and its specific therapeutic strategy need specific health care centres, as well as physicians and pathologists collaborating through dedicated networks. The aim of this article is to summarize the pathology, causes, mechanisms and therapeutic approaches of pseudomyxoma peritonei, as well as their interfaces with dedicated networks.

As part of the national 2009-2013 Cancer Plan, and with the support of the National cancer Institute and the French ministry of health, the National network for the treatment of rare peritoneal malignancies (RENAPE) has been organized. Its main objective is to optimize the framework for the healthcare management and treatment of rare peritoneal malignancies. This specific organization covers the whole national territory including clinical expert and specialized structures and should lead to an appropriate treatment based on expertise and proximity. Within the RENAPE network, the RENA-PATH group gathers the pathologists actively involved in the management of rare peritoneal malignancies. The actions of RENA-PATH are focused primarily on the harmonization of pathological diagnostic criteria, reporting of new cases in the RENAPE registry and histology reviewing.

Malignant primary peritoneal tumors are rare and should be kept in mind when peritoneal carcinomatosis is diagnosed without primary tumor found. The principal etiologies are peritoneal mesthelioma, pseudomyxoma peritonei and primary peritoneal serous carcinoma. Their diagnosis requires most of the time biopsy performing by laparoscopy that should prevent tumoral parietal diffusion (port sites on the middle line). The treatment of reference combines optimal cytoreductive surgery and perioperative intraperitoneal chemotherapy when general status allows performing it. The management of these diseases should be done into specialized centers, included into national network (RENAPE), because of specificity and complexicity of treatments and to facilitate clinical and fundamental research on rare disease.

So far, peritoneal carcinomatosis had been considered as the last progression stage of intra-abdominal cancers, and thus without any therapeutic recourse. During the last ten years, the association of tumour surgical resection and perioperative intraperitoneal chemotherapy (with or without hyperthermia) has proven to produce long term survival and even cure. This aggressive therapeutic strategy is associated with mortality and morbidity, which add to the mortality and morbidity of surgery and chemotherapy. It thus requires a careful patient selection conducted by specialized multidisciplinary teams. The main indications are peritoneal carcinomatosis on colorectal cancer, stomach cancer, ovarian cancer, pseudomyxoma and mesothelioma. The treatment can also be initiated secondarily, if carcinomatosis is detected during a procedure performed in a center where this type of treatment is not provided. An organ resection should thus be performed. The patient is then referred to a specialized center, either within the ten days following the procedure, or after three months, most of the time after an adjuvant therapy.

We report 42 cases of gastric cancer with peritoneal carcinosis treated with intraperitoneal chemohyperthermia. Intraperitoneal chemohyperthermia was achieved with a closed sterile circuit containing mitomycin C, 10 mg/l producing an input temperature varying from 46 to 49 degrees C for 90 minutes. There were three postoperative deaths: one pulmonary embolism at day 4, one multiple organ failure et day 4, and one septic shock at day 25 due to a colonic fistula. Two patients suffered complications: one opening of the duodenal stump requiring reoperation on day 5, and one prolonged postoperative ileus lasting to day 10. Of the 12 patients with ascites, resorption was achieved in 8. In patients with early-stage peritoneal carcinosis (granulations less than 5 mm) survival at 1, 2 and 3 years was 90%, 61% and 41% respectively. For those with more extensive carcinosis, survival at 1 year was 10%. Five patients survived more than 30 months, three have survived to 34, 43 and 73 months. Intraperitoneal chemohyperthermia is a new treatment for carcinosis of gastric origin. These early results must be assessed further with larger controlled.