696 results on '"Sugarbaker, PH"'
Search Results
2. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study
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Glehen, O., Kwiatkowski, F., Sugarbaker, Ph, Elias, D., Levine, Ea, Gilly, Fn, DE SIMONE, M., Barone, R., Yonemura, Y., Cavaliere, F., Quenet, F., Gutman, M., Aak, Tentes, Lorimier, G., Bernard, Jl, Bereder, Jm, Porcheron, J., GOMEZ PORTILLA, A., Shen, P., Deraco, M., Rat, P., Kecmanovic, D., Pesko, P., Piso, P., Sebbag, G., Lowy, Am, Legendre, H., DI CARLO, Isidoro, Link, Kh, Ferreira, F., Bayon, Lg, Lange, J., Zhao, J., and Morris, Dl
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Carcinosis ,Adolescent ,Colorectal cancer ,medicine.medical_treatment ,Perioperative Care ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Infusions, Parenteral ,Survival analysis ,Peritoneal Neoplasms ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,business.industry ,General surgery ,Carcinoma ,Retrospective cohort study ,Perioperative ,Middle Aged ,medicine.disease ,Prognosis ,Survival Analysis ,Surgery ,Treatment Outcome ,Oncology ,Chemotherapy, Adjuvant ,Peritoneal Cancer Index ,Hyperthermic intraperitoneal chemotherapy ,Female ,business ,Colorectal Neoplasms - Abstract
Purpose The three principal studies dedicated to the natural history of peritoneal carcinomatosis (PC) from colorectal cancer consistently showed median survival ranging between 6 and 8 months. New approaches combining cytoreductive surgery and perioperative intraperitoneal chemotherapy suggest improved survival. Patients and Methods A retrospective multicenter study was performed to evaluate the international experience with this combined treatment and to identify the principal prognostic indicators. All patients had cytoreductive surgery and perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy). PC from appendiceal origin was excluded. Results The study included 506 patients from 28 institutions operated between May 1987 and December 2002. Their median age was 51 years. The median follow-up was 53 months. The morbidity and mortality rates were 22.9% and 4%, respectively. The overall median survival was 19.2 months. Patients in whom cytoreductive surgery was complete had a median survival of 32.4 months, compared with 8.4 months for patients in whom complete cytoreductive surgery was not possible (P < .001). Positive independent prognostic indicators by multivariate analysis were complete cytoreduction, treatment by a second procedure, limited extent of PC, age less than 65 years, and use of adjuvant chemotherapy. The use of neoadjuvant chemotherapy, lymph node involvement, presence of liver metastasis, and poor histologic differentiation were negative independent prognostic indicators. Conclusion The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with PC from colorectal origin with acceptable morbidity and mortality. The complete cytoreductive surgery was the most important prognostic indicator.
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- 2004
3. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group
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Di Saverio, S, Coccolini, F, Galati, M, Smerieri, N, Biffl, WL, Ansaloni, L, Tugnoli, G, Velmahos, GC, Sartelli, M, Bendinelli, C, Fraga, GP, Kelly, MD, Moore, FA, Mandalà, V, Mandalà, S, Masetti, M, Jovine, E, Pinna, AD, Peitzman, AB, Leppaniemi, A, Sugarbaker, PH, Goor, HV, Moore, EE, Jeekel, J, Catena, F, Di Saverio, S, Coccolini, F, Galati, M, Smerieri, N, Biffl, WL, Ansaloni, L, Tugnoli, G, Velmahos, GC, Sartelli, M, Bendinelli, C, Fraga, GP, Kelly, MD, Moore, FA, Mandalà, V, Mandalà, S, Masetti, M, Jovine, E, Pinna, AD, Peitzman, AB, Leppaniemi, A, Sugarbaker, PH, Goor, HV, Moore, EE, Jeekel, J, and Catena, F
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Background: In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy.Recommendations: In absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution, surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not decrease recurrence rates or recurrences needing surgery.Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if first episode of SBO and/or anticipated single band. A l
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- 2013
4. The Assessment of Malignant Potential according to Peritoneal Carcinomatosis Index of Pseudomyxoma Peritonei
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Tsukiyama, Goro, primary, Yonemura, Yutaka, additional, Kawamura, Taiichi, additional, Bandoh, Etsuro, additional, Itoh, Hiroaki, additional, Kusafuka, Kimihide, additional, and Sugarbaker, PH, additional
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- 2007
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5. COMMENTARY
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Sugarbaker, PH, primary
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- 2000
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6. CORRESPONDENCE
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Sugarbaker Ph
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Gynecology ,Oncology ,medicine.medical_specialty ,business.industry ,General Medicine ,medicine.disease ,Internal medicine ,medicine ,Carcinoma ,Surgery ,Epithelial ovarian cancer ,business ,Cytoreductive surgery ,Survival analysis - Published
- 2001
7. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
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Chua TC, Moran BJ, Sugarbaker PH, Levine EA, Glehen O, Gilly FN, Baratti D, Deraco M, Elias D, Sardi A, Liauw W, Yan TD, Barrios P, Gómez Portilla A, de Hingh IH, Ceelen WP, Pelz JO, Piso P, González-Moreno S, and Van Der Speeten K
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- 2012
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8. A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*.
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Yan TD, Deraco M, Elias D, Glehen O, Levine EA, Moran BJ, Morris DL, Chua TC, Piso P, Sugarbaker PH, and Peritoneal Surface Oncology Group
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- 2011
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9. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of advanced primary and recurrent ovarian cancer.
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Sugarbaker PH
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- 2009
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10. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome?
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Sugarbaker PH
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Appendiceal mucinous neoplasms sometimes present with peritoneal dissemination, which was previously a lethal condition with a median survival of about 3 years. Traditionally, surgical treatment consisted of debulking that was repeated until no further benefit could be achieved; systemic chemotherapy was sometimes used as a palliative option. Now, visible disease tends to be removed through visceral resections and peritonectomy. To avoid entrapment of tumour cells at operative sites and to destroy small residual mucinous tumour nodules, cytoreductive surgery is combined with intraperitoneal chemotherapy with mitomycin at 42 degrees C. Fluorouracil is then given postoperatively for 5 days. If the mucinous neoplasm is minimally invasive and cytoreduction complete, these treatments result in a 20-year survival of 70%. In the absence of a phase III study, this new combined treatment should be regarded as the standard of care for epithelial appendiceal neoplasms and pseudomyxoma peritonei syndrome. [ABSTRACT FROM AUTHOR]
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- 2006
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11. Alloimmune cells consume interleukin-2 and competitively inhibit the anti-tumour effects of interleukin-2.
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Eggermont, AM, Steller, EP, Matthews, W, and Sugarbaker, PH
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- 1987
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12. Efficacy of chemoimmunotherapy with cyclophosphamide, interleukin-2 and lymphokine activated killer cells in an intraperitoneal murine tumour model.
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Eggermont, AMM and Sugarbaker, PH
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- 1988
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13. Resection of the liver for colorectal carcinoma metastases - A multi-institutional study of long-term survivors
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Hughes, KS, Rosenstein, RB, Songhorabodi, S, Adson, MA, Ilstrup, DM, Fortner, JG, Maclean, BJ, Foster, JH, Daly, JM, Fitzherbert, D, Sugarbaker, PH, Iwatsuki, S, Starzl, T, Ramming, KP, Longmire, WP, O'Toole, K, Petrelli, NJ, Herrera, L, Cady, B, McDermott, W, Nims, T, Enker, WE, Coppa, GF, Blumgart, LH, Bradpiece, H, Urist, M, Aldrete, JS, Schlag, P, Hohenberger, P, Steele, G, Hodgson, WJ, Hardy, TG, Harbora, D, McPherson, TA, Lim, C, Dillon, D, Happ, R, Ripepi, P, Villella, E, Smith, W, Rossi, RL, Remine, SG, Oster, M, Connolly, DP, Abrams, J, Al-Jurf, A, Hobbs, KEF, Li, MKW, Howard, T, Lee, E, Hughes, KS, Rosenstein, RB, Songhorabodi, S, Adson, MA, Ilstrup, DM, Fortner, JG, Maclean, BJ, Foster, JH, Daly, JM, Fitzherbert, D, Sugarbaker, PH, Iwatsuki, S, Starzl, T, Ramming, KP, Longmire, WP, O'Toole, K, Petrelli, NJ, Herrera, L, Cady, B, McDermott, W, Nims, T, Enker, WE, Coppa, GF, Blumgart, LH, Bradpiece, H, Urist, M, Aldrete, JS, Schlag, P, Hohenberger, P, Steele, G, Hodgson, WJ, Hardy, TG, Harbora, D, McPherson, TA, Lim, C, Dillon, D, Happ, R, Ripepi, P, Villella, E, Smith, W, Rossi, RL, Remine, SG, Oster, M, Connolly, DP, Abrams, J, Al-Jurf, A, Hobbs, KEF, Li, MKW, Howard, T, and Lee, E
- Abstract
In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to 1-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primarycarcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized. © 1988 American Society of Colon and Rectal Surgeons.
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- 1988
14. Computed tomography of the liver and spleen with intravenous lipoid contrast material: review of 60 examinations
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Vermess, M, primary, Doppman, JL, additional, Sugarbaker, PH, additional, Fisher, RI, additional, O'Leary, TJ, additional, Chatterji, DC, additional, Grimes, G, additional, Adamson, RH, additional, Willis, M, additional, and Edwards, BK, additional
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- 1982
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15. Carcinoembryonic antigen (CEA) monitoring of radiation therapy for colorectal cancer
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Sugarbaker, PH, primary, Bloomer, WD, additional, Corbett, ED, additional, and Chaffey, JT, additional
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- 1976
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16. CT of the liver and spleen with EOE-13: review of 225 examinations
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Miller, DL, primary, Vermess, M, additional, Doppman, JL, additional, Simon, RM, additional, Sugarbaker, PH, additional, O'Leary, TJ, additional, Grimes, G, additional, Chatterji, DG, additional, and Willis, M, additional
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- 1984
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17. Detection of hepatic metastases: comparison of EOE-13 computed tomography and scintigraphy
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Miller, DL, primary, Rosenbaum, RC, additional, Sugarbaker, PH, additional, Vermess, M, additional, Willis, M, additional, and Doppman, JL, additional
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- 1983
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18. A 'happy marriage' between open and closed techniques of heated intraperitoneal chemotherapy.
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Ortega-Deballon P, Facy O, Rat P, Esquivel J, and Sugarbaker PH
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- 2009
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19. Prognostic significance of histomorphologic parameters in diffuse malignant peritoneal mesothelioma.
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Cerruto CA, Brun EA, Chang D, and Sugarbaker PH
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- 2006
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20. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society
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Roland Andersson, Salomone Di Saverio, Franco Bazzoli, Antonio Daniele Pinna, Alessandro Repici, Jean Jaques Tuech, Hans Jeekel, Ari Leppäniemi, Fausto Catena, Paul H. Sugarbaker, Vincenzo Cennamo, Ernest E. Moore, Luca Ansaloni, Michele Pisano, Lorenzo Fuccio, Ansaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, Di Saverio S, Fuccio L, Jeekel H, Leppäniemi A, Moore E, Pinna AD, Pisano M, Repici A, Sugarbaker PH, and Tuech JJ
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Medicin och hälsovetenskap ,medicine.medical_specialty ,Decompression ,medicine.medical_treatment ,lcsh:Surgery ,Review ,030230 surgery ,Cochrane Library ,Anastomosis ,Medical and Health Sciences ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Neoadjuvant therapy ,COLORECTAL CANCER ,BRIDGE-TO-SURGERY ,business.industry ,Mortality rate ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Colostomy ,PALLIATION ,lcsh:RD1-811 ,lcsh:RC86-88.9 ,ENDOPROTHESIS ,3. Good health ,Surgery ,COLONIC STENTING ,030220 oncology & carcinogenesis ,Emergency Medicine ,Segmental resection ,business - Abstract
Background Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B). Conclusions Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A.
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- 2010
21. Education and Training in Peritoneal Surface Oncology.
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González-Moreno S, Deraco M, Kusamura S, Bijelic L, Lambert LA, Dromain C, Bibeau F, Liauw W, Reis A, Galan A, and Sugarbaker PH
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Peritoneal surface oncology (PSO) is a novel field dealing with the knowledge of peritoneal neoplasms, primary or secondary, and their clinical management. As a specific treatment with curative intent for peritoneal neoplasms developed over the years, there is a growing need to comprehensively educate and train surgical oncologists worldwide in this discipline, a recognized unmet need. The European School of Peritoneal Surface Oncology (ESPSO) emerged in 2014 to provide an answer to this need., (© 2024 Wiley Periodicals LLC.)
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- 2024
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22. PSOGI-Venice-2023, history in the making.
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Sugarbaker PH, Deraco M, and Sammartino P
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- 2024
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23. Cellularity of mucus is a prognostic variable in low-grade appendiceal mucinous neoplasms.
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Sugarbaker PH, Liang JJ, Deng T, and Chang D
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- Humans, Prognosis, Female, Male, Middle Aged, Aged, Neoplasm Grading, Adult, Survival Rate, Retrospective Studies, Appendiceal Neoplasms pathology, Mucus metabolism, Adenocarcinoma, Mucinous pathology, Adenocarcinoma, Mucinous surgery, Cytoreduction Surgical Procedures, Peritoneal Neoplasms secondary, Peritoneal Neoplasms pathology
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For peritoneal metastases from a primary appendiceal mucinous neoplasm to exist, the thin wall of the appendix must perforate to allow mucus or mucus plus tumor cells to gain access to the peritoneal spaces. The proportion of specimens containing tumor cells within mucus as compared to mucus only outside the appendix may have prognostic significance. The histopathology of tumor masses was determined from the specimens resected at the cytoreductive surgery (CRS). The presence versus absence of tumor cells in mucus and the proportion of specimens with tumor cells was determined and correlated with the overall survival of these patients. In 418 patients with a complete cytoreduction for a low-grade appendiceal mucinous neoplasm (LAMN), the cellularity of all resected specimens was determined. The hazard ratio of overall survival of patients whose specimens had no cells as compared to specimens with cells in mucus by histology was 4.41 (1.61, 12.1) (p = 0.0039). If overall survival of patients with all specimens without tumor cells was compared to patients with specimens with 1-99 % tumor and compared to patients with 100 % of specimens with tumor cells, the hazard ratios were 4.3 (1.34, 13.8) (p = 0.0143) and 9.62 (2.93, 31.6) (p = 0.0002), respectively. The cellularity of mucus within the specimens removed by a complete CRS has strong prognostic implications in LAMN patients. LAMN with acellular specimens (LAMNa) as compared to LAMN with tumor cells in specimens (LAMNb) should be staged as different histologic subtypes of mucinous appendiceal neoplasms., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (© 2024 Elsevier Ltd, BASO ∼ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
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- 2024
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24. Critical reappraisal of prognostic indicators for 949 mucinous appendiceal neoplasm patients.
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Sugarbaker PH and Chang D
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- Humans, Prognosis, Female, Male, Middle Aged, Peritoneal Neoplasms therapy, Peritoneal Neoplasms pathology, Peritoneal Neoplasms mortality, Peritoneal Neoplasms secondary, Aged, Adult, Survival Rate, Combined Modality Therapy, Retrospective Studies, Appendiceal Neoplasms pathology, Appendiceal Neoplasms therapy, Appendiceal Neoplasms mortality, Adenocarcinoma, Mucinous pathology, Adenocarcinoma, Mucinous therapy, Adenocarcinoma, Mucinous mortality, Cytoreduction Surgical Procedures, Hyperthermic Intraperitoneal Chemotherapy
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Background and Objectives: The standard of care for treatment of an appendiceal mucinous neoplasm with peritoneal dissemination is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). These two treatments are combined in the operating room. A crucial requirement for benefit long-term is proper patient selection. Clinical and histopathologic prognostic indicators are used, along with the patient's fitness for surgery, to select patients to receive CRS and HIPEC., Methods: This study seeks to identify the reliable prognostic indicators for four different groups of patients. They are (1) the low-grade appendiceal mucinous neoplasms (LAMN) with a complete CRS, (2) the mucinous appendiceal adenocarcinomas (MACA) with complete CRS, (3) MACA with lymph node metastases (MACA-LN) with complete CRS, and (4) all histologic subtypes with incomplete cytoreduction. The prognostic indicators were evaluated for their impact on overall survival in these four groups of patients., Results: The completeness of cytoreduction (CC) score statistically significantly showed survival differences in all three histologic subtypes. The peritoneal cancer index (PCI) showed significance with LAMN and MACA-LN but not with MACA and not with incomplete CRS. The prior surgical score (PSS) was a prognostic indicator that predicted the outcome with LAMN, MACA-LN, and incomplete CRS patients but not with the MACA group. Patients who were symptomatic or who had extensive systemic chemotherapy before CRS had a significantly reduced survival., Conclusion: The utility of prognostic indicators varied greatly within our four different groups of appendiceal mucinous neoplasms. CC score was always a reliable prognosticator. Surprisingly, PCI was not., (© 2024 Wiley Periodicals LLC.)
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- 2024
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25. Critical appraisal of total gastrectomy plus total colectomy with hyperthermic intraperitoneal chemotherapy as a treatment for advanced pseudomyxoma peritonei.
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Sugarbaker PH and Chang D
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Background: The absolute requirement for a long-term favorable result with cytoreductive surgery for pseudomyxoma peritonei is a complete resection of all visible disease. A combination of parietal peritonectomy procedures and visceral resections is required for this to occur. The cytoreductive surgery is supplemented by hyperthermic intraperitoneal chemotherapy., Methods: We searched our database and secured files for patients who required a total gastrectomy and a total colectomy to achieve a complete cytoreductive surgery. Survival of low-grade mucinous neoplasm (LAMN) and mucinous appendiceal adenocarcinoma (MACA) histologies were determined. Clinical and histologic variables were assessed for their impact on survival., Results: Thirteen of 450 patients (2.9%) with LAMN histology and 14 of 186 patients (7.5%) with MACA histology had these visceral resections. Median survival of these 27 patients was 10 years. LAMN and MACA patients showed the same survival. For LAMN histology, this requirement for extensive visceral resection markedly reduced survival (p < 0.0001). For MACA, there was no adverse impact on survival (p = 0.4359). Class 4 adverse events caused reduced survival (p = 0.0014)., Conclusions: A 10-year median survival accompanies total gastrectomy plus total colectomy for advanced pseudomyxoma peritonei. Systemic chemotherapy and class 4 adverse events reduced survival., (© 2024 Wiley Periodicals LLC.)
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- 2024
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26. It Is What the Surgeon Does Not See That Kills the Patient.
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Sugarbaker PH
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Background: Patients with colon cancer may present at multiple different stages of the disease process. Many patients can be cured of colon cancer as a result of a simple surgical procedure usually performed by minimally invasive techniques. However, there are a variable number of patients, estimated at approximately 10%, who have a more advanced disease. If these patients are treated by the current conventional standard of care, the likelihood for treatment failure is extremely high., Methods: These are not patients with known disseminated disease but patients who are at high risk of recurrent disease unless special treatments are initiated preoperatively and intraoperatively. The identification of these patients is by (1) a high-quality CT scan, (2) tumor markers found preoperatively, (3) colonoscopic findings, and (4) symptoms., Results: Patients identified as being at high risk require special preoperative treatments which include neoadjuvant chemotherapy. Intraoperative chemotherapy with HIPEC should occur as part of the treatment if peritoneal metastases are documented by biopsy. In the operating room, a thorough exploration of all possible occult peritoneal spaces for metastatic disease needs to be performed. A modified cytoreductive surgical procedure along with a colon resection is performed in order to minimize sites of occult peritoneal metastases. This includes the greater omentum, ovaries, and tubes in postmenopausal women. Peritonectomy is used to create a shroud around the tumor so that all peritoneum that has been in direct contact with the tumor surface is resected and is used as a barrier against tumor cell dissemination in the process of colon cancer resection. If peritoneal metastases are visualized at any site, HIPEC should be included as part of the treatment package., Conclusions: I am convinced that patients at high risk of recurrence will have an improved outcome with proper preoperative evaluation, preoperative neoadjuvant chemotherapy, and a revised intraoperative management strategy.
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- 2024
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27. Bidirectional chemotherapy long-term as a treatment strategy for peritoneal metastases.
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Sugarbaker PH
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Competing Interests: Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-23-2039/coif). The author has no conflicts of interest to declare.
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- 2024
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28. Use of early postoperative intraperitoneal 5-fluorouracil with index cytoreduction improves survival with secondary cytoreductive surgery.
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Sugarbaker PH and Chang D
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- Male, Humans, Middle Aged, Fluorouracil, Cytoreduction Surgical Procedures, Quality of Life, Combined Modality Therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Survival Rate, Retrospective Studies, Appendiceal Neoplasms surgery, Peritoneal Neoplasms drug therapy, Peritoneal Neoplasms surgery, Hyperthermia, Induced
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Background: In patients with appendiceal mucinous neoplasm with peritoneal dissemination, a cytoreductive surgery (CRS) with perioperative chemotherapy may result in long-term survival. Disease progression may require secondary cytoreductive surgery (SCRS) and other treatments in selected patients to improve survival and preserve an optimal quality of life., Methods: The clinical- and treatment-related variables associated with the index CRS and SCRS were statistically assessed for impact on survival after SCRS., Results: A total of 186 of 687 complete CRS patients (27.1%) had SCRS. Median follow-up was 10 years and median survival was 12 years. In 95 males (51%) the median age was 45.0 years. Survival benefit with SCRS was observed if early postoperative intraperitoneal chemotherapy (EPIC) with 5-fluorouracil (EPIC 5-FU) or hyperthermic intraperitoneal chemotherapy (HIPEC) plus EPIC 5-FU was used with the index CRS (hazard ratio [HR]: 0.6, p = 0.0360; HR: 0.4, p = 0.0004, respectively). By propensity matching of 51 pairs of patients, EPIC 5-FU used with index CRS caused a survival advantage compared to HIPEC alone (p = 0.0100) with index CRS (p = 0.0100)., Conclusions: Use of EPIC 5-FU at a complete index CRS was a prognostic variable that improved survival in patients requiring SCRS. Further investigations into the benefits of antiadhesion treatments with CRS and HIPEC are warranted., (© 2023 Wiley Periodicals LLC.)
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- 2024
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29. Phase 1 trial of same day cytology to guide the use of HIPEC.
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Sugarbaker PH and Deng T
- Abstract
Background: Peritoneal metastases from gastrointestinal or gynecologic malignancy are a prominent part of the natural history of these diseases. Peritoneal metastases, if not effectively treated, will result in a decreased survival and cause an impaired quality of life. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment specifically designed to combat peritoneal metastases. A group of patients who, from a theoretical perspective, may benefit from HIPEC are those patients with a positive peritoneal cytology. In order to identify these patients at the time of a surgical intervention, a same day cytology is to be performed., Materials and Methods: The result of this test is to be available at or before the completion of the cancer resection. If the cytology is positive, the patient immediately becomes a candidate for HIPEC. The HIPEC will be of maximal value if a complete cytoreduction, as judged by the surgeon, has been possible. This phase 1 trial is to demonstrate that the Surgical Oncology Service, the Department of Pathology, the Pharmacy and the Operating Room personnel can co-ordinate a phase 1 protocol to successfully complete the same day cytology with an efficient delivery of HIPEC. A standardized plan for consent, cytology collection, preparation of the specimen, reading of the specimen, reporting the results in a timely manner facilitates the administration of HIPEC in peritoneal cytology positive patients., Dissemination: Successful completion of these requirements is a positive result for this study and allows for future protocols to be generated. Successful completion of the same day cytology phase 1 protocol will allow the efficacy, safety, and efficiency of this plan of patient management to be evaluated., Competing Interests: Authors state no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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30. Conquering colon cancer peritoneal metastases one state at a time.
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Sugarbaker PH
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- 2023
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31. Prognostic indicators for colorectal peritoneal metastases are different for patients with complete versus incomplete cytoreductive surgery.
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Ghabra S, Chang D, and Sugarbaker PH
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- Humans, Prognosis, Cytoreduction Surgical Procedures, Peritoneum pathology, Combined Modality Therapy, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Retrospective Studies, Peritoneal Neoplasms surgery, Peritoneal Neoplasms pathology, Colorectal Neoplasms pathology, Hyperthermia, Induced
- Abstract
Background: In the management of peritoneal metastases in patients with colorectal cancer, the completeness of cytoreduction has consistently been the most prominent prognostic indicator. Other clinical and histologic features have been described that may also have an impact on survival., Methods: The colorectal peritoneal metastases patients treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy were divided into two groups. One group had complete CRS and the second group had an incomplete CRS. The prognostic variables in these two groups of patients were statistically analyzed for their impact on survival., Results: In the complete CRS group of 124 patients lymph node positivity, poorly differentiated histopathology, asymptomatic status following treatment with systemic chemotherapy, incomplete response to systemic chemotherapy, and moderate to high peritoneal cancer index showed a significantly reduced survival. All five of these prognostic variables ceased to show statistical significance in the group of 82 patients with incomplete cytoreduction., Conclusion: The cause for significance of five prognostic indicators identified in patients with complete cytoreduction versus loss of significance of these indicators in patients with incomplete cytoreduction has not been determined. An absence of residual disease in complete CRS patients and a widely variable extent of residual disease in incomplete CRS patients may be important. Prognostic indicators in patients with colorectal peritoneal metastases find their greatest usefulness in patients who have had a complete cytoreduction., (© 2023 Wiley Periodicals LLC.)
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- 2023
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32. Clinical and Histopathologic Features of 35 Patients Treated for Colorectal Peritoneal Metastases Who Survived 5 Years.
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Ghabra S, Desale S, and Sugarbaker PH
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- Humans, Middle Aged, Combined Modality Therapy, Cytoreduction Surgical Procedures adverse effects, Peritoneum surgery, Peritoneum pathology, Prognosis, Retrospective Studies, Survival Rate, Adult, Aged, Aged, 80 and over, Colorectal Neoplasms surgery, Hyperthermia, Induced adverse effects, Peritoneal Neoplasms secondary
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Background: Currently, patients with a limited extent of peritoneal metastases from colon and rectal cancer are treated by cytoreductive surgery combined with perioperative chemotherapy performed at experienced centers., Objective: To statistically evaluate features that may impact survival of ≥5 years. These data are used in the risk/benefit analyses performed by the multidisciplinary team., Design: This was a retrospective review of a prospective database., Settings: This single-institution study was conducted at an academic center., Patients: All patients who had biopsy-proven colon or rectal peritoneal metastases treated by systemic chemotherapy, complete cytoreductive surgery, and perioperative surgery were included., Main Outcome Measures: The primary outcomes measured were the clinical-, histologic-, and treatment-related features that had an impact on 5-year survival., Results: From 131 patients who had complete cytoreduction, 35 patients (26.7%) were identified as 5-year survivors. The median survival time was 27 months. The median age was 50.5 (range, 25-80) years. By univariant analysis, an absence of lymph node involvement at the time of primary colorectal cancer resection (HR 1.899 [95% CI, 1.064-3.388]; p = 0.03), complete or near-complete response to neoadjuvant chemotherapy (HR 0.251 [95% CI, 0.092-0.684]; p = 0.007), peritoneal cancer index ≤17 (HR 0.509 [95% CI, 0.329-0.788]; p = 0.002), complete visible resection of disease indicated by the completeness of cytoreduction score of 0 (HR 0.412 [95% CI, 0.224-0.756]; p = 0.004), and well-differentiated tumor (HR 0.34 [95% CI, 0.157-0.737]; p = 0.006) were significantly associated with ≥5 years survival., Limitations: Limitations include its retrospective nature, unmeasured confounders, and data from a single institution., Conclusions: The tumor biology as revealed by lymph node status and tumor differentiation plus extent of disease as measured by the response to neoadjuvant chemotherapy, peritoneal cancer index, and no visible residual disease indicated a favorable outcome. See Video Abstract at http://links.lww.com/DCR/C62 ., Caractersticas Clnicas E Histopatolgicas En Pacientes Tratados Por Metastasis Peritoneales De Orgen Colorectal Y Que Sobrevivieron Aos: ANTECEDENTES:Actualmente, los pacientes con extensión limitada de metástasis peritoneales de orígen colorectal son tratados mediante cirugía citorreductora asociada con una quimioterapia peri-peratoria realizadas en centros experimentados.OBJETIVO:Estúdio y evaluación estadística de las características que puedan impactar en la sobrevida de los pacientes a 5 años o más. Se utilizaron estos datos en el análisis de riesgo /beneficio realizados por un equipo multidisciplinario.DISEÑO:Revisión retrospectiva de una base de datos prospectiva.AJUSTES:Estudio realizado en una sola institución académica.PACIENTES:Todos aquellos que presentaban metástasis peritoneales de orígen colorectal, comprobadas por biopsia y tratadas con quimioterapia sistémica, cirugía peri-operatoria y citorreductora completas.MEDIDAS DE RESULTADO PRINCIPALES:Las medidads de resultados primarios fueron las características clínicas, histológicas y relacionadas con el tratamiento que tuvieron un impacto en la sobrevida a 5 años.RESULTADOS:De 131 pacientes que tuvieron una cirugía de citorreducción completa, 35 pacientes (26, 7%) fueron identificados como sobrevivientes a 5 años. La mediana de sobrevida fué de 27 meses. Se identificarion 16 varones. La mediana de edad fue de 50, 5 años con un rango de 25 a 80 años. Según análisis univariante, la ausencia de compromiso de los ganglios linfáticos en el momento de la resección del cáncer colorrectal primario (HR 1,899 (1,064, 3,388) p = 0,03), la respuesta completa o casi completa al tratamiento neoadyuvante con quimioterapia (HR 0,251 (0,092, 0,684) p = 0,007), el índice de cáncer peritoneal ≤17 (HR 0,509 (0,329, 0,788) p = 0,002), la resección completa y visible de la enfermedad indicada por la puntuación de citorreducción de 0 (HR 0,412 (0,224), 0,756) p = 0,004) y los tumores bien diferenciados (HR 0,34 (0,157, 0,737) p = 0,006) se asociaron significativamente con 5 o más años de sobrevida.LIMITACIONES:El estudio se encontró limitado por su naturaleza retrospectiva, por la no medida de factores de confusión y por los datos provenientes de una sola institución.CONCLUSIONES:La biología tumoral demostrada según el estado de los ganglios linfáticos y la diferenciación tumoral, agregada a la extensión de la enfermedad medida por la respuesta a la quimioterapia neoadyuvante, el índice de cáncer peritoneal y la ausencia visible de enfermedad residual, demostraron un resultado favorable. Consulte Video Resumen en http://links.lww.com/DCR/C62(Traducción-Dr. Xavier Delgadillo )., (Copyright © The ASCRS 2022.)
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- 2023
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33. Randomized trial of intravenous versus bidirectional chemotherapy after cytoreductive surgery for malignant peritoneal mesothelioma.
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Sugarbaker PH
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Background: Malignant peritoneal mesothelioma (MPM) is a rare disease that progresses within the peritoneal cavity and only disseminates to systemic sites in the terminal months of the disease. For this malignancy, there are several regimens of chemotherapy that have been accepted as standard, principally intraperitoneal chemotherapy (IPC) and intravenous chemotherapy (IVC); however, there is no standardized method of treatment. Selected patients with MPM who are amenable to cytoreductive surgery (CRS) and are fit for surgery typically undergo resection with hyperthermic intraperitoneal chemotherapy (HIPEC). Though individual toxicity and efficacy studies of IPC plus IVC (bidirectional) and IVC chemotherapy for MPM have been conducted, a prospective randomized clinical trial has not been performed for this disease., Materials and Methods: The study objective is to compare the efficacy and toxicity of normothermic bidirectional (IPC/IVC) chemotherapy versus IVC after CRS and HIPEC for epithelial MPM. The patient population are those individuals undergoing CRS for MPM. Exclusion criteria include previous therapy form mesothelioma. The study design is a randomized, nonblinded, phase II clinical trial comparing multicycle IVC with cisplatin (CDDP) and pemetrexed (PMTX) versus multicycle bidirectional chemotherapy with IVC CDDP and IPC PMTX after optimal CRS and HIPEC with CDDP and doxorubicin. The primary endpoint is 2-year disease-free survival. The secondary endpoint is 30-day post-treatment morbidity. The primary objective is to compare the 2-year rates of disease-free survival in the two treatment arms. The secondary objective is to compare the toxicity of each treatment., Dissemination: The prospective randomized trial provides not only a standardized approach to treatment but also a path forward to optimize the survival of patients with MPM. In addition, any increase or decrease in the adverse events associated with PMTX administered as IPC will be demonstrated. Because MPM is a rare disease a multi-institutional implementation of the protocol is required., Competing Interests: Author states no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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34. Determinants of Outcome with Reoperative Surgery for Pseudomyxoma Peritonei in 186 Patients.
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Sugarbaker PH and Chang D
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Objective: To describe the long-term survival and clinical- and treatment-related variables that determine the outcome of repeat cytoreductive surgery (CRS) for mucinous appendiceal neoplasms with peritoneal dissemination., Summary Background: After patients with peritoneal dissemination of an appendiceal mucinous neoplasm have a CRS, disease progression may require secondary cytoreductive surgery (SCRS) and other treatments performed in a timely manner to prolong survival and help preserve an optimal quality of life., Methods: The clinical- and treatment-related variables associated with the index CRS and the SCRS were statistically assessed for their impact on survival., Results: One hundred eighty-six of 687 complete CRS patients (27.1%) had SCRS. The median follow-up was 10 years and the median survival was 12 years. There were 95 males (51%) and the median age was 45.0 years. Survival benefit was associated with the index CRS by use of early postoperative intraperitoneal chemotherapy (EPIC) with 5-fluorouracil [Hazard ratio (HR), 0.4; P = 0.0004]. Also, survival of low-grade mucinous appendiceal neoplasms versus mucinous appendiceal adenocarcinoma (HR, 2.8; P < 0.0001) was improved. The interval between index CRS and SCRS was significant at ≤12 months versus 12-36 months versus >36 months ( P < 0.0001). Change in peritoneal cancer index and disease distribution as focal or diffuse was significant by univariant and multivariant analyses., Conclusions: If the CRS was complete, the use of EPIC 5-fluorouracil, the interval between the index CRS and the SCRS, the histologic grade of the mucinous neoplasm, and the extent of recurrent disease were prognostic variables that should be used to help select patients for SCRS., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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35. A narrative review of what can HIPEC do.
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Sugarbaker PH
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- Humans, Hyperthermic Intraperitoneal Chemotherapy, Cicatrix, Chemotherapy, Adjuvant, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Cytoreduction Surgical Procedures, Peritoneal Neoplasms therapy, Hyperthermia, Induced
- Abstract
Intraperitoneal chemotherapy as in hyperthermic intraperitoneal chemotherapy (HIPEC) has limited efficacy. It should not be expected to eradicate even the smallest vascularized tumor nodules. Neither should it be used in an attempt to eradicate tumor cells from within scar tissue. Perioperative intraperitoneal chemotherapy can be expected to eradicate free cancer cells or minute cancer nodules free floating in the fluid within peritoneal spaces. Also, loosely adherent tumor cells on peritoneal surfaces or within a resection site can be eradicated. This is a prevention of tumor cell entrapment. In so doing postoperative tumor progression within adhesions, within a resection site, and within scar tissue is prevented and result in improved survival. Tumor cells entrapped within scar tissue is relatively resistant to systemic chemotherapy. By eliminating tumor cell entrapment in scar HIPEC can increase the benefit of systemic chemotherapy., Competing Interests: Declaration of competing interest The author has no disclosures to declare., (Copyright © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
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- 2023
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36. Selection Factors for Treatment and Stratification of Rare Abdominal or Pelvic Tumors with Peritoneal Metastases.
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Sugarbaker PH
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To maximize the results of treatments for peritoneal metastases for rare abdominal or pelvic tumors, selection of patients with a possibility for long-term success is necessary. Because these malignancies are rare, data from which these selection factors can be extracted do not exist. In order to facilitate knowledgeable patient selection for treatment, the well established clinical and histopathologic features of the common malignancies treated for peritoneal metastases were reviewed. The potential application of selection factors for common diagnoses was explored in an attempt to provide selection factors for rare tumors. The histopathologic grade, the lymph node status, the Ki-67 proliferation index, prior surgical score (PSS), preoperative radiologic imaging, preoperative laparoscopic assessment, response to neoadjuvant chemotherapy, peritoneal cancer index (PCI), and completeness of cytoreduction score were all included in this search for relevant selection factors for a rare disease. To facilitate the use of selection factors from common peritoneal metastases diagnoses, these diseases were divided into four groups. Placement of the rare cause of peritoneal metastases into one of these four groups will allow knowledgeable selection for treatment. Rare diseases with a natural history resembling low-grade appendiceal neoplasms are in group 1, diseases resembling lymph node negative colorectal cancer are in group 2, diseases resembling lymph node positive colorectal peritoneal metastases in group 3, and diseases resembling gastric cancer in group 4., Competing Interests: Conflict of InterestThe author declares no competing interests., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)
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- 2023
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37. Ten-year survival of pancreas cancer with liver metastases treated by intraoperative and long-term intraperitoneal gemcitabine. A case report.
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Sugarbaker PH and Steves MA
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Introduction and Importance: Progress in the management of pancreas cancer has been slow to occur. Resection of the primary cancer in the head of the pancreas is possible and has become a standard of care in operable patients. Unfortunately, long-term survival after this extensive surgical procedure is nearly nonexistent., Case Presentation: A 55-year-old man was diagnosed with cancer within the pancreas head. He underwent a successful pancreaticoduodenectomy. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with gemcitabine was added in an attempt to eliminate cancer cells present within the peritoneal space at the time of the resection. Also, six cycles of normothermic intraperitoneal chemotherapy (NIPEC) delivered through an intraperitoneal port were completed. The patient developed a solitary liver metastasis which was removed with adequate margins. The patient remains alive and well and working ten years following treatments., Clinical Discussion: Pancreas cancer shows treatment failures on peritoneal surfaces, as liver metastases, and as systemic and distant lymph nodal disease. The pharmacology of intraperitoneal gemcitabine suggests that it can eliminate peritoneal metastases as a site for treatment failure. Radical surgery can remove lymph nodes in and around the malignancy that are likely to cause a recurrence. Eliminating other sites of treatment failure in this patient allowed the liver resection to result in a long-term survival., Conclusions: In patients with resectable cancer of the head of the pancreas, local-regional and distant peritoneal recurrence may be reduced as a result of HIPEC and NIPEC gemcitabine being added to the treatments. Additional chemotherapy agents are available to supplement the intraoperative and long-term intraperitoneal gemcitabine treatments. A strategy for bidirectional (both intravenous and intraperitoneal) chemotherapy for pancreas cancer remains as a viable option for improved survival., Competing Interests: Conflicts of interest Paul H. Sugarbaker and Mark A. Steves have no conflicts of interest to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2023
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38. Response to Nivolumab followed by complete cytoreductive surgery with HIPEC resulted in long-term survival in a patient with sarcomatoid-predominant biphasic peritoneal mesothelioma. A case report.
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Sugarbaker PH
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Introduction and Importance: Sarcomatoid-predominant biphasic peritoneal metastases is a rapidly progressing and deeply invasive variant of this disease with survival measured in months. Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a standard of care for epithelioid peritoneal mesothelioma, the sarcomatoid variant is so aggressive, the standard treatment is not recommended. Immunotherapy has recently been utilized for pleural mesothelioma. Partial responses to immunotherapy may be combined with CRS to achieve a favorable outcome in sarcomatoid-predominant peritoneal mesothelioma., Case Presentation: A 39-year-old woman developed an expanding abdomen. A 10 cm pelvic mass was removed by hysterectomy. With an initial diagnosis of advanced ovarian cancer, she was treated with cisplatin plus paclitaxel. Disease progression led to a review of her original pathology and a repeat biopsy which showed biphasic peritoneal mesothelioma with sarcomatoid predominance. Treatment with Nivolumab was transiently beneficial. Repeat CT 8 months later showed partial bowel obstruction and necrotic expanding tumor masses that were partially calcified. CRS with HIPEC and normothermic long-term intraperitoneal pemetrexed (NIPEC) plus intravenous cisplatin resulted in a 5-year disease-free survival., Clinical Discussion: The specimens removed at CRS showed marked progression within large masses. Smaller masses resected with CRS showed fibrosis and calcification. The response to Nivolumab was heterogeneous with smaller masses with good blood supply adequately treated but larger masses markedly progressed., Conclusions: A combination of partial response to immunotherapy with a complete CRS plus HIPEC and NIPEC can result in a long-term favorable outcome., Competing Interests: Declaration of competing interest The author has no disclosures to declare., (Copyright © 2023 The Author. Published by Elsevier Ltd.. All rights reserved.)
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- 2023
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39. Pleurectomy and decortication are associated with better survival for bicavitary cytoreductive surgery for mesothelioma compared with extrapleural pneumonectomy.
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Ripley RT, Holmes HM, Whitlock RS, Groth SS, Medina CG, Choi EA, Burt BM, and Sugarbaker PH
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- Humans, Pneumonectomy adverse effects, Pneumonectomy methods, Cytoreduction Surgical Procedures adverse effects, Treatment Outcome, Retrospective Studies, Pleural Neoplasms, Mesothelioma, Malignant, Mesothelioma, Lung Neoplasms surgery
- Abstract
Objectives: Mesothelioma is a nearly uniformly fatal tumor. Multimodality therapy including cytoreductive surgery and chemotherapy is associated with long-term survival in some patients. Cytoreductive surgery for thoracic disease includes a lung-sparing operation called an "extended pleurectomy/decortication" or a lung-sacrificing surgery called an "extrapleural pneumonectomy." The benefit of cytoreductive surgery for bicavitary disease (chest and abdomen) is poorly understood. Our objective was to evaluate the long-term survivals for patients undergoing cytoreductive surgery for bicavitary disease and to determine whether any prognostic factors were associated with outcome., Methods: We reviewed our Institutional Review Board-approved, institutional, International Association for the Study of Lung Cancer Mesothelioma Staging Project database. Inclusion criteria were all patients who underwent cytoreductive surgery for bicavitary disease. Overall survival was calculated by Kaplan-Meier methodology. All International Association for the Study of Lung Cancer database elements were evaluated by univariable analysis., Results: From February 2014 to August 2021, 440 patients with mesothelioma were evaluated. Fourteen patients (3%) underwent cytoreductive surgery of both chest and abdomen as a planned 2-stage operation. Most patients (13/14; 93%) underwent chest surgery before abdomen surgery. For the entire cohort, the median overall survival was 33.6 months with a 5-year survival of 20%. Extended pleurectomy/decortication was associated with a better outcome compared with extrapleural pneumonectomy, with median overall survivals of 58.2 versus 13.5 months, respectively., Conclusions: For a highly selected group of patients with bicavitary mesothelioma, long-term survival can be achieved with an aggressive, staged surgical approach. The patients who undergo extended pleurectomy/decortication with preservation of the lung appear to have more favorable outcomes compared with patients undergoing extrapleural pneumonectomy., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2023
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40. Pathogenesis of histologic variations of appendiceal mucinous neoplasms.
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Sugarbaker PH, Chang D, and Liang J
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- Humans, Retrospective Studies, Peritoneum pathology, Cytoreduction Surgical Procedures adverse effects, Survival Rate, Combined Modality Therapy, Appendiceal Neoplasms pathology, Peritoneal Neoplasms secondary, Adenocarcinoma, Mucinous pathology, Hyperthermia, Induced adverse effects
- Abstract
Background: In order for peritoneal metastases from a primary appendiceal mucinous neoplasm to occur, the wall of the appendix must perforate to allow mucus with tumor cells access to the peritoneal spaces. With progression the peritoneal metastases show a broad spectrum of tumor biology varying from indolent to aggressive activity., Methods: The histopathology of peritoneal tumor masses was determined from the clinical material resected at the time of cytoreductive surgery (CRS). All groups of patients were treated by a uniform strategy that involved complete CRS and perioperative intraperitoneal chemotherapy. Overall survival was determined., Results: From a database of 685 patients, four histologic subtypes were identified and long-term survival determined. Four hundred and fifty patients (66.0%) had low-grade appendiceal mucinous neoplasm (LAMN), 37 patients (5.4%) had mucinous appendiceal adenocarcinoma of intermediate subtype (MACA-Int), 159 patients (23.2%) had mucinous appendiceal adenocarcinoma (MACA), and 39 patients (5.4%) had a mucinous appendiceal adenocarcinoma with positive lymph nodes (MACA-LN). The mean survival of the four groups was 24.5, 14.8, 11.2 and 7.4 years, respectively (p < 0.0001). These four subtypes of mucinous appendiceal neoplasms were shown to have distinct survival estimates., Conclusions: The estimated survival of these four histologic subtypes in patients having a complete CRS plus HIPEC is of value to the oncologist managing these patients. A mutations and perforations hypothesis was offered in an attempt to explain the broad spectrum of mucinous appendiceal neoplasms that exist. Inclusion of MACA-Int and MACA-LN as standalone subtypes was thought to be necessary., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest associated with the manuscript entitled “Pathogenesis of histologic variations of appendiceal mucinous neoplasms”., (Copyright © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
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- 2023
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41. Total abdominal colectomy to facilitate complete cytoreduction in 56 patients with mucinous appendiceal neoplasms with peritoneal metastases.
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Sugarbaker PH and Chang D
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- Humans, Cytoreduction Surgical Procedures methods, Combined Modality Therapy, Colectomy, Retrospective Studies, Survival Rate, Appendiceal Neoplasms pathology, Peritoneal Neoplasms secondary, Hyperthermia, Induced methods, Adenocarcinoma, Mucinous pathology
- Abstract
Background: Cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy are currently the standard of care for management of appendiceal mucinous neoplasms with peritoneal metastases. The goal of the CRS is complete removal of all visible disease through the use of peritonectomy procedures and visceral resections. One of the major resections that may be required is total abdominal colectomy (TAC)., Methods: From a database and secured files of patients having a complete CRS, all patients who had TAC were identified. The clinical and histologic variables associated with these patients were identified and assessed for their impact on overall survival., Results: The 450 complete CRS with low-grade appendiceal mucinous neoplasms had 26 TAC (5.8%) with a 16.0-year median survival. The mucinous adenocarcinoma (MACA)-Intermediate (MACA-Int) group consisted of 37 patients with 8 patients (21.6%) having TAC that resulted in a median survival of 11.5 years. The 159 complete CRS with MACA had 22 TAC (13.8%) with a median survival of 7.5 years. There was a single mortality with a class 4 adverse event in 5 patients (10.7%). With a class 4 adverse event, survival decreased significantly (p = 0.0006, hazard ratio: 6.2)., Conclusion: Complete CRS required TAC in 56 of 646 patients (8.7%) with appendiceal mucinous neoplasms. With TAC, median survival was 12.0 years. A class 4 adverse event markedly reduced survival., (© 2023 Wiley Periodicals LLC.)
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- 2023
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42. Secondary cytoreductive surgery for 86 patients with mucinous appendiceal adenocarcinoma.
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Sugarbaker PH and Chang D
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- Humans, Cytoreduction Surgical Procedures, Combined Modality Therapy, Follow-Up Studies, Retrospective Studies, Survival Rate, Peritoneal Neoplasms therapy, Appendiceal Neoplasms pathology, Adenocarcinoma, Mucinous, Hyperthermia, Induced
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Background: After patients have a surgical procedure for a gastrointestinal cancer, follow-up is indicated. If cancer progression is documented in patients with mucinous appendiceal adenocarcinoma (MACA), a secondary cytoreductive surgery (SCRS) may be considered., Methods: In patients who had a prior complete cytoreductive surgery (CRS), variables associated with the index CRS and SCRS were extracted. These variables were statistically assessed for their impact on survival., Results: Of 198 MACA patients, 86 (43.4%) had SCRS. The median follow-up was 5.0 years and the median survival was 7 years. Significant prognostic variables associated with the index CRS by univariant analysis was histopathologic grade of MACA-Intermediate (MACA-Int) as compared to other MACA histologic subtypes (p = 0.0164). Significant prognostic variables associated with the SCRS were bowel obstruction (p = 0.0149), interval of CRS to SCRS (p = 0.0059), and completeness of cytoreduction (p = 0.0014)., Conclusions: In the analysis of variables from SCRS, the interval from CRS to SCRS ≤24 months indicates an aggressive biology of the disease. The CC score of complete versus incomplete decreased median survival from 11 to 4 years. A composite of these two variables allowed prediction of survival of 50% when patients showed these two favorable variables and only 9.1% when these variables were unfavorable., (© 2023 Wiley Periodicals LLC.)
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- 2023
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43. Palliation of mucinous appendiceal neoplasms with peritoneal metastases with total abdominal colectomy.
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Sugarbaker PH and Chang D
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- Humans, Peritoneum surgery, Colectomy, Cytoreduction Surgical Procedures methods, Survival Rate, Retrospective Studies, Appendiceal Neoplasms pathology, Peritoneal Neoplasms secondary, Neoplasms, Cystic, Mucinous, and Serous surgery, Adenocarcinoma, Mucinous surgery, Hyperthermia, Induced methods
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Background: Incomplete cytoreduction for mucinous appendiceal neoplasms is often required to temporarily alleviate symptoms. The surgical technology for this intervention may be complex and result in extensive morbidity and even mortality. Knowledgeable patient selection for this surgery is mandatory., Methods: A database was used to identify patients who had palliative surgery that included total abdominal colectomy (TAC). Clinical- and treatment-related variables were assessed for their impact on overall survival., Results: Seventy-eight patients had an incomplete cytoreductive surgery (CRS) that included a TAC. The median survival was 2.5 years and the median follow-up was 2 years. Patients with symptoms of abdominal distention and ascites showed a reduced prognosis (p = 0.0254). The low-grade appendiceal mucinous neoplasms (LAMN) and mucinous appendiceal adenocarcinoma intermediate type (MACA-Int) grouped together showed a prolonged survival (p = 0.0003). MACA with positive lymph nodes showed a reduced survival (p = 0.0009) when compared to MACA patients without positive lymph nodes. A peritoneal cancer index of 1-30 versus >30 and completeness of cytoreduction score of 2 versus 3 were not significant., Conclusion: TAC with end ileostomy was used as a treatment option to provide palliation of patients having an incomplete CRS for appendiceal mucinous neoplasms. With LAMN or MACA-Int, median survival was 5.0 years. The surgery can be performed with a morbidity of 9.0% and mortality of 2.6%. Although not considered a palliative option in the past, these data suggest TAC may be used with acceptable results in this group of patients., (© 2023 Wiley Periodicals LLC.)
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- 2023
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44. Similar Survival Among All Subtypes of Mucinous Appendiceal Adenocarcinoma Except the Intermediate Subtype, Which Shows an Improved Survival.
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Sugarbaker PH, Chang D, and Liang JJ
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- Humans, Middle Aged, Retrospective Studies, Prognosis, Cytoreduction Surgical Procedures, Survival Rate, Peritoneal Neoplasms therapy, Adenocarcinoma, Mucinous surgery, Appendiceal Neoplasms surgery, Hyperthermia, Induced
- Abstract
Background: Limited success in the management of mucinous appendiceal adenocarcinoma (MACA) has been reported., Methods: Cytoreductive surgery with perioperative intraperitoneal chemotherapy was used to treat a cohort of patients with peritoneal dissemination of MACA. The clinical and histopathologic variables were assessed for their impact on overall survival., Results: The study analyzed 196 patients during a median follow-up period of 8 years. The patients had a median age was 46 years, a median survival of 12 years, and a mean survival of 12.4 years. Preoperative systemic chemotherapy and a high prior surgical score had a negative impact on prognosis. Survival was better for 37 patients (18.9%) with mucinous appendiceal adenocarcinoma-Intermediate (MACA-Int) histology than for 159 patients (81.1%) with MACA grade 1, 2, or 3, or signet ring cells (S) (p = 0.0004). Although MACA-1 and MACA-2 versus MACA-3 and MACA-S had a difference in survival of 63.9 versus 43.2 years at 5 years, with long-term follow-up evaluation, the differences in survival became insignificant (p = 0.5841)., Conclusion: The histologic subtype of MACA-Int had a 10-year survival of 81.1%, which was markedly superior to that of MACA-1, -2, -3, or -S (32.7%). With long-term follow-up evaluation, MACA-1, -2, -3, and -S did not differ significantly in survival., (© 2022. Society of Surgical Oncology.)
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- 2023
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45. ASO Author Reflections: Similar Survival of All Subtypes of Mucinous Appendiceal Adenocarcinoma Except the Intermediate Subtype Which Shows an Improved Survival.
- Author
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Sugarbaker PH, Chang D, and Liang JJ
- Subjects
- Humans, Adenocarcinoma, Mucinous pathology, Appendiceal Neoplasms pathology
- Published
- 2023
- Full Text
- View/download PDF
46. Secondary cytoreductive surgery for lymph node positive mucinous appendiceal neoplasms.
- Author
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Sugarbaker PH and Chang D
- Subjects
- Male, Humans, Adult, Cytoreduction Surgical Procedures, Quality of Life, Prognosis, Lymph Nodes pathology, Retrospective Studies, Survival Rate, Combined Modality Therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Appendiceal Neoplasms pathology, Hyperthermia, Induced
- Abstract
Background: Patients who have surgery for a gastrointestinal cancer routinely have clinical and radiological tests in an effort to detect recurrent disease. If cancer progression is documented, additional surgery performed in a timely manner may prolong survival and help maintain an optimal quality of life. In mucinous appendiceal cancer patients a secondary cytoreductive surgery (SCRS) may be considered if recurrent disease is detected., Methods: In patients with both lymph node metastases and peritoneal metastases from a mucinous appendiceal adenocarcinoma (MACA-LN) who had a prior complete cytoreductive surgery (CRS), the clinical- and treatment-related variables associated with the index CRS and the SCRS were extracted from a database and secured research files. These variables were statistically assessed for their impact on survival., Results: Twelve of 39 lymph node positive patients (30.8%) had SCRS. The mean follow-up was 7.6 years and the median survival was 4.5 years. There were 4 males (33%) and median age was 44 years. Significant prognostic variables associated with improved survival with the index CRS by univariant analysis was the use of early postoperative intraperitoneal chemotherapy (EPIC) (p = 0.0469). For the SCRS, no significant prognostic variables, not even completeness of cytoreduction, were discovered., Conclusions: In MACA-LN patients, improved survival with SCRS was shown as compared to patients who recurred but did not undergo SCRS. In this group of patients with an aggressive disease, if SCRS was possible it improved survival with long-term (greater than 5 years) follow-up., Competing Interests: Declaration of competing interest The authors have no disclosures to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
- Published
- 2023
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47. Lymph node positive pseudomyxoma peritonei.
- Author
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Sugarbaker PH and Chang D
- Subjects
- Humans, Lymphatic Metastasis, Cytoreduction Surgical Procedures, Retrospective Studies, Combined Modality Therapy, Survival Rate, Peritoneal Neoplasms surgery, Peritoneal Neoplasms pathology, Hyperthermia, Induced, Adenocarcinoma, Mucinous pathology, Pseudomyxoma Peritonei surgery, Pseudomyxoma Peritonei complications, Appendiceal Neoplasms surgery, Appendiceal Neoplasms complications
- Abstract
Background: Appendiceal mucinous neoplasms are routinely accompanied by peritoneal metastases at the time of diagnosis of the primary appendiceal tumor. In contrast, liver metastases and lymph node metastases are unusual., Methods: From an extensive database, patients with lymph node metastases identified at the time of primary appendiceal cancer resection were selected for special study. The clinical, treatment-related and histologic variables of this group of patients were statistically analyzed for their impact on overall survival., Results: From a prospectively maintained database of 685 patients with a complete cytoreduction of a mucinous appendiceal neoplasm with peritoneal dissemination, 39 patients (5.6%) had lymph node metastases at the time of primary diagnosis. The median follow-up was 5.0 years and overall median survival was 6.0 years. Histologically, 6 of these patients (15.4%) had an appendiceal mucinous neoplasm - Intermediate type (MACA-Int). In 5 patients, the involved lymph nodes were not within the ileocolic lymph node group. The 7 patients (17.9%) who had a complete or near complete response to neoadjuvant chemotherapy prior to definite cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) showed prolonged survival (HR 4.8 (1.1, 20.5) p = 0.0323). A prior right colon resection required repeat resection in 87% of patients., Conclusion: Long-term survival is unusual but occasionally seen in this group of patients. Response to neoadjuvant chemotherapy is an important determinant of a favorable outcome., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest associated with the manuscript entitled “Lymph node positive pseudomyxoma peritonei”., (Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
- Published
- 2022
- Full Text
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48. Secondary cytoreductive surgery for low-grade appendiceal mucinous neoplasms.
- Author
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Sugarbaker PH and Chang D
- Subjects
- Humans, Cytoreduction Surgical Procedures, Retrospective Studies, Combined Modality Therapy, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Peritoneal Neoplasms therapy, Hyperthermia, Induced, Appendiceal Neoplasms, Adenocarcinoma, Mucinous
- Abstract
Background: In patients with low-grade appendiceal mucinous neoplasms (LAMN), a secondary cytoreductive surgery (SCRS) is often performed if recurrent disease is detected., Methods: In patients with a complete cytoreductive surgery (CRS), the clinical- and treatment-related variables associated with the index CRS and the SCRS were statistically assessed for their impact on overall survival after SCRS., Results: Eighty-eight patients of 450 patients (19.6%) had SCRS. The mean survival was 15.3 years for patients requiring SCRS as compared to 24.5 years for the group as a whole. Variables associated with improved survival as a result of the index CRS by multivariant modeling were absence of total gastrectomy (p = 0.0038), moderate peritoneal cancer index of 15-30 (p = 0.0020) and time interval of greater than 36 months from CRS to SCRS (p = 0.0013). Multivariant modeling associated with SCRS were complete CRS (p = 0.0104) and disease progression limited to the abdominal wall (p = 0.0106). Early postoperative intraperitoneal chemotherapy (EPIC) 5-fluorouracil used with CRS improved the outcome with SCRS (p = 0.0095)., Conclusions: A requirement for SCRS in 88 patients decreased median survival to 15.3 years as compared to 24.5 years in all 450 LAMN patients (p < 0.0001). Prognostic indicators from both the index CRS and the SCRS had an impact on the outcome of SCRS., (© 2022 Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
49. Incomplete cytoreduction with peritoneal metastases from appendiceal mucinous neoplasms.
- Author
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Sugarbaker PH and Chang D
- Subjects
- Humans, Cytoreduction Surgical Procedures adverse effects, Retrospective Studies, Prospective Studies, Ascites etiology, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Peritoneal Neoplasms surgery, Hyperthermia, Induced adverse effects, Appendiceal Neoplasms surgery, Appendiceal Neoplasms pathology, Adenocarcinoma, Mucinous surgery
- Abstract
Background: Complete cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy is the standard of care for mucinous appendiceal neoplasms with peritoneal metastases. Despite many publications regarding selection factors favoring a complete CRS, incomplete CRS does occur. Patients with an incomplete CRS are the focus of this manuscript., Methods: A retrospective analysis of prospective, histologic, and perioperative data was performed. Overall survival was the endpoint for the numerous assessments. Judgments regarding when to and when not to proceed with an incomplete CRS were sought., Results: From a database of 949 patients who underwent an index CRS for appendiceal mucinous neoplasm, 264 patients (27.8%) had an incomplete CRS. The median overall survival was 1.8 years. Low-grade histopathology and absence of tense ascites or bowel obstruction were significantly associated with increased overall survival. More extensive surgery suggested a more favorable outcome., Conclusions: When a surgeon is confronted by a procedure that will inevitably end with an incomplete CRS, a current trend is to close quickly and always avoid complications. Patients with low-grade neoplasms who present in the absence of tense ascites or bowel obstruction may gain years of survival by surgical reduction of tumor burden., (© 2022 Wiley Periodicals LLC.)
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- 2022
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50. Extent of Disease on Visceral Peritoneal Surfaces of Mucinous Appendiceal Neoplasms Controls Survival.
- Author
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Sugarbaker PH and Chang D
- Abstract
Objective: To determine causes of treatment failure of low-grade appendiceal mucinous neoplasms (LAMN)., Background: For 3 decades, LAMN have been treated by cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy. This combined treatment has resulted in a large change in the survival of these patients., Methods: A retrospective review of a prospectively maintained database was performed. A restricted cohort of patients with only LAMN histology and complete CRS were included in the statistical analysis., Results: Four hundred and fifty patients were available with a median follow-up of 15.3 years (range 10-35 years). The median age was 49.7 and there were 196 males (43.6%). The mean survival was 24.5 years. Extent of parietal peritonectomy, resection of uterus, ovaries and apex of vagina had no impact on survival. Variables that indicated an increased extent of disease on visceral peritoneal surfaces had a significant impact on survival. Early postoperative intraperitoneal chemotherapy with 5-fluorouracil did not augment hyperthermic intraperitoneal chemotherapy (HIPEC). Patients who required reoperation for recurrence or patients with class 4 adverse events had a reduced prognosis., Conclusions: The mean survival of LAMN treated by complete CRS and perioperative chemotherapy was 24.5 years. Extent of disease quantitated on visceral peritoneal surfaces by the extent of visceral resections was the variable associated with treatment failure. Peritonectomy plus HIPEC was able to control disease on parietal peritoneal surfaces. Not only a larger extent of disease but also its location on visceral peritoneal surfaces controlled survival., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2022
- Full Text
- View/download PDF
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