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V preteklosti so bolnike z zasevki po peritoneju obravnavali kot neozdravljivo bolne s terminalnim stanjem raka, ki se zdravi samo paliativno. Ob takšnem pristopu je bilo povprečno preživetje bolnikov le dva meseca. Zdravljenje teh bolnikov se je v devetdesetih letih prejšnjega stoletja pomembno spremenilo. Nekateri raziskovalci so bili namreč mnenja, da so peritonealni zasevki v določenih primerih samo vrsta loko-regionalne bolezni in se bolnik lahko (p)ozdravi. Eden glavnih zagovornikov te teorije in novega načina zdravljenja je bil Paul Sugarbaker. V sklopu zdravljenja se je začela uporabljati citoreduktivna kirurgija v kombinaciji z intraperitonealno kemoterapijo. Namen kirurškega posega je bila makroskopska odstranitev tumorja, nato pa z intraperitonealno kemoterapijo odstranitev še morebitnih mikroskopskih “preostankov” bolezni. Postopek, pri katerem citostatik med operacijo uvedemo in segrevamo, se imenuje hipertermična intraperitonealna kemoterapija. Hipertermija ima že sama po sebi protitumorski učinek na maligne celice, saj povzroči razgradnjo proteinov, aktivranje lizosomov in apoptozo. Ob segrevanju raztopine citostatika potečejo zapletene kemijske reakcije, ki dodatno povečajo njegovo učinkovitost in povečajo globino prodiranja zdravila v tumorsko tkivo. O najboljših rezultatih te oblike zdravljenja so poročali v primerih psevdomiksoma peritoneja, raka debelega črevesa in danke, karcinoma slepiča, karcinoma jajčnikov in peritonealnega mezotelioma. V prispevku avtorji predstavijo to zahtevno metodo zdravljenja, indikacije in vključitvena merila bolnikov ter sodobna spoznanja o učinkovitosti te metode za določene vrste raka.

Isolated limb perfusion is a surgical procedure that can be used to treat an advanced malignant melanoma and soft tissue sarcomas, it is also effective in treating in-transit metastases of melanoma and local metastases of soft tissue sarcomas. With perfusion of the affected limb with cytostatic agents it is possible to avoid amputation and mutilating operations that significantly reduced the function of the limb. Since the procedure is isolated on a limb, it can be perfused with much higher doses of cytotoxic drugs, systemic toxicity is thus reduced or prevented. The most common side effects are erythema and edema.Cytotoxic drugs, that are manly used, are melphalan and tumor necrosis factor alpha. Efficient also proved to be simultaneous hyperthermia of the affected limb.

Background: Breast cancer is the most common cancer affecting women and the majority of cases require surgical treatment. In the last few decades evidence-based medicine allowed surgeons to develop methods requiring less extensive surgery. Even three decades ago, every case was treated by dissecting the whole breast along with the pectoralis major muscle, pectoralis minor muscle and the axillary lymph nodes. Today we treat more than half of patients by removing only part of the breast. And when dissecting the whole breast, we can often spare the skin envelope. Conclusions: Upon tumor removal many cases require breast reconstruction in order to retain the normal appearance of the breast. The evolution of breast reconstruction can be studied in two domains: after partial removal of the breast and after complete removal of the breast, each with its own methodologic requirements and different spectrum of complications. The reconstruction results have been improving in both domains. Radiotherapy is obligatory with partial breast dissection but also often required with complete breast dissection. The esthetic results of immediate breast reconstruction after complete removal of the breast tend to be worse in cases requiring radiotherapy. For that reason the majority of authors recommend delayed reconstruction.