191 results on '"Peritoneal malignancy"'
Search Results
2. ED diagnosis of peritoneal carcinomatosis.
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Scheinfeld, Devorah, Schwartz, Carly, and Fink, Adam Z.
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PERITONEAL cancer , *COMPUTED tomography , *GASTROINTESTINAL system , *CARCINOMA , *STATISTICAL hypothesis testing - Abstract
Purpose: The goal of our study was to better characterize new CT diagnoses of peritoneal carcinomatosis (PC) in the ED, and to evaluate how to best identify the primary lesion. Prompt identification of the source of the carcinomatosis may allow for the patient to receive early initial care from the correct clinical service. Methods: All new CT cases of PC-like appearance identified on CT in the ED from January 2017 through July 2020. Each report and corresponding medical record were manually reviewed. Patient demographics, presence/absence of intravenous contrast, source organ predicted by the radiologist in the CT scan report, pathologic diagnosis, and amount of ascites were tabulated. Chi-tests were used to test the statistical significance of differences between groups. Results: Of the 131 CT cases of new PC-like appearance which received workup, 108 cases had pathologically proven PC and 23 cases had no underlying malignancy yielding a positive predictive value for actual PC of 82%. The most common cause of new PC in women was gynecological (66%), and in men was of GI tract origin (57%). Concordance between radiologist prediction and final pathology was higher with intravenous contrast (58%) compared to without contrast (40%); although this difference was not statistically significant (p = 0.19). A moderate or large amount of ascites was found in more than half of GYN primaries and in adenocarcinoma of unknown primary and there was a statistically significant difference in amount of ascites between cancer primaries (p = 0.01). Conclusion: A PC-like appearance on CT in the ED will likely be in patients with known malignancy, but of the new cases, there is a high PPV for it to represent new peritoneal carcinomatosis. Gynecological and GI malignancies are the most common cause in women and men, respectively, and this may help in focusing the radiologist's search pattern. Usage of intravenous contrast may help in identifying a primary lesion, and the presence of high-volume ascites should suggest a GYN primary or adenocarcinoma of unknown primary when there is no other obvious primary lesion. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Evaluating geographical disparities on clinical outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
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Siu, Adrian, Steffens, Daniel, Ansari, Nabila, Karunaratne, Sascha, Solanki, Henna, Ahmadi, Nima, Solomon, Michael, Moran, Brendan, and Koh, Cherry
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HYPERTHERMIC intraperitoneal chemotherapy , *CYTOREDUCTIVE surgery , *PERITONEAL cancer , *TREATMENT effectiveness , *HEALTH services accessibility - Abstract
Background: Rural Australians typically encounter disparities in healthcare access leading to adverse health outcomes, delayed diagnosis and reduced quality of life (QoL) parameters. These disparities may be exacerbated in advanced malignancies, where treatment is only available at highly specialised centres with appropriate multidisciplinary expertise. Thus, this study aims to determine the association between patient residence on oncological, surgical and QoL outcomes following cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC). Methods: A retrospective analysis was conducted on consecutive patients undergoing CRS and HIPEC at Royal Prince Alfred Hospital from January 2017 to March 2022. On the basis of their postcode of residence, patients were stratified into metropolitan and regional groups. Data encompassing demographics, oncological, surgical and QoL outcomes were compared. Statistical analysis included chi-square test, t-tests and Kaplan–Meier survival curves. Results: Among the 317 patients, 228 (72%) were categorised as metropolitan and 89 (28%) as regional. Metropolitan patients presented higher rates of recurrence (61.8% versus 40.0%, p = 0.014) and shorter overall mean survival [3.8 years (95% CI: 3.44–4.09) versus 4.2 years (95% CI: 3.76–4.63), p = 0.019] compared with regional patients. No other statistically significant differences were observed in oncological, surgical and QoL outcomes. Conclusions: Most oncological, surgical and QoL parameters did not differ by geographical location of patients undergoing CRS and HIPEC for peritoneal malignancies at a high-volume quaternary referral centre. Observed differences in recurrence and survival may be attributed to the selective nature of surgical referrals and variable follow-up patterns. Future research should focus on characterising referral pathways and its influence on post-operative outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Weekend Discharge Is Not Associated With Increased Readmission After Hyperthermic Intraperitoneal Chemotherapy.
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Florissi, Isabella, Radomski, Shannon N., Shou, Benjamin, Cloyd, Jordan M., Kim, Alex, Grotz, Travis, Fournier, Keith, Baumgartner, Joel M., Lambert, Laura, Abbott, Daniel E., Schwartz, Patrick, Staley, Charles A., Clarke, Callisia, Dineen, Sean, Patel, Sameer H., Wilson, Gregory C., Raoof, Mustafa, Johnston, Fabian M., and Greer, Jonathan B.
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HYPERTHERMIC intraperitoneal chemotherapy , *PATIENT readmissions , *PERITONEAL cancer , *HOSPITAL admission & discharge - Abstract
We explored the association between weekend discharge and 30- and 90-d readmission rates in patients undergoing hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal carcinomatosis. The US HIPEC Collaborative database, comprised of a longitudinal cohort of patients undergoing CRS/HIPEC for peritoneal carcinomatosis at twelve academic institutions between 2000 and 2017, was queried for date of discharge information. Patients were retrospectively divided into weekday and weekend/holiday discharge groups. Patients <18 y old, lacking day of discharge information, or who experienced intraoperative/in-hospital mortality were excluded. Comparisons were made between patients discharged on a weekday versus those discharged on a weekend or major holiday. 1415 patients met inclusion criteria for the study: 1108 (78%) patients with a weekday discharge and 308 (22%) with a weekend/holiday discharge. Median age at time of surgery was 55 y (Interquartile Range: 46-63); 59% (n = 841) patients were female, 25% (n = 328) of patients had high volume disease (defined as a peritoneal cancer index >20 intraoperatively), and 92% (n = 1210) of patients had a complete cytoreduction (defined as a completeness of cytoreduction score of 0 or 1). Overall, 15% (n = 218) of patients were readmitted within 30 d and 19% (n = 265) within 90 d. In a linear mixed effects model, weekend discharge was not associated with higher 30- or 90-d readmissions (P = 0.291, P = 0.743). Weekend discharges are safe following CRS/HIPEC. Length of stay initiatives should focus on discharging the patient when medically ready, rather than avoiding weekend discharge out of an abundance of caution. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Personalising care for patients: implementing a treatment summary folder following cytoreductive surgery.
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Dyer, Sandra, Campbell, Karen, and Lavender, Verna
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PILOT projects , *ADJUVANT chemotherapy , *MEDICAL information storage & retrieval systems , *THERMOTHERAPY , *CONFIDENCE , *POSTOPERATIVE care , *INDIVIDUALIZED medicine , *RETROSPECTIVE studies , *ACQUISITION of data , *SATISFACTION , *PATIENTS' attitudes , *QUALITATIVE research , *DOCUMENTATION , *HUMAN services programs , *CANCER patients , *MEDICAL records , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *CYTOREDUCTIVE surgery , *DISCHARGE planning - Abstract
The article focuses on the implementation of a personalized treatment summary folder for patients who underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). It mentions study aimed to gather patient feedback on the folder's content and timing, with results indicating that the folder was highly helpful, provided appropriate information, and increased patient confidence upon discharge for the majority of respondents.
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- 2023
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6. Advances in the management of myeloma: an update.
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Evans, Victoria, Taher, Rayan, Tzivanakis, Alexios, Perkins, Siân, Westbrook, Samantha, Clarke, Alison, Andrews, Louisa, and Stanford, Sophia
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THERAPEUTIC use of protease inhibitors , *MULTIPLE myeloma treatment , *THERAPEUTIC use of monoclonal antibodies , *OCCUPATIONAL roles , *NURSING , *IMMUNOMODULATORS , *TUMOR classification , *TREATMENT effectiveness , *NURSES , *QUALITY of life , *MULTIPLE myeloma , *NURSE practitioners , *DRUG side effects , *CYTOGENETICS , *OVERALL survival , *SYMPTOMS - Abstract
Background: A patient survey highlighted that patients treated with cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) at one NHS trust lacked confidence with the transition of care between teams. A personalised folder of treatment information was designed and given to patients prior to discharge. Aims: To obtain patient feedback on the implementation and content of the folder Methods: 30 consecutive patients were given the folder at discharge. Participants completed an online questionnaire to determine whether the information in the folder was appropriate, given at the right time in the pathway and enhanced confidence on discharge. Findings: 90% response rate was achieved. Of the respondents, 96% strongly agreed/agreed that the folder was helpful, 4% disagreed; 92% strongly agreed/agreed that the amount of information was right, 8% preferred more information, none less; 74% agreed/strongly agreed that the folder was provided at the right time; 96% said that the content met their expectations. Conclusion: Patients treated with CRS and HIPEC have specific needs related to their treatment. Implementation of the patient information folder at discharge increases patient confidence. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Incidence and outcomes of delayed presentation and surgery in peritoneal surface malignancies.
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Tan, Jun Kiat Thaddaeus, Si Min Wong, Jolene, Chin Jin Seo, Lim, Cindy, Hong-Yuan Zhu, Ong, Chin-Ann Johnny, and Chia, Claramae Shulyn
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TREATMENT delay (Medicine) ,PERITONEAL cancer ,HYPERTHERMIC intraperitoneal chemotherapy ,PROGRESSION-free survival ,PROPORTIONAL hazards models ,CYTOREDUCTIVE surgery - Abstract
Background: Peritoneal surface malignancies (PSM) present insidiously and often pose diagnostic challenges. There is a paucity of literature quantifying the frequency and extent of therapeutic delays in PSM and its impact on oncological outcomes. Methods: A review of a prospectively maintained registry of PSM patients undergoing Cytoreductive Surgery and Hyperthermic Intra-peritoneal Chemotherapy (CRS-HIPEC) was conducted. Causes for treatment delays were identified. We evaluate the impact of delayed presentation and treatment delays on oncological outcomes using Cox proportional hazards models. Results: 319 patients underwent CRS-HIPEC over a 6-years duration. 58 patients were eventually included in this study. Mean duration between symptom onset and CRS-HIPEC was 186.0 ± 37.1 days (range 18-1494 days) and mean duration of between patient-reported symptom onset and initial presentation was 56.7 ± 16.8 days. Delayed presentation (> 60 days between symptom onset and presentation) was seen in 20.7% (n=12) of patients and 50.0% (n=29) experienced a significant treatment delay of > 90 days between 1
st presentation and CRS-HIPEC. Common causes for treatment delays were healthcare provider-related i.e. delayed or inappropriate referrals (43.1%) and delayed presentation to care (31.0%). Delayed presentation was a significantly associated with poorer disease free survival (DFS) (HR 4.67, 95% CI 1.11-19.69, p=0.036). Conclusion: Delayed presentation and treatment delays are common and may have an impact on oncological outcomes. There is an urgent need to improve patient education and streamline healthcare delivery processes in the management of PSM. [ABSTRACT FROM AUTHOR]- Published
- 2023
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8. A Review of the Use of Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancy in Pediatric Patients.
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Byrwa, David J., Twist, Clare J., Skitzki, Joseph, Repasky, Elizabeth, Ham III, P. Ben, and Gupta, Ajay
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THERAPEUTIC use of antineoplastic agents , *ADJUVANT chemotherapy , *ONLINE information services , *CINAHL database , *MESOTHELIOMA , *THERMOTHERAPY , *MEDICAL information storage & retrieval systems , *SAMPLE size (Statistics) , *SYSTEMATIC reviews , *CANCER chemotherapy , *RHABDOMYOSARCOMA , *PEDIATRICS , *SURGICAL complications , *PERITONEUM tumors , *COLORECTAL cancer , *CISPLATIN , *MEDLINE , *CYTOREDUCTIVE surgery , *OVERALL survival - Abstract
Simple Summary: Hyperthermic intraperitoneal chemotherapy (HIPEC) is used to target microscopic peritoneal disease which can remain after visible disease has been surgically removed. It is used in the management of multiple adult cancer types, yet its use in the pediatric population is limited. This review paper provides an overview of the use of this modality in pediatrics in order to identify chemotherapy choice, document reported post-operative morbidity and mortality, and evaluate impact on overall survival. The use of HIPEC, most commonly with cisplatin, is generally tolerable with short-term post-operative complications and no reported post-operative mortality, yet the impact on overall survival versus systemic chemotherapy and debulking surgery is uncertain due to lack of clinical trials and small sample size. Continued gathering of outcome data of pediatric patients treated with HIPEC will aid the rational and safe application of HIPEC to pediatric peritoneal malignancies. Hyperthermic intraperitoneal chemotherapy (HIPEC) can directly target microscopic peritoneal disease, has achieved regular consideration in the treatment of several adult cancer types, and is more recently being studied in pediatrics. This review paper provides an overview of the use of this modality in pediatrics in order to identify medication choice, discuss post-operative morbidity and mortality, and evaluate impact on overall survival. Four databases were searched including Scopus, PubMed, Embase, and CINAHL and ultimately 37 papers documenting the use of this modality comprising 264 pediatric patients were included. Malignancies treated include desmoplastic small round cell tumor, rhabdomyosarcoma, angiosarcoma, colorectal carcinoma, and mesothelioma, with several rarer tumor types. Cisplatin was the most commonly used drug for HIPEC at varying concentrations for 30–90 min in duration at temperatures of approximately 41–42 °C. Reported toxicities were generally self-limited and there was no post-operative mortality. The impact on overall survival versus systemic chemotherapy and debulking surgery is uncertain due to lack of clinical trials and very small sample size across tumor subsets and the overall pediatric population. The relationship between degree of tumor burden and extent of surgical debulking needs to be further clarified. Future directions include prospective clinical trials, establishment of patient databases to facilitate standardization of HIPEC in pediatric patients, and additional approaches to optimize HIPEC. [ABSTRACT FROM AUTHOR]
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- 2023
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9. Current Research and Development in Hyperthermic Intraperitoneal Chemotherapy (HIPEC)—A Cross-Sectional Analysis of Clinical Trials Registered on ClinicalTrials.gov.
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Ukegjini, Kristjan, Guidi, Marisa, Lehmann, Kuno, Süveg, Krisztian, Putora, Paul Martin, Cihoric, Nikola, and Steffen, Thomas
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ADJUVANT chemotherapy , *DISEASE progression , *STOMACH tumors , *THERMOTHERAPY , *OVARIAN tumors , *PERITONEAL cancer , *SYSTEMATIC reviews , *CROSS-sectional method , *TREATMENT effectiveness , *COLORECTAL cancer , *DESCRIPTIVE statistics , *CYTOREDUCTIVE surgery , *MEDICAL research , *CLINICAL trial registries , *EVALUATION - Abstract
Simple Summary: Peritoneal metastases have a poor prognosis, and one potential treatment option is cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). The specific role of HIPEC is still poorly defined. In this cross-sectional study, we systematically analyzed all HIPEC trials registered on ClinicalTrials.gov to identify current research areas and to provide a perspective on expected outcomes. Only 11% (n = 26) of HIPEC trials registered on ClinicalTrials.gov (n = 234) have been published. The registered trials are very heterogeneous regarding methodological approaches and study designs. Currently, research is being conducted on 20 different drugs. The most studied cancers in HIPEC trials are peritoneal metastatic colorectal tumors, gastric cancer, and ovarian cancer. Introduction: Over the past two decades, cytoreductive surgery and HIPEC has improved outcomes for selected patients with peritoneal metastasis from various origins. This is a cross-sectional study with descriptive analyses of HIPEC trials registered on ClinicalTrials.gov. This study aimed to characterize clinical trials on HIPEC registered on ClinicalTrials.gov with the primary objective of identifying a trial focus and to examine whether trial results were published. Methods: The search included trials registered from 1 January 2001 to 14 March 2022. We examined the associations of exposure variables and other trial features with two primary outcomes: therapeutic focus and results reporting. Results: In total, 234 clinical trials were identified; 26 (11%) were already published, and 15 (6%) trials have reported their results but have not been published as full papers. Among ongoing nonpublished trials, 81 (39%) were randomized, 30 (14%) were blinded, n = 39 (20%) were later phase trials (i.e., phases 3 and 4), n = 152 (73%) were from a single institution, and 91 (44%) had parallel groups. Most of the trials were recruiting at the time of this analysis (75, 36%), and 39 (20%) were completed but had yet to publish results. In total, 68% of the trials focused on treatment strategies, and 53% investigated the oncological outcome. The most studied neoplasms for HIPEC trials were peritoneally metastasized colorectal cancer (32%), gastric cancer (29%), and ovarian cancer (26%). Twenty different drugs were analyzed in these clinical trials. Conclusions: Many study results are awaited from ongoing HIPEC trials. Most HIPEC trials focused on gastric, colorectal, or ovarian cancer. Many clinical trials were identified involving multiple entities and chemotherapeutic agents. [ABSTRACT FROM AUTHOR]
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- 2023
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10. Fear of Cancer Recurrence in peritoneal malignancy patients following treatment: a cross-sectional study.
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Taher, Rayan, Carr, Norman John, Vanderpuye, Nancy, and Stanford, Sophia
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Purpose: To assess Fear of Cancer Recurrence (FCR)—its prevalence, trajectory, and relationship to several demographic and clinical characteristics, and quality of life—in a sample of peritoneal malignancy survivors, up to 5 years post-surgery. Methods: The Fear of Cancer Recurrence Inventory—Short Form (FCRI-SF) and 36-Item Short-Form Health Survey (SF-36) were used to collect cross-sectional data from peritoneal malignancy survivors to assess their Fear of Cancer Recurrence and quality of life respectively as well as other demographic and clinical data. Results: The results show that more than two-thirds of the participants (N = 301) experience severe/clinical FCR. FCR is relatively stable over time. Younger patients who are struggling with anxiety or depression or receiving professional mental health support at the time of the surgery are at a higher risk of FCR. FCR is associated with a worse quality of life. Conclusions: Peritoneal malignancy survivors are at a high risk of FCR, and it compromises their psychological, mental, and social well-being (quality of life). Implications for cancer survivors. Raise awareness about the high risk of FCR in this population and the demographic and clinical factors that are associated with it. Encourage peritoneal malignancy services and health professionals to address FCR in this population by normalizing it and providing support for those struggling with it. [ABSTRACT FROM AUTHOR]
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- 2023
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11. Incidence and outcomes of delayed presentation and surgery in peritoneal surface malignancies
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Jun Kiat Thaddaeus Tan, Jolene Si Min Wong, Chin Jin Seo, Cindy Lim, Hong-Yuan Zhu, Chin-Ann Johnny Ong, and Claramae Shulyn Chia
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peritoneal malignancy ,cytoreductive surgery ,hyperthermic intraperitoneal chemotherapy ,delay ,survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundPeritoneal surface malignancies (PSM) present insidiously and often pose diagnostic challenges. There is a paucity of literature quantifying the frequency and extent of therapeutic delays in PSM and its impact on oncological outcomes.MethodsA review of a prospectively maintained registry of PSM patients undergoing Cytoreductive Surgery and Hyperthermic Intra-peritoneal Chemotherapy (CRS-HIPEC) was conducted. Causes for treatment delays were identified. We evaluate the impact of delayed presentation and treatment delays on oncological outcomes using Cox proportional hazards models.Results319 patients underwent CRS-HIPEC over a 6-years duration. 58 patients were eventually included in this study. Mean duration between symptom onset and CRS-HIPEC was 186.0 ± 37.1 days (range 18-1494 days) and mean duration of between patient-reported symptom onset and initial presentation was 56.7 ± 16.8 days. Delayed presentation (> 60 days between symptom onset and presentation) was seen in 20.7% (n=12) of patients and 50.0% (n=29) experienced a significant treatment delay of > 90 days between 1st presentation and CRS-HIPEC. Common causes for treatment delays were healthcare provider-related i.e. delayed or inappropriate referrals (43.1%) and delayed presentation to care (31.0%). Delayed presentation was a significantly associated with poorer disease free survival (DFS) (HR 4.67, 95% CI 1.11-19.69, p=0.036).ConclusionDelayed presentation and treatment delays are common and may have an impact on oncological outcomes. There is an urgent need to improve patient education and streamline healthcare delivery processes in the management of PSM.
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- 2023
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12. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy: Initial Report from Shiraz Surgical Oncology Group
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Majid Akrami, Samad Khezri, Sedigheh Tahmasebi, Mohammad Yasin Karami, Zahra Shiravani, Vahid Zangouri, Abdolrasoul Talei, and Nazanin Karimaghaei
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peritoneal malignancy ,drug therapy ,cytoreductive surgical procedures ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly used to treat peritoneal carcinomatosis (PC). The objective was to evaluate the outcomes of cytoreductive surgery (CRS) and HIPEC in our center.Method: In this retrospective study, data were collected from 43 patients with PC who underwent CRS-HIPEC in 2016 at Faghihi Hospital of Shiraz University of Medical Sciences. Outcomes were collected and analyzed. Analyses were conducted through SPSS 23. P-value < 0.05 was considered to be statistically significant.Results: The mean age of the patients was 52.23 پ} 11.82 years. The participants in the study analysis consisted of 36 female (83.7%) and seven male patients (16.3%). The most common primary tumor was ovarian cancer (62.8%). Completeness of the cytoreduction score of CC0/CC1 was obtained in 87.7% of the patients. The 1- and 3- year overall survivals were 88% and 60%, respectively.Conclusion: Our study supports that employing CRS and HIPEC for PC is feasible with acceptable morbidity in our center.
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- 2022
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13. Perioperative Management
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Raue, Wieland, Sander, Michael, Hawliczek, Anja, Rau, Beate, editor, Königsrainer, Alfred, editor, Mohamed, Faheez, editor, and Sugarbaker, Paul H., editor
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- 2021
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14. Quality of Life After CRS and HIPEC
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Hartmann, Jens, Bockelmann, Christina, Garg, Pankaj Kumar, Rau, Beate, editor, Königsrainer, Alfred, editor, Mohamed, Faheez, editor, and Sugarbaker, Paul H., editor
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- 2021
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15. Histopathological and immunohistochemical features of 14 peritoneal mesotheliomas with clinical outcomes and recent updates.
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Karmarkar, Srushti, Rekhi, Bharat, Deodhar, Kedar, Menon, Santosh, and Deodhar, Kedar K
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OVARIAN epithelial cancer , *TREATMENT effectiveness , *HISTOPATHOLOGY , *OVERALL survival , *CALRETININ , *TROPHOBLASTIC tumors - Abstract
Background: Malignant peritoneal mesotheliomas (MPMs) are rare tumors with overlapping clinical and histopathological features, especially with epithelial ovarian carcinomas (EOCs). There is no substantial documentation on these rare tumors from our country.Objective: To study the clinicopathological features including immunohistochemical (IHC) profile and clinical outcomes of 14 MPMs, diagnosed at our institution.Materials and Methods: This was a retrospective study, wherein 14 cases of MPM, occurring in female patients, diagnosed at our institution, between January 2008 and May 2019 were included, after a critical review.Results: Median age was 54.5 years. Most patients presented with ascites, omental nodularity, and fat stranding. Microscopically, most cases (11, 78.6%) displayed epithelioid morphology, followed by biphasic pattern (2, 14.3%) and a single case of well-differentiated MPM. IHC, diagnostic sensitivity and specificity of calretinin were 100% (13/13) and 85.7%; of HBME1 were 100% (5/5) and 100%; and of podoplanin (D2-40) were 60% (2/5) and 100%. Other positively expressed immunomarkers were epithelial membrane antigen (n = 2/5, 40%), cytokeratin 5/6 (n = 4/4, 100%), and WT1 (n = 9/10, 90%). Most patients (5/12, 41.7%) were treated with chemotherapy. The 3-year disease-free and overall survival rates were 25.7% and 54%, respectively, including improved survival trend in patients with epithelioid type of MPMs.Conclusion: MPMs are diagnosed with a combination of clinicopathological features and optimal IHC markers. Their differentiation from EOCs and other metastatic carcinomas is imperative in view of significant treatment implications. [ABSTRACT FROM AUTHOR]- Published
- 2022
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16. The Significance of the Morphological Appearance of Peritoneal Lesions on Imaging in Patients With Peritoneal Malignancies-A Report From Phase 1 of the PRECINCT Study.
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Bhatt A, Rousset P, Moran BJ, Kazi M, Baratti D, Souadka A, Deraco M, Sammartino P, Sardi A, and Glehen O
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Background and Aim: This is a report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, in which we studied the incidence of disease at pathological evaluation in different morphological appearances of peritoneal malignancies (PM) on imaging., Methods: Radiological findings were captured in a specific format that included a description of the morphological appearance of PM and a correlation performed with pathological findings., Results: In 630 patients enroled at seven centres (September 2022-December 2023), 24 morphological terms were used. Among prespecified terms (N = 8 used in 6350 [92.2%] regions), scalloping was pathologically positive in 93.5%, confluent disease in 78.8%, tumour nodules in 69.6%, thickening in 66.1%, infiltration in 56.3%. Among unspecified appearances (N = 16) for 540 (7.8%) regions, 'enhancement' was positive in 41.5%, micronodules in 65.3% and nodularity in 60.2%. Hierarchal clustering placed gastric cancer and rare tumours together and colorectal cancer, ovarian cancer and peritoneal mesothelioma in one cluster., Conclusions: The incidence of disease at pathological evaluation for most morphological appearances was high (> 50%). Morphological description should be provided in routine radiology reports. A set of standardized terms with their description should be developed by a consensus among experienced radiologists., (© 2024 Wiley Periodicals LLC.)
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- 2024
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17. Impact of Previous Abdominal Surgery and Timing of Peritoneal Metastases on Accuracy of Imaging in Predicting the Surgical PCI: A Report From the PRECINCT Study.
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Bhatt A, Rousset P, Moran BJ, Kazi M, Baratti D, Morris D, Labow D, Sardi A, Sammartino P, and Glehen O
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Background and Aim: In this report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, a correlation was performed between the radiological PCI (peritoneal cancer index; rPCI) and surgical PCI (sPCI). The impact of timing of peritoneal malignancy (PM) and previous abdominal surgery was also studied., Methods: The rPCI and sPCI were considered the 'same' if they differed by ≤ 3 points. The agreement was assessed using Bland-Altman analysis and the strength of the agreement was assessed using the concordance correlation coefficient (CCC). The extent of prior surgery was classified according to prior surgical score (PSS)., Results: In 707 (79.4%) patients, rPCI and sPCI concurred in 280 (39.6%). In the Bland-Altman analysis, < 40% patients were in the ±3 PCI points limit of acceptable difference. The average difference between the two scores was 4.5 points (95% CI- -5.16 to -3.92). The CCC- was 0.59 for the whole cohort ('moderate' concordance) and was not influenced by imaging modality, timing of PM or PSS., Conclusions: The rPCI underestimated sPCI by an average of 4.5 points. The role of peritoneal MRI in patients undergoing iterative procedures and the performance of imaging according to sites of recurrence need further evaluation., (© 2024 Wiley Periodicals LLC.)
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- 2024
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18. The rare occurrence of unifocal peritoneal mesothelioma: a case report, literature review, and future directions.
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Ghabra S, Dinerman AJ, Sitler CA, Ahn D, Joyce SR, Satterwhite A, Sullivan MA, and Blakely AM
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Background: Mesothelioma is a rare, aggressive disease originating from mesothelial cells and carries a poor prognosis. Mesothelioma may arise from the pleura, pericardium, or peritoneum. Peritoneal mesothelioma (PM) usually spreads in a diffuse manner; however, a localized unifocal form of PM may occur. Literature on unifocal mesothelioma remains scarce., Case Description: Herein, we highlight a case of localized epithelioid PM in an 81-year-old gentleman with the unique challenges faced during management. The pelvic mass was 7 cm, well-circumscribed, and hyper-vascular with fibrous attachments to the abdominal wall. The patient had a peritoneal cancer index (PCI) of 4 on initial diagnostic laparoscopy. Diagnosis was confirmed by histology. Resection of the mass with a partial omentectomy was performed. Months later, the patient developed recurrence detected on follow-up imaging in the peri-splenic region. The patient underwent cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for 60 minutes using mitomycin C and cisplatin followed by an uneventful recovery. Our case report is followed by a review of literature on disease pathophysiology, treatment options, and recently promising immunotherapy approaches., Conclusions: CRS and HIPEC remains the standard treatment regimen for patients with PM. Nonetheless, a more nuanced approach might be indicated in specific patients with localized unifocal PM. Disease distribution and burden may impact the decision on surgical management in selected patients., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-266/coif). The authors have no conflicts of interest to declare., (2024 Journal of Gastrointestinal Oncology. All rights reserved.)
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- 2024
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19. Novel Techniques and the Future of HIPEC (Immunotherapy, Viral Therapy)
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Beane, Joal D., Bartlett, David L., Fong, Yuman, editor, Gamblin, T. Clark, editor, Han, Ernest S., editor, Lee, Byrne, editor, and Zager, Jonathan S., editor
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- 2020
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20. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy: Initial Report from Shiraz Surgical Oncology Group.
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Akrami, Majid, Khezri, Samad, Tahmasebi, Sedigheh, Karami, Mohammad Yasin, Shiravani, Zahra, Zangouri, Vahid, Talei, Abdolrasoul, and Karimaghaei, Nazanin
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ADJUVANT chemotherapy , *THERMOTHERAPY , *PERITONEAL cancer , *RETROSPECTIVE studies , *PERITONEUM tumors , *TREATMENT effectiveness , *DESCRIPTIVE statistics , *CYTOREDUCTIVE surgery - Abstract
Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly used to treat peritoneal carcinomatosis (PC). The objective was to evaluate the outcomes of cytoreductive surgery (CRS) and HIPEC in our center. Method: In this retrospective study, data were collected from 43 patients with PC who underwent CRS-HIPEC in 2016 at Faghihi Hospital of Shiraz University of Medical Sciences. Outcomes were collected and analyzed. Analyses were conducted through SPSS 23. P-value < 0.05 was considered to be statistically significant. Results: The mean age of the patients was 52.23 ± 11.82 years. The participants in the study analysis consisted of 36 female (83.7%) and seven male patients (16.3%). The most common primary tumor was ovarian cancer (62.8%). Completeness of the cytoreduction score of CC0/CC1 was obtained in 87.7% of the patients. The 1- and 3-year overall survivals were 88% and 60%, respectively. Conclusion: Our study supports that employing CRS and HIPEC for PC is feasible with acceptable morbidity in our center. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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21. The role of imaging in diagnosis and management of malignant peritoneal mesothelioma: a systematic review.
- Author
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Carlson, Bradley, Harmath, Carla, Turaga, Kiran, Kindler, Hedy L., Armato III, Samuel G., and Straus, Christopher
- Subjects
- *
TUMORS , *PERITONEUM , *PERITONEUM diseases , *SYSTEMATIC reviews , *CARCINOMA - Abstract
Purpose: Imaging of the peritoneum and related pathology is a challenge. Among peritoneal diseases, malignant peritoneal mesothelioma (MPeM) is an uncommon tumor with poor prognosis. To date, there are no specific guidelines or imaging protocols dedicated for the peritoneum and MPeM. The objective of this study was to analyze the literature describing imaging modalities used for MPeM to determine their relative clinical efficacy and review commonly reported imaging features of MPeM to promote standardized reporting. Methods: We performed a systematic review of original research articles discussing imaging modalities in MPeM from 1999 to 2020. Effectiveness measures and common findings were compared across imaging modalities. Results: Among 582 studies analyzed, the most-used imaging modality was CT (54.3%). In the differentiation of MPeM from peritoneal carcinomatosis, one study found CT had a diagnostic sensitivity of 53%, specificity of 100%, and accuracy of 68%. Two studies found fluorodeoxyglucose positron emission tomography (FDG-PET) had sensitivity of 86–92%, specificity of 83–89%, and accuracy of 87–89%. Another study found magnetic resonance imaging (MRI) was the best predictor of the peritoneal carcinomatosis index. Characteristics shown to best differentiate MPeM from other diseases included ascites, peritoneal thickening, mesenteric thickening, pleural plaques, maximum tumor dimension, and number of masses. Conclusion: Most published MPeM imaging studies utilized CT. PET/CT or MRI appear promising, and future studies should compare effectiveness of these modalities. MPeM imaging reports should highlight ascites, number of and maximum tumor dimension, peritoneal/mesenteric thickening, and associated pleural plaques, allowing for better aggregation of MPeM imaging data across studies. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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22. Current Research and Development in Hyperthermic Intraperitoneal Chemotherapy (HIPEC)—A Cross-Sectional Analysis of Clinical Trials Registered on ClinicalTrials.gov
- Author
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Kristjan Ukegjini, Marisa Guidi, Kuno Lehmann, Krisztian Süveg, Paul Martin Putora, Nikola Cihoric, and Thomas Steffen
- Subjects
peritoneal malignancy ,hipec ,cytoreductive surgery ,intraperitoneal chemotherapy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction: Over the past two decades, cytoreductive surgery and HIPEC has improved outcomes for selected patients with peritoneal metastasis from various origins. This is a cross-sectional study with descriptive analyses of HIPEC trials registered on ClinicalTrials.gov. This study aimed to characterize clinical trials on HIPEC registered on ClinicalTrials.gov with the primary objective of identifying a trial focus and to examine whether trial results were published. Methods: The search included trials registered from 1 January 2001 to 14 March 2022. We examined the associations of exposure variables and other trial features with two primary outcomes: therapeutic focus and results reporting. Results: In total, 234 clinical trials were identified; 26 (11%) were already published, and 15 (6%) trials have reported their results but have not been published as full papers. Among ongoing nonpublished trials, 81 (39%) were randomized, 30 (14%) were blinded, n = 39 (20%) were later phase trials (i.e., phases 3 and 4), n = 152 (73%) were from a single institution, and 91 (44%) had parallel groups. Most of the trials were recruiting at the time of this analysis (75, 36%), and 39 (20%) were completed but had yet to publish results. In total, 68% of the trials focused on treatment strategies, and 53% investigated the oncological outcome. The most studied neoplasms for HIPEC trials were peritoneally metastasized colorectal cancer (32%), gastric cancer (29%), and ovarian cancer (26%). Twenty different drugs were analyzed in these clinical trials. Conclusions: Many study results are awaited from ongoing HIPEC trials. Most HIPEC trials focused on gastric, colorectal, or ovarian cancer. Many clinical trials were identified involving multiple entities and chemotherapeutic agents.
- Published
- 2023
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23. Presentation of a rare, highly aggressive peritoneal disease: desmoplastic small round cell tumor and its therapeutic options.
- Author
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Ramspott, Jan Philipp, Jäger, Tarkan, Neureiter, Daniel, Emmanuel, Klaus, and Schredl, Philipp
- Abstract
Summary: Background: Desmoplastic small round cell tumor is a rare highly aggressive peritoneal disease (sarcoma) with mortality rates up to 70% in the first 3 years after diagnosis. It mainly affects young men. Patients clinically complain about diffuse abdominal pain. Methods: This case report describes the clinical course of a 69-year-old man who presented with recurrent abdominal pain. Physical examination, laboratory testing, imaging, and gastroscopy were performed. Intra-abdominal peritoneal biopsies were taken during diagnostic laparoscopy. Results: Physical examination was unremarkable. Laboratory results showed elevated white blood cells, C‑reactive protein, and negative tumor markers. Computed tomography and positron emission tomography scan revealed extensive peritoneal metastases with diffuse intra-abdominal signal intensities and ascites. Gastroscopy was unremarkable, whereas diagnostic laparoscopy confirmed imaging results with a peritoneal cancer index of 39. Extensive immunohistochemical and consecutive molecular investigations led to the diagnosis of an intraperitoneal desmoplastic small round cell tumor. Conclusion: Our case report demonstrates a very rare cause of recurrent abdominal pain. Desmoplastic small round cell tumor is a rare and highly aggressive undifferentiated sarcoma, which mainly affects young men. Treatment options include chemotherapy, radiotherapy, cytoreductive surgery, and/or hyperthermic intraperitoneal chemotherapy. Standardized treatment protocols are still lacking because only a few cases have been described so far. Differential diagnoses include all malignancies with peritoneal masses. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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24. Short-term outcomes in older patients with peritoneal malignancy treated with cytoreductive surgery and HIPEC: Experience with 245 patients from a national centre.
- Author
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Keyes, Alan Martin, Kelly, Michael Eamon, McInerney, Niall, Khan, Mohammad Faraz, Bolger, Jarlath Christopher, McCormack, Emilie, Grundy, Josh, McCormack, Orla, MacHale, John, Conneely, John, Brennan, Donal, Cahill, Ronan, Shields, Conor, Moran, Brendan, and Mulsow, Jürgen
- Subjects
HYPERTHERMIC intraperitoneal chemotherapy ,PERITONEAL cancer ,OLDER patients ,CYTOREDUCTIVE surgery ,PATIENTS' attitudes ,INTENSIVE care units - Abstract
Cytoreductive Surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the optimal management of selected patients with peritoneal malignancy. There is limited published evidence on outcomes in older patients treated by this complex therapeutic strategy. A retrospective review of a prospective database of all patients who underwent CRS with HIPEC in a single institution over seven years. A comparative analysis of outcomes in patients under 65 undergoing CRS and HIPEC with patients ≥65 years was performed. The key endpoints were morbidity, mortality, reintervention rate and length of stay in the high dependency/intensive care (HDU/ICU) units. Overall, 245 patients underwent CRS and HIPEC during the study period, with 76/245 (31%) ≥65 years at the time of intervention. Tumour burden measured by the peritoneal carcinomatosis index (PCI) score was a median of 11 for both groups. Median length of hospital stay in the ≥65-year-old group was 14.5 days versus 13 days in the <65-year-old group (∗p = 0.01). Patients aged ≥65-years spent a median of one more day in the critical care unit ∗(p = 0.001). Significant morbidity (Clavien-Dindo ≥ Grade IIIa) was higher in the ≥65-year than the <65-year group (18.4% versus 11.2%). There were no perioperative deaths in the ≥65-year group. This study demonstrates higher perioperative major morbidity in ≥65-year group, but with low mortality in patients undergoing CRS/HIPEC for disseminated intraperitoneal malignancy. This increased morbidity does not translate into higher rates of re-interventions and highlights the importance of optimal patient selection. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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25. Decision-Making Analysis for Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer: A Survey by the Executive Committee of the Peritoneal Surface Oncology Group International (PSOGI).
- Author
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Steffen, Thomas, Häller, Lukas, Bijelic, Lana, Glatzer, Markus, Glehen, Olivier, Goéré, Diane, de Hingh, Ignace, Li, Yan, Moran, Brendan J., Morris, David L., Piso, Pompiliu, Quadros, Claudio A., Rau, Beate, Sugarbaker, Paul, Yonemura, Yutaka, and Putora, Paul M.
- Subjects
- *
ATTITUDE (Psychology) , *CANCER patients , *CANCER relapse , *COMMITTEES , *CONSENSUS (Social sciences) , *DECISION trees , *EXECUTIVES , *HEALTH care teams , *INFORMED consent (Medical law) , *INTERNATIONAL agencies , *MEDICAL personnel , *METASTASIS , *ONCOLOGY , *OVARIAN tumors , *PERITONEAL cancer , *THERMOTHERAPY , *DECISION making in clinical medicine , *PATIENT selection , *DESCRIPTIVE statistics , *OVARIAN epithelial cancer , *ADJUVANT chemotherapy - Abstract
Objectives: To assess the individual treatment strategies among international experts in peritoneal carcinosis, specifically their decision-making in the process of patient selection for hyperthermic intraperitoneal chemotherapy (HIPEC) in women suffering from ovarian cancer, to identify relevant decision-making criteria, and to quantify the level of consensus for or against HIPEC. Methods: The members of the executive committee of the Peritoneal Surface Oncology Group International (PSOGI) were asked to describe the clinical conditions under which they would recommend HIPEC in patients with ovarian cancer and to describe any disease or patient characteristics relevant to their decision. All answers were then merged and converted into decision trees. The decision trees were then analyzed by applying the objective consensus methodology. Results: Nine experts in surgical oncology provided information on their multidisciplinary treatment strategy including HIPEC for patients with advanced ovarian cancer. Three of the total of 12 experts did not perform HIPEC. Five criteria relevant to the decision on whether HIPEC is performed were applied. In patients with resectable disease, a peritoneal cancer index (PCI) <21, and epithelial ovarian cancer without distant metastasis, consent was received by 75% to perform HIPEC for women suffering from recurrent disease. Furthermore, in the primary disease setting, consent was received by 67% to perform HIPEC according to the same criteria. Discussion and Conclusion: Among surgical oncology experts in peritoneal surface malignancy and HIPEC, HIPEC plays an important role in primary and recurrent ovarian cancer, and the PCI is the most important criterion in this decision. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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26. Prehabilitation of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy.
- Author
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Cortés-Guiral, Delia, Mohamed, Faheez, Glehen, Olivier, and Passot, Guillaume
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CYTOREDUCTIVE surgery ,HYPERTHERMIC intraperitoneal chemotherapy ,PERITONEAL cancer ,PREHABILITATION - Abstract
Treatment of peritoneal malignancy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is often undertaken in patients who have nutritional, physical and psychological challenges as a result of advanced disease. Prehabilitation is a multimodal approach that helps optimize postoperative recovery and reduce morbidity and may be of benefit in this group of patients. It begins once the decision to operate is made and continues until recovery to baseline health. Here we present recommendations on Prehabilitation for patients undergoing cytoreductive surgery and HIPEC following discussion at the 10th Peritoneal Malignancy Workshop in Paris September 2018. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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27. Imaging Diagnosis of Desmoplastic Small Round Cell Tumor: A Report of Two Cases.
- Author
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Pimiento Figueroa J, Royero-Arias M, Mejia M, and Garcia EE
- Abstract
Desmoplastic small round cell tumor (DSRCT) is a rare multifocal peritoneal sarcoma, typically found in adolescent and young adult males. Symptoms are nonspecific and vary depending on tumor involvement. Diagnosis is primarily histopathological, although imaging results can assist in the diagnostic process. Although not pathognomonic, certain radiologic findings can help narrow down potential diagnoses and sometimes suggest the condition, as seen in our cases. Treatment options are not well-established or effective, and despite employing various therapeutic approaches, the prognosis remains poor. We present two cases of boys aged 11 and 10 with a final diagnosis of DSRCT, emphasizing the imaging findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Pimiento Figueroa et al.)
- Published
- 2024
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28. Outcomes following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies: 10 Year experience.
- Author
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Graham I, Boston A, Hayward R, and Berri R
- Subjects
- Humans, Hyperthermic Intraperitoneal Chemotherapy, Cytoreduction Surgical Procedures methods, Retrospective Studies, Combined Modality Therapy, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Peritoneal Neoplasms pathology, Percutaneous Coronary Intervention, Hyperthermia, Induced
- Abstract
Introduction: The treatment of peritoneal malignancies has evolved and select patients can undergo effective surgical therapies. Access to innovative oncology procedures can be improved if programs are developed within and outside of academic cancer centers. We report the creation of a high volume, comprehensive peritoneal malignancy program developed in a community center., Methods: A retrospective single-site study was conducted using registry data comprising all patients who underwent Cytoreductive Surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC) between October 2011-December 2021., Results: 353 patients underwent CRS and HIPEC. 208 patients experienced in-hospital morbidity (58.9 %). Group comparison by disease site, PCI, and the completeness of cytoreduction demonstrated survival differences in mean overall survival and disease-free survival in 1-, 3- and 5-year ranges., Conclusions: This study demonstrates that with a standardized protocol and a surgeon-led multidisciplinary team it is possible to offer safe outcome driven, complex oncologic surgery in a community-based cancer program., Competing Interests: Declaration of competing interest None of the authors listed in this manuscript have any financial or personal declarations of conflict or interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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29. Peritoneal malignancy in the global COVID-19 pandemic: experience of recovery and restoration in a high-volume centre through NHS and independent sector collaboration.
- Author
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Arbuthnot EJ, Parker J, Cecil T, Mohamed F, Williams R, Page M, and Moran B
- Subjects
- Humans, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Cytoreduction Surgical Procedures, Pandemics, Retrospective Studies, State Medicine, Survival Rate, COVID-19 epidemiology, COVID-19 therapy, Hyperthermia, Induced, Peritoneal Neoplasms epidemiology, Peritoneal Neoplasms therapy
- Abstract
Introduction: Treatment of peritoneal malignancy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) requires substantial critical care, theatre and nursing resources. The COVID-19 pandemic caused challenges in providing a high volume, tertiary referral service., Methods: We reviewed data on referrals and operations performed in a tertiary referral centre in both NHS and independent sector settings. The impact of COVID-19 on activity was assessed using 2019 as a benchmark., Results: New patient referrals were similar, with 891 in 2019 compared with 833 in 2020. Delivery of CRS and HIPEC operations were initially impacted by COVID-19. NHS and independent sector collaboration facilitated recovery, with 284 patients treated in 2020 compared with 280 in 2019., Conclusions: Close collaboration and structural organisation between the clinical and management teams in the NHS and independent sectors facilitated recovery and restoration of a complex tertiary referral service for peritoneal malignancy during the COVID pandemic.
- Published
- 2024
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30. Holistic care in advanced pseudomyxoma peritonei: the clinical nurse specialist role in a rare malignancy of the abdomen and pelvis.
- Author
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Staunton, Oonagh
- Abstract
This article explores the complexities of providing holistic nursing care to patients with pseudomyxoma peritonei (PMP), an uncommon cancer of the abdomen and pelvis. It focuses on patients diagnosed at an advanced stage. Patient outcomes can be optimised with robust specialist referral pathways, effective communication and increased professional awareness of rare diseases. The quality of care can be assured with service development and innovation at the point of delivery, backed up by ongoing training, support and best-practice guidelines. The clinical nurse specialist plays an especially vital role in advanced PMP. This involves co-ordination of multidisciplinary care and community support. It also includes patient advocacy, clinical consultancy and psychosocial support, as well as the personalisation of patient-centred care and education for the many and varied individual needs of patients and their families at a very emotive time. This is demonstrated in a national specialised service that was established In Ireland in 2013. It serves patients with rare peritoneal malignancies, who had previously had to travel to the UK for surgical management. The service has continued to develop in practice and innovation for this patient cohort. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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31. Primary peritoneal serous papillary carcinoma: a case series.
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Blontzos, Nikolaos, Vafias, Evangelos, Vorgias, George, Kalinoglou, Nikolaos, and Iavazzo, Christos
- Subjects
- *
PAPILLARY carcinoma , *WEIGHT loss , *PERITONEAL cancer , *APPETITE loss , *WEIGHT gain - Abstract
Purpose: To present the clinical and laboratory characteristics, as well as the management, of patients with primary peritoneal serous papillary carcinoma (PPSPC).Methods: This is a retrospective study of 19 patients with PPSPC who underwent debulking surgery followed by first line chemotherapy and were managed in Metaxa Memorial Cancer Hospital between January 2002 and December 2017.Results: The median age of the patients was found to be 66 years (range 44-76 years). Clinical presentation of PPSPC included abdominal distention and pain, constipation, as well as loss of appetite and weight gain. Two of the patients did not mention any symptomatology and the disease was suspected by an abnormal cervical smear and elevated CA125 levels respectively. Biomarkers measurement during the initial management of the patients revealed abnormal values of CA125 for all the participants (median value 565 U/ml). Human epididymis secretory protein 4 (HE4) and ratios of blood count were also measured. Perioperative Peritoneal Cancer Index ranged from 6 to 20. Optimal debulking was achieved in 5 cases. All patients were staged as IIIC and IVA PPSPC and received standard chemotherapy with paclitaxel and carboplatin, whereas bevacizumab was added in the 5 most recent cases. Median overall survival was 29 months.Conclusion: PPSPC is a rare malignancy, the management of which should take place in tertiary oncology centers. [ABSTRACT FROM AUTHOR]- Published
- 2019
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32. Two cases of malignant peritoneal mesothelioma without asbestos exposure.
- Author
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Jung-Woo Park
- Subjects
- *
MESOTHELIOMA , *ASBESTOS , *PLEURA cancer , *RARE diseases , *PLEURA diseases - Abstract
Malignant peritoneal mesothelioma is a rare disease and usually develops in individuals aged between 50 and 69 years. Exposure to asbestos is reported in 80% of cases of pleural mesothelioma, but in peritoneal type such an exposure is noted in only 8% of cases. Prognosis is poor for mesothelioma with a median survival of <1 year. Here, we report two cases of malignant peritoneal mesothelioma without history of exposure to asbestos. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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33. Synopsis of a clinical practice guideline for pancreatic ductal adenocarcinoma with peritoneal dissemination in Japan; Japan Peritoneal Malignancy Study Group
- Author
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Tsutomu Fujii, Hideyo Miyato, Joji Kitayama, Daisuke Hashimoto, Hiroyuki Isayama, So Yamaki, Yasushi Tsuji, Hironori Yamaguchi, Suguru Yamada, Kei Saito, Masamichi Hayashi, Toru Watanabe, Shigeto Ishii, Hideaki Shimada, Yousuke Nakai, Hayato Baba, Keisuke Kurimoto, Tomohisa Yamamoto, Naminatsu Takahara, and Sohei Satoi
- Subjects
medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,endocrine system diseases ,Hepatology ,business.industry ,General surgery ,Guideline ,Discontinuation ,Pancreatic Neoplasms ,Peritoneal malignancy ,Clinical Practice ,Natural history ,Japan ,Ascites ,medicine ,Humans ,Surgery ,Poor performance status ,medicine.symptom ,business ,Peritoneal Neoplasms ,Carcinoma, Pancreatic Ductal - Abstract
BACKGROUND/PURPOSE Patients with pancreatic ductal adenocarcinoma (PDAC) with peritoneal dissemination have a dismal prognosis because discontinuation of systemic chemotherapy is required for massive ascites or poor performance status. The natural history, diagnosis and treatment of PDAC with peritoneal dissemination have not been fully investigated. METHODS We systematically reviewed published information on the clinical diagnosis and treatment of PDAC with peritoneal dissemination using the PubMed database (2000-2020) and provided recommendations in response to clinical questions. This guideline was created according to the "Minds Clinical Practice Guideline Development Guide 2017". The literature quality and body of evidence were evaluated with the GRADE System and classified into four levels ("strong", "medium", "weak", "very weak"). The strength of each final recommendation was decided by a vote of committee members based on the GRADE Grid method. RESULTS These guidelines address 3 subjects: diagnostic, chemotherapeutic, and surgical approaches. They include 9 clinical questions and statements with recommendation strengths, evidence levels, and agreement rates, in addition to one "column". CONCLUSIONS This is the English synopsis of the 2021 Japanese clinical practice guideline for PDAC with peritoneal dissemination. It summarizes the clinical evidence for the diagnosis and treatment of PDAC with peritoneal dissemination and provides future perspectives.
- Published
- 2022
34. Disparities in the Management of Peritoneal Surface Malignancies
- Author
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Ugwuji N. Maduekwe and Kathleen Marulanda
- Subjects
Oncology ,medicine.medical_specialty ,Peritoneal surface ,Colorectal cancer ,business.industry ,Hyperthermia, Induced ,medicine.disease ,Combined Modality Therapy ,Poor adherence ,Peritoneal malignancy ,medicine.anatomical_structure ,Peritoneum ,Internal medicine ,medicine ,Humans ,Surgery ,Hyperthermic intraperitoneal chemotherapy ,Colorectal Neoplasms ,Cytoreductive surgery ,Ovarian cancer ,business ,Peritoneal Neoplasms ,Retrospective Studies - Abstract
Peritoneal surface malignancies are a group of aggressive cancers involving the peritoneum. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can improve outcomes and survival in select patients. Despite significant advancements in care, racial disparities in peritoneal malignancy outcomes persist and may have even worsened over time. Poor adherence to guideline-recommended therapy introduces wide variability in patient care and often results in fewer options and suboptimal treatment of vulnerable populations. This review explores biological, sociodemographic, and environmental factors that contribute to disparities in peritoneal malignancy outcomes.
- Published
- 2022
35. Parenteral nutrition after cytoreductive surgery for peritoneal malignancy: Should it be administered routinely?
- Author
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Khan A, Beaumont A, Laing E, Guerra G, Jain A, Warrier S, and Heriot A
- Subjects
- Humans, Female, Middle Aged, Cytoreduction Surgical Procedures, Retrospective Studies, Parenteral Nutrition, Peritoneal Neoplasms therapy, Percutaneous Coronary Intervention
- Abstract
Purpose/background: Cytoreductive surgery (CRS) is complex abdominal surgery that is used to treat peritoneal malignancy. CRS is associated with major morbidity and efforts to address this include optimisation of perioperative care. There is variation in international protocols on the nutritional management after CRS, in particular whether parenteral nutrition (PN) should be routinely or selectively administered., Hypothesis/aim: This study assessed parenteral nutrition use, factors associated with PN requirement and nutritional outcomes in a centre that selectively uses PN after CRS., Methods/interventions: A retrospective analysis was undertaken on patients who underwent cytoreductive surgery ± hyperthermic intraperitoneal chemotherapy (HIPEC) at Peter MacCallum Cancer Centre between 1st January 2015 and 31st December 2020 using data entered into a prospectively maintained database. Patient characteristics, nutritional status, oncological parameters, operative details and postoperative outcome data were retrieved. Categorical variables were compared using the chi-squared test and continuous data was compared using a non-parametric Mann-Whitney U-test. A p-value <0.05 was considered statistically significant. Cox regression analysis was performed to identify independent predictors of requiring PN and postoperative weight change over admission., Results: A total of 222 patients who had CRS between were included (mean age 56 years; female 61.3%). Preoperative nutritional characteristics of participants included a mean body mass index (BMI) of 27.6 kg/m
2 and the majority (77.9%) were not at nutritional risk pre-operatively with a Patient Generated Subjective Global Assessment (PG-SGA) score of category A. A high proportion of patients had surgery for colonic adenocarcinoma (58.1%), received HIPEC (87.4%) and achieved complete cytoreduction (82%). Postoperative parenteral nutrition was required for 65 patients (29.3%). The most frequent indication for PN was postoperative ileus (63.1%) with the mean (SD) time to commencing PN being postoperative day 5. Factors associated with the requirement for postoperative PN included preoperative albumin (OR 0.89; p = 0.015), weight loss >5% of body weight in the 6 months prior to admission (OR 2.2; p = 0.05), higher PCI score (OR 1.048; p = 0.005), number of anastomoses completed (OR 1.766; p = 0.017) and development of any postoperative complication (OR 2.71; p = 0.009). PN use was not associated with postoperative weight change., Conclusion: Most patients undergoing CRS did not require post-operative PN. Nutritional and operative factors may identify patients who are likely to need PN after surgery. Selective use of PN did not impact on postoperative weight change., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)- Published
- 2023
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36. Personalising care for patients: implementing a treatment summary folder following cytoreductive surgery.
- Author
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Evans V, Taher R, Tzivanakis A, Perkins S, Westbrook S, Clarke A, Andrews L, and Stanford S
- Subjects
- Humans, Patients, Cytoreduction Surgical Procedures, Patient Discharge
- Abstract
Background: A patient survey highlighted that patients treated with cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) at one NHS trust lacked confidence with the transition of care between teams. A personalised folder of treatment information was designed and given to patients prior to discharge., Aims: To obtain patient feedback on the implementation and content of the folder., Methods: 30 consecutive patients were given the folder at discharge. Participants completed an online questionnaire to determine whether the information in the folder was appropriate, given at the right time in the pathway and enhanced confidence on discharge., Findings: 90% response rate was achieved. Of the respondents, 96% strongly agreed/agreed that the folder was helpful, 4% disagreed; 92% strongly agreed/agreed that the amount of information was right, 8% preferred more information, none less; 74% agreed/strongly agreed that the folder was provided at the right time; 96% said that the content met their expectations., Conclusion: Patients treated with CRS and HIPEC have specific needs related to their treatment. Implementation of the patient information folder at discharge increases patient confidence., Competing Interests: Declaration of interest: none
- Published
- 2023
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37. Impact of ovarian metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy originating from appendiceal and colorectal cancer.
- Author
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Bignell, M. B., Mehta, A. M., Alves, S., Chandrakumaran, K., Dayal, S. P., Mohamed, F., Cecil, T. D., and Moran, B. J.
- Subjects
- *
GASTROINTESTINAL system , *CYTOREDUCTIVE surgery , *CANCER chemotherapy , *COLON cancer , *METASTASIS - Abstract
Abstract: Aim: Ovarian metastases from gastrointestinal tract malignancies have been considered an ominous finding with poor prognosis. The aim of this project was to determine the impact on survival, and potential cure, when cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are combined to treat peritoneal malignancy in women with Krukenberg tumours. Method: A retrospective analysis of prospectively collected data between January 2010 and July 2015. Female patients undergoing complete CRS (macroscopic tumour removal) and HIPEC for pseudomyxoma peritonei (PMP) of appendiceal origin, or colorectal peritoneal metastases (CPM) were included. Survival was estimated using the Kaplan–Meier method and survival rates compared using the log‐rank test. Results: In total, 889 patients underwent surgery for peritoneal malignancy, of whom 551 were female. Of these, 504/551 (91%) underwent complete CRS and HIPEC. Overall, 405/504 (80%) had at least one involved ovary removed either during CRS and HIPEC or at their index prereferral operation. Three hundred and fifty‐two patients (87%) had an appendiceal tumour and 53 (13%) had CPM. At a median follow up of 40 months, overall survival (OS) did not differ significantly between patients with or without ovarian involvement in women with a primary low‐grade appendiceal tumour or CPM. In women with high‐grade primary appendiceal pathology, OS was significantly lower in patients with ovarian metastases compared with those without ovarian involvement. Conclusion: Women with ovarian metastases from low‐grade appendiceal tumours or colorectal cancer treated with CRS and HIPEC have similar survival rates to patients without ovarian metastases. Long‐term survival and cure is feasible in patients amenable to complete tumour removal. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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38. Patients undergoing cytoreductive surgery for peritoneal malignancy of appendiceal origin should be consented for umbilical excision as 30% have umbilical infiltration
- Author
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Shinichiro Sakata, Norman J Carr, Nima Ahmadi, Tun G Tan, Danko Kostadinov, F. Mohamed, Alexios Tzivanakis, Sanjeev Dayal, Tom D Cecil, and B. J. Moran
- Subjects
medicine.medical_specialty ,Umbilicus (mollusc) ,Peritoneal malignancy ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Mucinous carcinoma ,Pathological ,Peritoneal Neoplasms ,Retrospective Studies ,Umbilicus ,business.industry ,Incidence (epidemiology) ,Gastroenterology ,Cytoreduction Surgical Procedures ,Hyperthermia, Induced ,medicine.disease ,Surgery ,Appendiceal Neoplasms ,030220 oncology & carcinogenesis ,Adenocarcinoma ,030211 gastroenterology & hepatology ,Cytoreductive surgery ,business ,Infiltration (medical) - Abstract
Aim Cytoreductive surgery (CRS) for peritoneal malignancy has traditionally included umbilical excision with no published evidence on the incidence of umbilical involvement. The primary aim of this work was to determine the incidence of umbilical involvement in patients undergoing CRS for peritoneal malignancy of appendiceal origin. The secondary aim was to investigate the relationship of umbilical involvement with prior surgery affecting the umbilicus, such as diagnostic laparoscopy and midline laparotomy. Method This study is from a national referral centre in the United Kingdom for appendiceal tumours and peritoneal malignancy. It is a retrospective analysis from a dedicated prospective database. We evaluated the most recent 200 consecutive patients who underwent CRS for peritoneal malignancy of appendiceal origin where all pathology specimens were reported by a recognized expert pathologist in appendiceal tumours and peritoneal malignancy. Results From June 2016 to September 2019, 200 consecutive patients had CRS and 178 had umbilical excision. Of these 54/178 (30.3%) had disease involving the umbilicus. The pathological findings in the 178 patients were low-grade mucinous carcinoma peritonei in 90/178 (50.6%), high-grade mucinous carcinoma peritonei in 31/178 (17.4%), metastatic appendiceal adenocarcinoma in 29/178 (16.4%) and diffuse acellular mucin in 28/178 (15.7%). Umbilical involvement was found in 25/90 (27.8%) with low-grade, 11/31 (35.5%) with high-grade, 8/29 (27.6%) with adenocarcinoma and 10/28 (35.7%) of patients with acellular mucin. In the 54 patients with umbilical disease, 30/54 (55.6%) had previous diagnostic surgery affecting the umbilicus. In the 124 patients without umbilical disease, 76/124 (61.2%) had prior surgery involving the umbilicus. The difference between the groups was not significant (p = 0.24). Conclusion In patients with peritoneal malignancy of appendiceal origin, approximately 30% have umbilical involvement, irrespective of the primary appendiceal pathology. Umbilical involvement was not associated with prior surgery involving the umbilicus. This is the first report to document the incidence of umbilical pathology and supports consideration of routine umbilical excision in CRS for peritoneal malignancy.
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- 2021
39. Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up
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S. Kusamura, V. Kepenekian, L. Villeneuve, R.J. Lurvink, K. Govaerts, I.H.J.T. De Hingh, B.J. Moran, K. Van der Speeten, M. Deraco, O. Glehen, Pedro Barrios-Sanchez, Joel M. Baumgartner, Almog Ben-Yaacov, Rosella Bertulli, Peter Cashin, Tom Cecil, Sanjeev Dayal, Michele De Simone, Jason M. Foster, Diane Goere, Kuno Lehmann, Yan Li, Brian W. Loggie, Faheez Mohamed, David L. Morris, Aviram Nissan, Pompiliu Piso, Marc Pocard, Beate Rau, Marc A. Reymond, Lucas Sideris, John D. Spiliotis, Paul H. Sugarbaker, Victor J. Verwaal, Malcom S. Wilson, Yutaka Yonemura, and Yang Yu
- Subjects
Diagnostic Imaging ,Mesothelioma ,medicine.medical_specialty ,Delphi Technique ,Peritoneal surface ,Steering committee ,Hyperthermic Intraperitoneal Chemotherapy ,Peritoneal malignancy ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Peritoneal Neoplasms ,business.industry ,Cytoreduction Surgical Procedures ,General Medicine ,medicine.disease ,respiratory tract diseases ,Clinical Practice ,Oncology ,Diagnosis treatment ,Malignant Peritoneal Mesothelioma ,030220 oncology & carcinogenesis ,Peritoneal mesothelioma ,030211 gastroenterology & hepatology ,Surgery ,Hyperthermic intraperitoneal chemotherapy ,Radiology ,business - Abstract
Peritoneal mesothelioma (PM) is a rare and aggressive primary peritoneal malignancy characterized by widespread multiple metastatic tumour nodules originating from the peritoneum. The conventional classification distinguishes diffuse malignant peritoneal mesothelioma (DMPM) and border-line forms: multicystic peritoneal mesothelioma (MCPM) and well-differentiated papillary peritoneal mesothelioma (WDPPM). Despite the novel achievements in the management of PM, there is difficulty in conducting randomized trials due to its rarity and aggressive biology in many cases. As there is, a necessity to standardize diagnosis and management of PM, the Peritoneal Surface Oncology Group International (PSOGI) commissioned a steering committee to elaborate clinical guidelines.
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- 2021
40. Peritoneal Malignancy
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Schwab, Manfred, editor
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- 2017
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41. Massive peritoneal cavity calcification in the course of advanced ovarian cancer: a case report
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Gustaw Wójcik, Jolanta Piskorz, and Włodzimierz Bulikowski
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abdominal cavity ,ovarian cancer ,calcification peritoneum ,peritoneal malignancy ,Medicine - Abstract
Ovarian cancer usually does not give any clinical signs until it reaches a large size. This condition is often associated with the occurrence of metastases within the peritoneal cavity, pelvic and abdominal cavities. Ovarian cancer can spread by intraperitoneal implantation, by way of the lymphatic system, and also through the systemic circulation. Even when the tumor reaches a large size, the symptoms are not specific and may resemble other ailments. Therefore, ovarian cancer is detected in most cases only in the third and fourth level of advancement.Peritoneal calcification occurs in many diseases. The degree of calcium deposits is usually small and does not give clinical symptoms.In the reported case, computed tomography of the abdomen showed numerous scattered peritoneal calcifications of irregular shape as well as massive calcification in the uterus and appendages. In the detection of changes associated with calcification, multidetectory computed tomography shows a very high sensitivity. It makes the precise location and assessment of the extent of changes possible.
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- 2015
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42. Low Preoperative Serum Albumin Levels Are Associated With Impaired Outcome After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies
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Charalampos Seretis, Jagjit Gill, Umar Shariff, Haney Youssef, Ali Mohamed Elhassan, and Adnan Ather Malik
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medicine.medical_specialty ,Serum albumin ,Peritoneal malignancy ,Review ,Intraperitoneal chemotherapy ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Cytoreductive surgery ,Hypoalbuminemia ,Gastrointestinal cancer ,Nutrition ,Cancer ,biology ,HIPEC ,business.industry ,Albumin ,Retrospective cohort study ,General Medicine ,Perioperative ,medicine.disease ,Surgery ,030220 oncology & carcinogenesis ,biology.protein ,030211 gastroenterology & hepatology ,business - Abstract
Preoperative hypoalbuminemia is known to be associated with postoperative morbidity and mortality, as well as with poor survival after gastrointestinal cancer surgery. However, limited data exist regarding the prognostic significance of hypoalbuminemia in patients with peritoneal metastases undergoing cytoreductive surgery, combined with perioperative intraperitoneal chemotherapy. We performed a systematic literature review of the previously published studies addressing the potential association between preoperative albumin levels and overall surgical outcomes after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancies. Our research yielded a total of nine retrospective studies which met our inclusion criteria, and despite their heterogeneity; and we can conclude that preoperatively low albumin levels are associated with greater likelihood of overall and major morbidity, as well as less favorable oncological outcome after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy.
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- 2020
43. The transition from primary colorectal cancer to isolated peritoneal malignancy is associated with an increased tumour mutational burden
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Claire Bryer, Andrew D Beggs, Joanne D. Stockton, Valerie Pestinger, Celina Whalley, Sally Hallam, and Haney Youssef
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Male ,Oncology ,medicine.medical_specialty ,Standard of care ,Colorectal cancer ,lcsh:Medicine ,Hyperthermic Intraperitoneal Chemotherapy ,Predictive markers ,Article ,Dioxygenases ,Epigenesis, Genetic ,Negative regulator ,Peritoneal malignancy ,Gastrointestinal cancer ,Proto-Oncogene Proteins ,Internal medicine ,parasitic diseases ,Cancer genomics ,Biomarkers, Tumor ,Humans ,Medicine ,lcsh:Science ,Wnt Signaling Pathway ,Peritoneal Neoplasms ,Aged ,Multidisciplinary ,business.industry ,Gene Expression Profiling ,Patient Selection ,lcsh:R ,Neoplasms, Second Primary ,Intraperitoneal chemotherapy ,Cytoreduction Surgical Procedures ,Genomics ,Middle Aged ,Prognosis ,medicine.disease ,DNA-Binding Proteins ,Mutation ,Cohort ,embryonic structures ,Treatment strategy ,Female ,lcsh:Q ,Colorectal Neoplasms ,business ,Cytoreductive surgery ,human activities - Abstract
Colorectal Peritoneal metastases (CPM) develop in 15% of colorectal cancers. Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS & HIPEC) is the current standard of care in selected patients with limited resectable CPM. Despite selection using known prognostic factors survival is varied and morbidity and mortality are relatively high. There is a need to improve patient selection and a paucity of research concerning the biology of isolated CPM. We aimed to determine the biology associated with transition from primary CRC to CPM and of patients with CPM not responding to treatment with CRS & HIPEC, to identify those suitable for treatment with CRS & HIPEC and to identify targets for existing repurposed or novel treatment strategies. A cohort of patients with CPM treated with CRS & HIPEC was recruited and divided according to prognosis. Molecular profiling of the transcriptome (n = 25), epigenome (n = 24) and genome (n = 21) of CPM and matched primary CRC was performed. CPM were characterised by frequent Wnt/ β catenin negative regulator mutations, TET2 mutations, mismatch repair mutations and high tumour mutational burden. Here we show the molecular features associated with CPM development and associated with not responding to CRS & HIPEC. Potential applications include improving patient selection for treatment with CRS & HIPEC and in future research into novel and personalised treatments targeting the molecular features identified here.
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- 2020
44. Peritoneal malignancy: anatomy, pathophysiology and an update on modern day imaging
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Conor Shields, Jack W Power, Andrew D. Yates, Jurgen Mulsow, Helen M. Fenlon, Philip J Dempsey, and Carmel G Cronin
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Radical treatment ,medicine.medical_specialty ,Treatment regimen ,business.industry ,Cytoreduction Surgical Procedures ,Review Article ,General Medicine ,Disease ,Magnetic Resonance Imaging ,Peritoneal malignancy ,Positron-Emission Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Disease process ,Radiology ,Patient group ,Tomography, X-Ray Computed ,Cytoreductive surgery ,business ,Peritoneal Neoplasms ,Disease burden - Abstract
With increasing subspecialised experience in radical cytoreductive surgery and intra-abdominal chemotherapy for peritoneal malignancy, outcomes have improved significantly in selected patients. The surgery and the treatment regimens are radical and therefore correct patient selection is critical. The radiologist plays a central role in this process by estimating, as precisely as possible, the pre-treatment disease burden. Because of the nature of the disease process, accurate staging is not an easy task. Tumour deposits may be very small and in locations where they are very difficult to detect. It must be acknowledged that no form of modern day imaging has the capability of detecting the smallest peritoneal nodules, which may only be visible to direct inspection or histopathological evaluation. Nonetheless, it behoves the radiologist to be as exact and precise as possible in the reporting of this disease process. This is both to select patients who are likely to benefit from radical treatment, and just as importantly, to identify patients who are unlikely to achieve adequate cytoreductive outcomes. In this review, we outline the patterns of spread of disease and the anatomic basis for this, as well as the essential aspects of reporting abdominal studies in this patient group. We provide an evidence-based update on the relative strengths and limitations of our available multimodality imaging techniques namely CT, MRI and positron emission tomography/CT.
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- 2022
45. An 18 year population-based study on site of origin and outcome of patients with peritoneal malignancy in Ireland.
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Solon, J.G., O'Neill, M., Chang, K.H., Cahill, R., Shields, C., Mulsow, J., Moran, B., and Deady, S.
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EPIDEMIOLOGY of cancer ,PERITONEAL cancer ,HEALTH outcome assessment ,EPIDEMIOLOGY ,TUMOR classification ,MEDICAL databases ,PROGNOSIS - Abstract
Peritoneal malignancy (PM) is predominantly metastatic spread from advanced gastrointestinal or gynaecological cancer. PM is generally considered incurable and therefore has rarely been the focus of novel therapeutic strategies. This study assessed patterns and survival outcomes for patients with PM in Ireland. The National Cancer Registry Ireland database was interrogated to identify patients diagnosed with PM during the period 1994–2012. Patient and tumour characteristics were retrieved and survival outcomes calculated. 5791 patients were diagnosed during the study period. Median age at diagnosis was 68 years; females accounted for 62%. The incidence increased annually from 228 in 1994 to 401 in 2012. Primary PM accounted for 3% of cases. Colorectal (22%), ovarian (16%) and gastric (13%) cancers accounted for the majority of cases of secondary PM. Almost 75% of patients had PM at initial presentation. Almost 40% of patients (n = 2274) underwent surgical intervention, while 44% (n = 2560) had tumour directed chemotherapy. The median survival (MS) in patients with secondary PM was 6.6 months, and did not improve significantly during the study period. Outcomes were best in patients with ovarian cancer (MS 15.9 months) and colorectal cancer (MS 14.3 months) and worst in patients with lung (MS 2.4 months) and pancreas (MS 1.9 months) cancers. This is the first population-based study from Ireland to report the incidence and outcomes for PM. PM is more common than previously reported and survival remains poor. These findings highlight the need for greater clinician awareness and the need to focus on new therapeutic approaches to improve patient outcomes. [ABSTRACT FROM AUTHOR]
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- 2017
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46. Indications for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in elderly patients with peritoneal malignancy.
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Kitai, Toshiyuki, Yamanaka, Kenya, Miyauchi, Yuya, and Kawashima, Masahiro
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- *
HYPERTHERMIC intraperitoneal chemotherapy , *CYTOREDUCTIVE surgery , *PERITONEAL cancer , *OLDER patients , *COMBINATION drug therapy , *CANCER treatment - Abstract
Purpose: A combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is effective for some peritoneal malignancies. However, the indications for elderly patients remain unclear, with substantial postoperative morbidity and mortality being problematic. Materials: Clinical data were analyzed in 42 patients undergoing CRS + HIPEC for peritoneal malignancy. The primary tumor was located in the appendix in 32 cases and elsewhere in 10 cases. Operative results and survival data were compared between patients aged ≥70 and <70 years. Results: Fourteen patients were older than 70 years. Elderly patients had a higher peritoneal cancer index (32.0 vs. 21.5), higher CA19-9 level (189.0 vs. 28.1), and higher frequency of grade 4-5 complications (5/9 vs. 2/26) than the younger patients. Grade 4-5 respiratory failure occurred in three elderly patients. There was a significant difference of postoperative survival between the elderly patients and younger patients, with 5-year survival rates being 41.3 and 74.2%, respectively ( p = 0.0166). The poor prognosis of elderly patients was related to the higher frequency of grade 4-5 complications. Conclusions: Elderly patients were referred for treatment with more advanced disease than younger patients. An age ≥70 years was associated with more frequent grade 4-5 complications and worse survival. Performing CRS + HIPEC in elderly patients should be considered carefully due to the risk of severe complications, especially respiratory failure. [ABSTRACT FROM AUTHOR]
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- 2017
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47. Mentored experience of establishing a national peritoneal malignancy programme – Experience of first 50 operative cases.
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Chang, K.H., Kazanowski, M., Staunton, O., Cahill, R.A., Moran, B.J., Shields, C., and Mulsow, J.
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PERITONEAL cancer ,CYTOREDUCTIVE surgery ,CANCER thermotherapy ,CANCER chemotherapy ,ABDOMINAL surgery ,CANCER treatment - Abstract
Background Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are considered standard of care for pseudomyxoma peritonei (PMP) and selected patients with colorectal peritoneal metastases (CPM) or peritoneal mesothelioma. A National Peritoneal Malignancy programme was established in Ireland (population of 4.5 million) in May 2013 with mentoring and support from the Peritoneal Malignancy Institute, Basingstoke UK. This study reviews the operative and oncological outcomes for the first 50 patients who underwent CRS and HIPEC in Ireland. Methods This is a retrospective review of all patients referred, and of the subset who underwent CRS and HIPEC, for peritoneal malignancy in Ireland between May 2013 and November 2015. Results During the study period, 130 patients were referred and 50 patients were selected for CRS and HIPEC. Three patients were found to have unresectable disease at laparotomy. Of the remaining 47 patients, eight had major tumour debulking. In total, 39 underwent complete cytoreduction and 45 received HIPEC. After a median follow-up of 12.7 months, 12 patients had developed further metastatic disease. The rates of complete cytoreduction, major complication (Clavien–Dindo III/IV) and operative mortality were 83%, 0% and 0%, respectively. 32% of patients experienced grade I/II complications. Conclusions We report the successful establishment of a national peritoneal malignancy programme. Mentoring from an experienced centre may have shortened the known learning curve evident by our encouraging outcomes. The follow-up period is short, however our early results are comparable with internationally reported figures. [ABSTRACT FROM AUTHOR]
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- 2017
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48. Role of Imaging in Peritoneal Surface Malignancies.
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Krishnamurthy, Santosh and Balasubramaniam, Raghav
- Abstract
Imaging plays a vital role in the evaluation of peritoneal malignancies. The presence of peritoneal metastases (PM) alters tumor staging, with direct implications in treatment choice and prognosis. Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) as a combined modality treatment have led to prolonged survival and even cure in selected patients with PM. Better outcomes are seen in patients with limited disease spread. Therefore, early diagnosis of peritoneal tumor seeding is essential. Despite significant advancement of technology, assessment of the origin of PM is often difficult, due partly to the complex peritoneal anatomy and partly due to the complex overlap of imaging features. Multidetector CT (MDCT) is the main stay due to its wide availbility, rapid evaluation, robust technique and good resolution. Imaging plays a vital role in selecting patients for the combined modality treatment. MRI is not as popular as CT due to limited availability, time required for the study and lack of experience with interpreting the results. PET-CT is useful in ruling out extra peritoneal disease and it is the CT component that is more reliable for predicting the disease extent. This article reviews the current use of various imaging modalities in various stages of treatment of patients with PM especially those undergoing CRS and HIPEC. [ABSTRACT FROM AUTHOR]
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- 2016
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49. Holistic care in advanced pseudomyxoma peritonei: the clinical nurse specialist role in a rare malignancy of the abdomen and pelvis
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Oonagh Staunton
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,General surgery ,Cancer ,medicine.disease ,Malignancy ,Clinical nurse specialist ,Peritoneal malignancy ,Medical–Surgical Nursing ,medicine.anatomical_structure ,Holistic nursing ,medicine ,Abdomen ,Pseudomyxoma peritonei ,business ,Pelvis - Abstract
This article explores the complexities of providing holistic nursing care to patients with pseudomyxoma peritonei (PMP), an uncommon cancer of the abdomen and pelvis. It focuses on patients diagnosed at an advanced stage. Patient outcomes can be optimised with robust specialist referral pathways, effective communication and increased professional awareness of rare diseases. The quality of care can be assured with service development and innovation at the point of delivery, backed up by ongoing training, support and best-practice guidelines. The clinical nurse specialist plays an especially vital role in advanced PMP. This involves co-ordination of multidisciplinary care and community support. It also includes patient advocacy, clinical consultancy and psychosocial support, as well as the personalisation of patient-centred care and education for the many and varied individual needs of patients and their families at a very emotive time. This is demonstrated in a national specialised service that was established In Ireland in 2013. It serves patients with rare peritoneal malignancies, who had previously had to travel to the UK for surgical management. The service has continued to develop in practice and innovation for this patient cohort.
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- 2020
50. A rare case report of extensive abdominopelvic endometriosis mimicking peritoneal malignancy: an imaging investigation
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Warissara Jutidamrongphan, Teeravut Tubtawee, Thorsang Chayovan, and Keerati Hongsakul
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Peritoneal malignancy ,medicine.medical_specialty ,business.industry ,Rare case ,medicine ,Endometriosis ,General Medicine ,Radiology ,medicine.disease ,business - Abstract
Introduction: Endometriosis is a benign condition characterized by endometrial tissue deposited outside the uterine cavity. Endometriosis characteristics include a well-defined cyst (endometrioma) with or without internal septations and seeding nodules; however, no case of extensive infiltrating abdominopelvic endometriosis have been reported.Case presentation: A 48-year-old female presented with incidentally found a hypervascular lesion in the pelvic cavity from routine checkup ultrasound. The computed tomography (CT) angiography investigation showed pelvic arteriovenous malformation (AVM). She underwent embolization at interventional radiology unit and the CT angiography follow up showed complete occlusion of pelvic AVM. However, eight months after embolization, she came with severe abdominal pain and hypotension. Emergency CT showed a large abdominopelvic mass with hemoperitoneum which was suspected for gynecologic or peritoneal malignancy. Further magnetic resonance image (MRI) was highly suspicious of peritoneum or mesentery malignancy. Surgical tumor removal was performed. The histologic results were negative for malignancy and the tumor was compatible with endometriosis.Conclusion: Extensive abdominopelvic endometriosis is rare, and its imaging findings may not exclude peritoneal malignancy. Therefore, a definite diagnosis via histological investigation is necessary.Â
- Published
- 2020
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