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Treatment of colorectal peritoneal metastases with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is still evolving. Conducting a randomized trial is challenging due to the high heterogeneity in the presentation of peritoneal disease and various surgical approaches. Biological research may facilitate more rapid translation of information into clinical practice. There is an emerging need for a preclinical model to improve HIPEC treatment protocols in terms of drug doses and treatment durations. The aim of the study is to design a tool that serves as an in vitro three-dimensional (3D) microfluidic peritoneal metastatic colorectal cancer model to test the efficacy of different HIPEC treatments.

Aim: Our study aimed to establish a mouse model with colorectal cancer-induced peritoneal metastasis(PM) and to compare the efficacy of hyperthermic intraperitoneal chemotherapeutic agents, mitomycin C and oxaliplatin. Materials and Methods: The peritoneal metastasis model was established in nude mice using the CC531 colon carcinoma cell line. Models with PM were randomized into four groups of seven animals each: Group-1, control group; Group-2, hyperthermic intraperitoneal chemotherapy(HIPEC) with mitomycin C(MMC), and Group-3, HIPEC with Oxaliplatin(OXA). Results: Tumor development was achieved in all animals. While the tumor burden decreased significantly in the treatment Group-2(p=.013). In the PM mouse model, hyperthermic intraperitoneal administration of MMC had a higher tumoricidal effect than hyperthermic intraperitoneal administration of OXA. Conclusions: Our PM model provided a good opportunity to examine the efficacy of HIPEC and IPIP. Hyperethermic intraperitoneal mitomycin applied in the colorectal PM animal model was found to have higher tumoricidal activity than oxaliplatin. In future studies, we plan to evaluate efficacies of different drugs in the PM models we have created. [ABSTRACT FROM AUTHOR]

Introduction: Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management, and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdominopelvic surgery. Methods: Patients who had major intraoperative pelvic hemorrhage during complex abdominopelvic surgery at 11 tertiary referral centers between 1997 and 2017 were included. Patient characteristics, management strategies to control bleeding, short- and long-term postoperative outcomes were evaluated retrospectively. Results: There were 120 patients with a mean age of 56.6 ± 2.4 years and a mean BMI of 28.3 ± 1 kg/m2. While 104 (95%) of the patients were operated for malignancy, 16 (5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90 (75%). Major pelvic hemorrhage was managed simultaneously in 114 (95%) patients. Electrocauterization 27 (23%), pelvic packing 26 (22%), suturing 7 (6%), thumbtacks application 7 (6%), muscle welding 4 (4%), use of energy devices 2 (2%), and topical hemostatic agents 2 (2%) were the management tools. Combined techniques were used in 43 (36%) patients. Short-term morbidity and mortality rates were 48 (40%) and 2 (2%), respectively. High preoperative CRP levels (p = 0.04), history of preoperative radiotherapy (p = 0.04), longer bleeding time (p = 0.006), and increased blood transfusion (p = 0.005) were the factors associated with postoperative morbidity. Conclusion: Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdominopelvic surgery. [ABSTRACT FROM AUTHOR]

Background: Pancreatic ductal adenocarcinoma (PDAC) is aggressive, with more than 80% present with metastatic disease, and an overall survival of less than a year with systemic chemotherapy treatment. Cytoreductive surgery (CRS) and intraperitoneal chemotherapy are two treatment modalities being explored to improve the survival rates of these patients. Case presentation: A 45-year-old man presented with epigastric pain, mass, and weight loss. Investigations revealed a pancreatic tumour with liver and extensive peritoneal metastases. After 18 cycles of chemotherapy, there was significant disease regression which allowed CRS and HIPEC to be performed. HIPEC, PIPAC, and repeated intraperitoneal liquid chemotherapy have been shown to be safe. Longer survival and reduced disease related complications are among the advantages seen in published data. Conclusion: Complete cytoreduction and HIPEC, repeated cycles of either intraperitoneal chemotherapy or PIPAC, are associated with longer survival and reasonable adverse effects. Patients diagnosed with PDAC and peritoneal metastases should be considered for these treatment strategies. [ABSTRACT FROM AUTHOR]