Intraoperative Intraperitoneal Chemotherapy Research Articles

Important Predictive Factors for the Prognosis of Patients With Peritoneal Metastasis of Gastric Cancer.

This study investigated predictive factors for patients with peritoneal metastases of gastric cancer (PMGC) who underwent conversion cytoreductive surgery (C-CRS) and hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC) after responding to induction chemotherapy (laparoscopic HIPEC [LHIPEC]) followed by concomitant systemic and intraperitoneal chemotherapy (bidirectional intraperitoneal and systemic chemotherapy [BIC]). Diagnostic laparoscopy was performed for 62 patients with PMGC between January 2017 and December 2022. The patients underwent LHIPEC and BIC induction chemotherapy using intraperitoneal docetaxel (30mg/m2) and cisplatin (30mg/m2), and intravenous chemotherapy for three cycles. The predictive parameters for progression-free and overall survival were analyzed using Kaplan-Meier and Cox regression analyses. The optimal cutoff values for Ki-67 parameters were assessed using receiver operating characteristic curve analysis. The study retrospectively examined 36 (58 %) of 62 patients who responded to induction therapy and underwent C-CRS or HIPEC. A Ki-67 index lower than 10 (p = 0.000), lymph node involvement (LNI) less than 2 (p = 0.039), and an omental lesion size score lower than 0.5 cm (p = 0.002) were predictive of recurrence-free and overall survival in addition to completeness of cytoreduction and the peritoneal cancer index. Cox regression analysis showed that the independent factors associated with recurrence-free survival were decreased Ki-67 expression (≥10 % vs <10 %) (hazard ratio [HR] 4.7; 95 % confidence interval [CI] 1.6-5.210; p = 0.020) and LNI higher than 2 (HR 1.92; 95% CIS 0.923-4.0; p = 0.023). Lymph node involvement and decreased Ki-67 expression are independent predictive factors of recurrence-free survival for patients with PMGC after induction chemotherapy.

A Clinical Study of Intraoperative Perfusion Chemotherapy With Raltitrexed in Colon Cancer: A Prospective Cohort Study.

Colorectal cancer (CRC) ranks as the second leading cause of cancer-related mortality among women and the third leading cause of cancer-associated mortality among men. Treatment of colon cancer is very crucial for a patient's survival. In this study, we assessed the reliability, efficacy, and safety of raltitrexed in intraoperative intraperitoneal chemotherapy for colon cancer. A total of 57 patients with clinical stages II and III of colon cancer were included in the study. R0 resection surgery + hyperthermic intraperitoneal chemotherapy (HIPEC) procedure was done with raltitrexed. It was given in a dose of 3 mg/m2 in a 0.9% NS injection in a volume of 500 milliliters. Postoperative complications were observed. The most common postoperative complication was nausea/vomiting, which was seen in 21 out of 57 patients (37%). The second most common complication was fever (18/57). None of the patients died or developed renal toxicity, hepatic toxicity, and intestinal obstruction. Raltitrexed is a reliable, efficient, and safe drug and can be used in intraoperative intraperitoneal chemotherapy of colon cancer.

A real-word study: is normothermic intraoperative intraperitoneal chemotherapy impactful as we expect?

Patients with gastric cancer have a poor prognosis. Currently, intraperitoneal chemotherapy has been considered a therapeutic option to improve prognosis due to its appealing theoretical rationales. But there is no consensus on the choice of chemotherapeutic agents used in intraperitoneal chemotherapy for gastric cancer. The real-world efficacy of applying intraoperative chemotherapy in gastric cancer still remains undefined. Patients with gastric cancer who underwent radical gastrectomy at the Gastrointestinal Department of The First Affiliated Hospital of Anhui Medical University between 2012 and 2019 were enrolled in this study. Patients were divided into two groups based on whether they received intraperitoneal chemotherapy. The t-test (mean of two samples) was conducted to compare the difference in measurement data between the two groups, and the chi-square test was used to compare the difference in count data. Kaplan-Meier method with log-rank test was performed to analyze the overall survival of patients. Kaplan-Meier method with log-rank test was also performed in various subgroups to respectively compare the survival of patients. Multivariate Cox analysis was performed to analyze the prognosis factors of these patients. A total of 1253 patients were included in the final analysis, in which 861 patients received intraperitoneal chemotherapy and 352 not received intraperitoneal chemotherapy. The clinicopathological features of the participants in the two groups were comparable. There was no significant difference between the two groups in overall survival (P > 0.05). Consistently, no significant difference was found between the two groups in each subgroup (P > 0.05). The multivariate Cox analysis demonstrated that only age, BMI, pathological type, TNM stage, and differentiation grade were independent risk factors of survival. Intraoperative intraperitoneal chemotherapy usage did not improve survival in patients with gastric cancer undergoing radical gastrectomy.

Preliminary security investigation and short-time follow-up of intraoperative intraperitoneal chemotherapy with lobaplatin for advanced colorectal cancer

Abstract Objective The aim of this study was to conduct a security assessment of intraoperative intraperitoneal chemotherapy using lobaplatin for advanced colorectal cancer. Methods From February 2015 to February 2016, 143 patients with colorectal cancer who underwent surgery in our department were selected prospectively. All patients were randomly screened and enrolled into the intraperitoneal chemotherapy (IPC) (74 cases) and control (69 cases) groups, depending on the distribution of cases in the random table. In the trial group, patients were administered 40 mg lobaplatin by intraperitoneal implantation intraoperatively, together with intravenous chemotherapy post-operatively using a typical FOLFOX strategy with oxaliplatin, fluorouracil, and leucovorin. In the control group, only FOLFOX was administered. Bowel function recovery time, adverse reactions and complications, and pre-and post-chemotherapy laboratory examinations were compared. In addition, a 5-year-long follow-up was performed. Results Recovery times of bowel function were 73.5 ± 9.7 h and 74.8 ± 10.3 h respectively, and the difference was not significant (P &gt; 0.05). Wound fat liquefaction was observed in five cases in both groups (6.8% vs. 7.2%, P &gt; 0.05). The outcomes of nausea and vomiting (57 cases, 77.0% vs. 50 cases, 72.5%), constipation (43 cases, 58.1% vs. 36 cases, 52.2%), and diarrhea (5 cases, 6.8% vs. 5 cases, 7.2%) were not statistically significant (all P &gt; 0.05). Indices of white blood cell count, blood platelet count, and hepatorenal function were not significantly different (all P&gt;0.05) neither post-operatively nor post-chemotherapy. The 5-year survival rate was not significantly different between the groups (58.1% vs. 56.5%, P &gt; 0.05). Conclusion Intraoperative chemotherapy with lobaplatin for advanced colorectal cancer is safe and tolerable.

Risk of Acute Kidney Injury Following Mytomicin C Resorption during Hyperthermic Intraperitoneal Chemotherapy

Background: Surgical cytoreduction and simultaneous hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) is a common treatment for peritoneal carcinomatosis. During intraperitoneal chemotherapy, mitomycin C is frequently used. Mitomycin C is known to be nephrotoxic. Little is known about the effect of systemically absorbed mitomycin C on renal function during HIPEC surgery. Methods: In twenty-two patients undergoing cytoreductive surgery and HIPEC for peritoneal carcinomatosis the systemic levels of mitomycin C were measured in plasma. The relation of plasma levels of mitomycin C with duration of surgery and complexity of surgery was evaluated. Furthermore, we evaluated the relation between systemic mitomycin C levels with renal function. Results Two patients of the total of 22 patients developed acute kidney injury. In these patients, preoperative creatinine level increased from (1) 109 μmol/L to maximum 890 μmol/L on the 6th postoperative day after which renal replacement therapy was started and (2) from 67 μmol/L to 213 μmol/L. Whereas maximum plasma levels of mitomycin C in these 2 patients were 145 μg/L and 280 μg/L compared to the levels in the other patients (167 μg/L ±80.8). Peak levels of plasma creatinine were on post operative day 2. None of the other patients needed renal replacement therapy. Eight patients showed significant increase of plasma creatinine levels, i.e. &gt;20% increase from preoperative values. We did not observe a correlation between complexity of surgery, increased absorption of mitomycin C, higher mitomycin C plasma levels and signs of kidney injury. Conclusions: Systemic absorption of mitomycin C during HIPEC surgery is independent to extension of cytoreductive surgery and duration of surgery. In this small study group, we observed an impairment of renal function which may be related to systemic absorption of mitomycin C. Further research is warranted to answer possible association of mitomycin C levels in patients at risk for development of AKI.

Application of the method of intraoperative intraperitoneal aerosol chemotherapy (PIPAC) in complex treatment of locally advanced gastric cancer with cytologically negative peritoneal lavages: the protocol for GASPACCO clinical trial

Перспективной стратегией профилактики и лечения карциноматоза брюшины является концепция регионарного воздействия на опухолевые клетки, основанная на доставке непосредственно в брюшину высоких доз химиотерапевтического препарата с приемлемым уровнем системной токсичности. Внутрибрюшная аэрозольная химиотерапия под давлением (PIPAC — Pressurized Intraperitoneal Aerosol Chemotherapy) ― новая технология доставки химиопрепарата к брюшине с профилактической целью при распространенном раке желудка, эффективность и безопасность которой не доказана в рандомизированных клинических исследованиях. Представлен протокол клинического исследования GASPACCO (Oncological Benefits of PIPAC in Patients With T3-4 Gastric Cancer Cyt-), инициированный ФГБОУ ПСПбГМУ им. акад. И.П. Павлова Минздрава России. Клиническое исследование зарегистрировано на портале ClinicalTrials.gov за номером NCT04595929. Дизайн исследования: одноцентровое, проспективное, рандомизированное клиническое исследование, оценивающее преимущества применения метода интраоперационной внутрибрюшинной аэрозольной химиотерапии (PIPAC) в комплексном лечении местно-распространенного рака желудка T3–4 и(или) при поражении регионарных лимфатических узлов без отдаленных метастазов и негативной цитологией при перитонеальном смыве (cyt-) по сравнению со стандартным лечением. Первичная конечная точка исследования: общая выживаемость (за время наблюдения). Вторичные конечные точки исследования: безрецидивная выживаемость, частота развития перитонеального карциноматоза, частота серьезных нежелательных явлений, качество жизни пациентов в послеоперационном периоде (EORTC QLQ-C30), интенсивность болевого синдрома, послеоперационная смертность и осложнения. Материалы и методы. Рандомизация 1:1 по 152 больных на два рукава: группа активного сравнения PIPAC (4 цикла неоадъювантной химиотерапии FLOT ― гастрэктомия с диссекцией лимфатических узлов D2 ― PIPAC) и группа активного контроля (неоадъювантная химиотерапия ― гастрэктомия с лимфодиссекцией D2 без PIPAC). Результаты и обсуждение. С целью оценки преимущества применения метода PIPAC в комплексном лечении местно-распространенного рака желудка по сравнению со стандартным лечением в клиническое исследование GASPACCO планируется включить 304 больных.

Chinese experts consensus on the prevention and treatment of complications caused by intraperitoneal perfusion chemotherapy for gastrointestinal tumors (2022 edition)

Peritoneal metastasis is one of the common metastasis of gastrointestinal malignancy. Intraperitoneal chemotherapy (including hyperthermic intraperitoneal chemotherapy and intraoperative intraperitoneal chemotherapy) not only can effectively increase the peritoneal drug concentration, but also can reduce side effects of systemic chemotherapy. It can significantly prolong the long term survival of patients with peritoneal metastasis and improve the quality of life. In order to standardize the popularization and application of intraperitoneal chemotherapy, relevant professional committees have formulated expert consensus on intraperitoneal chemotherapy. However, there is no systematic guidance on the prevention and treatment of related complications of intraperitoneal chemotherapy. Under the guidance of the Complications Management Committee of the Colorectal Cancer Professional Committee of the Chinese Medical Association and the Colorectal Cancer Professional Committee of the Chinese Anti-cancer Association, we organized domestic experts in relevant fields to formulate this consensus according to the procedural specifications and relevant literature reports. This consensus aims to summarize the causes of common complications of intraperitoneal chemotherapy such as pneumonia, intraperitoneal hemorrhage, fever, peritonitis, ileus, intestinal dysfunction, anastomotic bleeding, anastomotic leakage, leakage or infection of perfusion tube, nausea and vomiting, myelosuppression, hepatic or nephritic dysfunction. After repeatedly soliciting the opinions of domestic authoritative experts and their discussion and modification, a consensus was formed to provide effective reference for the prevention and treatment of complications.

The Role of Intraperitoneal Intraoperative Chemotherapy with Paclitaxel in the Surgical Treatment of Peritoneal Carcinomatosis from Ovarian Cancer-Hyperthermia versus Normothermia: A Randomized Controlled Trial.

Background: The treatment of ovarian carcinomatosis with cytoreductive surgery and HIPEC is still controversial. The effect and pharmacokinetics of the chemotherapeutics used (especially taxanes) are currently under consideration. Methods: A phase II, simple blind and randomized controlled trial (NTC02739698) was performed. The trial included 32 patients with primary or recurrent ovarian carcinomatosis undergoing cytoreductive surgery (CRS) and intraoperative intraperitoneal chemotherapy with paclitaxel (PTX): 16 in hyperthermic (42–43 °C) and 16 in normothermic (37 °C) conditions. Tissue, serum and plasma samples were taken in every patient before and after intraperitoneal chemotherapy to measure the concentration of PTX. To analyze the immunohistochemical profile of p53, p27, p21, ki67, PCNA and caspase-3 and the pathological response, a scale of intensity and percentage of expression and a grouped Miller and Payne system were used, respectively. Perioperative characteristics and morbi-mortality were also analyzed. Results: The main characteristics of patients, surgical morbidity, hemotoxicity and nephrotoxicity were similar in both groups. The concentration of paclitaxel in the tissue was higher than that observed in plasma and serum, although no statistically significant differences were found between the two groups. No statistically significant association regarding pathological response and apoptosis (caspase-3) between both groups was proved. There were no statistically significant differences between the normothermic and the hyperthermic group for pathological response and apoptosis. Conclusions: The use of intraperitoneal PTX has proven adequate pharmacokinetics with reduction of cell cycle and proliferation markers globally without finding statistically significant differences between its administration under hyperthermia versus normothermia conditions.

Results of treatment of cancer patients with peritoneal carcinomatosis

Objective: At present, common forms of cancer of different localization can not be ignored. New approaches to the treatment of metastatic lesions have some success in clinical application. This study is devoted to the experience of using the technology of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in practice, as well as the analysis of overall and relapse-free survival in the examined groups of patients.&#x0D; Patients and methods: A total of 119 people were recruited from 2013 to 2020 inclusive. Patients were divided into two groups: the clinical control group (n = 53) consisted of individuals who underwent suboptimal cytoreduction; in the main group (n = 66) there were patients who performed optimal or complete cytoreductive volume and in some cases underwent intraoperative hyperthermic chemotherapy. Patients diagnosed with stage IIIC ovarian cancer were treated. In the initial analysis of these groups, time indicators (period before surgery, duration of surgery, number of postoperative bed-days), as well as the presence and nature of complications in the postoperative period were taken into account.&#x0D; Results: The analysis showed an increase in relapse-free survival from 10 months in the control group to 13-19 months in the main group, also significantly increased (from 5 to 22%) the number of complications of class III-IV in HIPEC.&#x0D; Conclusion: The study is prospective and retrospective, recruitment into groups has been conducted since 2013. Observation of the studied groups continues. The expected results will be a significant discrepancy between overall and recurrence-free survival in the study groups.

One-year COVID-19 outcomes on the oncology care patient pathway: Results of a French descriptive, cross-sectional comprehensive study (ONCOCARE-COV).

BackgroundThe COVID‐19 pandemic led to a widely documented disruption in cancer care pathway. Since a resurgence of the pandemic was expected after the first lockdown in France, the global impact on the cancer care pathway over the year 2020 was investigated.AimsThis study aimed to describe the changes in the oncology care pathway for cancer screening, diagnosis, assessment, diagnosis annoucement procedure and treatment over a one‐year period.Materials & MethodsThe ONCOCARE‐COV study was a comprehensive, retrospective, descriptive, and cross‐sectional study comparing the years 2019 and 2020. All key indicators along the cancer care pathway assessing the oncological activity over four periods were described. This study was set in a high‐volume, public, single tertiary care center divided in two complementary sites (Reims University Hospital and Godinot Cancer Institute, Reims, France) which was located in a high COVID‐19 incidence area during both peaks of the outbreak.ResultsA total of 26,566 patient's files were active during the year 2020. Breast screening (−19.5%), announcement dedicated consultations (−9.2%), Intravenous and Hyperthermic Intraoperative Intraperitoneal Chemotherapy (HIPECs) (−25%), and oncogeriatric evaluations (−14.8%) were heavily disrupted in regard to 2020 activity. We identified a clear second outbreak wave impact on medical announcement procedures (October, −14.4%), radiotherapy sessions (October, −16%), number of new health record discussed in multidisciplinary tumor board meeting (November, −14.6%) and HIPECs (November, −100%). Moreover, 2020 cancer care activity stagnated compared to 2019.DiscussionThe oncological care pathway was heavily disrupted during the first and second peaks of the COVID‐19 outbreak. Between lockdowns, we observed a remarkable but non‐compensatory recovery as well as a lesser impact from the pandemic resurgence. However, in absence of an increase in activity, a backlog persisted.ConclusionPublic health efforts are needed to deal with the consequences of the COVID‐19 pandemic on the oncology care pathway.

Assessment of the efficacy and safety of intraperitoneal chemotherapy in patients with advanced gastric cancer in Chinese population: a meta-analysis

To investigate the safety and efficacy of intraoperative intraperitoneal chemotherapy in treating advanced gastric cancer. A randomized controlled trial (RCT) of gastric cancer surgery combined with intraoperative intraperitoneal chemotherapy for the efficacy and safety were screened by computer search PubMed, Medline, Springer, Elsevier Science Direct, Weipu, Wanfang and China National Knowledge Infrastructure (CNKI) with the last report up to October 2019. The control group underwent radical gastrectomy, and the experimental group underwent intraoperative intraperitoneal chemotherapy and radical gastrectomy. A total of 997 (Experimental group 453; Control group 544) participants were considered in this meta-analysis. Compared with the control group, the experimental group has higher 1-year survival rate [OR=2.40, 95%CI (1.34, 4.33), P=0.003], 2-year survival rate [OR=3.45, 95%CI (2.08, 5.75), P<0.00001], 3-year survival rate [OR=2.70, 95%CI (2.05, 3.54), P<0.00001] and 5-year survival rate [OR=2.90, 95%CI (1.93, 4.37), P<0.00001]. There is no significant difference in postoperative bleeding (P=0.95), postoperative infection (P=0.26), postoperative anastomotic leakage (P=0.41), and postoperative intestinal obstruction (P=0.11). Intraoperative intraperitoneal chemotherapy with advanced gastric cancer in the Chinese population can improve patients’ survival rate after surgery and does not increase the incidence of postoperative complications, so it is clinically significant and safe.

EP.FRI.999 Case report of a Low Grade appendiceal mucinous neoplasm (LAMN) and review of literature

Abstract A mucocele refers to an appendix that has dilated due to progressive accumulation of mucus within its lumen. Appendiceal mucocele is a rare cause of an acute abdomen. They represent 0.2-0.7% of all appendix specimens. LAMN account for less than 0.3% of appendicectomy specimens. We present a 38 year old man with an acute RIF’s pain who went on to have CT scan which revealed a mucocele of appendix but did not show any features of perforation or pseudomyxoma peritonei. He had a laparoscopic converted to open appendicectomy. The proximal 2 cm of appendix was oedematous but normal calibre. Histology revealed a low grade appendiceal mucinous neoplasm (LAMN) that was completely excised. The mucocele of the appendix was first described by Rokitansky in 1842. Appendix mucocele may come as a consequence of obstructive or inflammatory processes, cystadenomas or cystadenocarcinomas. Appendiceal mucinous neoplasms commonly presents in the sixth decade of life and our patient was much younger in comparison. Several literatures suggest the value of preoperative CT imaging in obtaining diagnosis and also in planning further treatment. Appendicectomy or a right hemicolectomy is treatment of choice based on presence or absence of following factors 1. Perforated mucocele 2. Involvement of the base of the appendix. 3. Positive lymph nodes of mesoappendix and ileocolic. Patients with malignancy or pseudomyxoma peritonei are likely to require cytoreductive surgery, heated intraoperative intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy.

Long-term outcomes after cytoreductive surgery and hyperthermic perioperative chemotherapy for morcellated uterine leiomyosarcoma: case series

<h3>Objectives:</h3> Uterine leiomyosarcoma (uLMS) is a rare aggressive malignant mesenchymal tumor with high risk of recurrence and poor prognosis regardless of stage. If the tumor was morcellated, the oncologist will encounter special problems that require aggressive management of peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) is an intraoperative intraperitoneal chemotherapy administration under hyperthermic condition. Early postoperative intraperitoneal chemotherapy (EPIC) is a second perioperative regional chemotherapy with a goal to eradicate peritoneal metastatic disease. These treatments are possible following a complete cytoreduction surgery (CRS). Only few studies have evaluated outcomes in patients with morcellated uLMS who underwent HIPEC and/or EPIC following CRS. The purpose of the study is to evaluate the long-term outcomes in patients with morcellated uLMS who underwent CRS and HIPEC plus EPIC. <h3>Methods:</h3> We previously reported short-term outcomes (median 14.5 months) in six patients who underwent CRS and HIPEC in an attempt to successfully manage the disseminated disease following morcellation. We reviewed patient demographics, tumor characteristics, treatment history, perioperative complications and outcomes. The grade of the malignancy, peritoneal cancer index (PCI), and completeness of cytoreduction score (CC score) were available for all patients. <h3>Results:</h3> Six patients with morcellated uLMS who underwent CRS and HIPEC were identified in our database. HIPEC was used for 90 minutes following the CRS in the operating room. The regimen consisted of cisplatin 50 mg/m² and doxorubicin 15 mg/m² by intraperitoneal instillation that was manually distributed into the abdominal and pelvic space and maintained at 42.5?. Of the six patients, five patients also received EPIC.Mean age at CRS followed by HIPEC was 49 years (range 40-62) and mean interval from the initial surgery was 17 months (range 1 month to 7 years). The mean PCI was 18 and a CC-0 cytoreduction was achieved in all patients. The 3-year overall survival was 50% and 5-year overall survival was 33% with the median follow-up of 30 months (range 5 months to 73 months). A low grade of sarcoma and a low PCI suggested a favorable outcome. <h3>Conclusions:</h3> Our case series suggests that CRS and HIPEC plus EPIC is well-tolerated and may be a therapeutic option for newly diagnosed uterine leiomyosarcoma following morcellation. Therapeutic options for patients with uLMS post-morcellation are limited and further research to eliminate disease dissemination is needed.

Intraperitoneal Chemotherapy Using Fluorouracil Implants Combined With Radical Resection and Postoperative Adjuvant Chemotherapy for Stage III Gastric Cancer: A Multi-Center, Randomized, Open-Label, Controlled Clinical Study.

BackgroundReducing peritoneal recurrence after radical surgery is an important choice to improve the prognosis of patients with advanced gastric cancer. Intraoperative intraperitoneal chemotherapy has the potential to be a promising treatment strategy. In the present study, we conducted a multi-center, randomized, controlled clinical study to evaluate the efficacy and safety of intraoperative intraperitoneal chemotherapy using sustained-release fluorouracil implants plus radical gastrectomy and adjuvant chemotherapy for cTNM stage III gastric cancer.MethodsThe patients were randomized into intraperitoneal chemotherapy group (sustained-release fluorouracil implants administration after standard D2 radical gastrectomy, and followed by XELOX adjuvant chemotherapy) and control group (standard D2 radical gastrectomy, and followed by XELOX adjuvant chemotherapy). A total of 122 patients from three centers were enrolled from September 2015 to February 2017.ResultsOne hundred and two eligible patients completed the treatment course. The median follow-up time was 41.7 months (36.1–52.9 months). The 3-year progression-free survival rate and overall survival of patients in the intraperitoneal chemotherapy group were 43.9% and 49.1%, respectively, which were significantly better than those of the control group, 31.0% and 38.4%. In the intraperitoneal chemotherapy group, the number of cases with peritoneal recurrence was significantly less than that of the control group, 9 cases (17.3%) vs. 19 cases (44.2%). There were neither significant differences between the groups in the incidence of hematogenous metastasis, lymph node metastasis, nor local metastasis.ConclusionFor cTNM stage III gastric cancer, intraoperative sustained-release fluorouracil implants after radical resection combined with postoperative adjuvant chemotherapy, could significantly reduce the risk of peritoneal recurrence and prolong PFS.Clinical Trial Registration https://clinicaltrials.gov/, identifier (NCT02269904).

Hyperthermic intra-operative intraperitoneal chemotherapy as an adjuvant to pancreatic cancer resection

Even after potentially curative resection the long-term survival of pancreatic cancer is poor. The local-regional failures are frequent. Previous studies have shown that adjuvant treatment with hyperthermic intra-operative intraperitoneal chemotherapy (HIPEC) may effectively control local disease. The objective of the study is to update the results of the prior publications by integrating data from recently accrued cases. Also, to revisit the clinical and pharmacological rationale for the intraperitoneal administration of chemotherapy in pancreatic cancer patients undergoing potentially curative resection. This is a prospective study of pancreatic cancer patients that underwent R0 resection in combination with HIPEC-gemcitabine. Morbidity and mortality were recorded. Survival was calculated and the sites for recurrent disease were recorded. The updated results for 33 patients that underwent treatment until 2016 and for 6 more patients that were included until 2018 were presented. The hospital mortality and morbidity rate were 5.1% (2 patients), and 28.2% (11 patients) respectively. The median and 5-year survival rate was 17 months and 24% respectively. With a median follow-up time of 13 months 23 patients (59%) were recorded with recurrence. Local regional failures were recorded in 4 patients (10.3%). HIPEC following R0 resection is a feasible and safe adjuvant treatment for pancreatic cancer. The local-regional failures appear to be significantly decreased and to result in an increased overall survival. Further studies with combined intraperitoneal and systemic perioperative chemotherapy may serve to supplement our data with an increased benefit for patients having pancreas cancer resection.

Ovarian Carcinoma with Peritoneal Metastasis: Rethinking of Management

Epithelial Ovarian Carcinoma (EOC), a type of cancer that is usually diagnosed in advanced stages. To date, standard treatment of EOC is surgery with neoadjuvant or adjuvant platin and taxane based systemic chemotherapy. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) is considered in cases of recurrence of EOC. HIPEC has been accepted as a gold standart for the treatment of pseudomyoxoma peritonei of ovarian and appendiceal origin. More recently, a randomized clinical trial supports that HIPEC is a promising treatment option for peritoneal metastasis (PM) of ovarian cancer (OC) in surgical series. HIPEC is also reported to be an effective treatment option in primary and recurrent cancer cases with PM of OC. As a result, the standardization and optimization of the HIPEC technique, determination of patient subgroups with PM of the OC responding to treatments, personalized evaluation and the treatments currently carried out by the multidisciplinary team still need to be re-evaluated.&#x0D; In this review, it is aimed to update the standard treatment approach in case of peritoneal metastasis of ovarian cancer, along with the systemic treatments and HIPEC treatment approaches combined with surgery.

Effect and safety of intraoperative intraperitoneal chemotherapy on patients suffering from colorectal cancer

BackgroundColorectal cancer (CRC), the third most commonly diagnosed malignant carcinoma and the third most common cause of carcinoma-related mortality, continues to be a major international health problem. And approximately 33% of patients suffer from recurrence after radical surgery. Free malignant cell implanting in the peritoneum is generally accepted as one of the main reasons of such outcome. We did this present clinical study with the aim of evaluating the effects and safety of intraoperative intraperitoneal chemotherapy (IOC) on patients suffering from colorectal cancer, with hoping to find a novel, effective, and available approach to deal with malignant cell implanting during surgeries.MethodsIn total, 391 patients who went through colorectal radical surgery were considered eligible between June 1, 2017, and December 31, 2018. 220 patients were treated with surgery without IOC, while other 171 patients received surgery plus IOC. Clinical characteristics, operative findings, postoperative short-term outcomes, disease-free survival (DFS), and overall survival (OS) were compared between these above 2 groups in the selected population.ResultThe present research included 391 patients (251 men and 140 women) who underwent surgery without IOC (n = 171) or surgery plus IOC (n = 220), with a mean (SD) age of 60.4 (9.7) years in the surgery without IOC group and 60.6 (8.7) in the surgery plus IOC group (P=.85). No significant differences were witnessed between the two groups in surgery-related information and postoperative complications. It is worth noting that IOC independent of other factors was associated with a favor prognosis in CRC patients with stage II/III (HR 0.50, 95%CI 0.30–0.82, P=.006). Moreover, for patients with stage II colorectal carcinoma, DFS did not differ between two groups (P=.553, Kaplan-Meier log-rank), and OS was no exception. In stage III CRC patients, the estimated DFS rate for patients receiving IOC was 82.2% and patients without IOC was 66.4% after 3 years, which demonstrated that IOC was associated with a favorable prognosis in stage III patients (P=.012, Kaplan-Meier log-rank). Furthermore, the differences were still remained between the two groups when considering the influence about postoperative chemotherapy (P=.014, Kaplan-Meier log-rank). IOC can also significantly improve patients’ overall survival whether they get treatment with POC (P=.006, Kaplan-Meier log-rank; P=.025, Kaplan-Meier log-rank).ConclusionsIn the present study, we have found that surgery plus IOC generated a favorable prognosis for stage III CRC patients but not stage II without any side-effects when the dosage of lobaplatin was 0.1g/L. As a new, safe, and simple procedure, IOC therapy is easily performed—and does not require any special devices or techniques. Thus, IOC is a promising and exciting therapeutic strategy for patients with CRC.

Intraoperative photodynamic therapy and hyperthermic intraperitoneal chemotherapy in cytoreductive treatment of patients with disseminated mucinous carcinoma of appendix

The article presents the experience of surgical treatment of 57 patients with peritoneal pseudomyxoma of appendicular genesis. In 32 (56.1%) patients, the operation was supplemented with intraoperative photodynamic therapy (IOPDT). In the other 25 (43.9%) patients, hyperthermic intraperitoneal chemotherapy (HIPEC) was performed. The analysis according to the value of the peritoneal carcinomatosis index, completeness of cytoreduction, the volume of operations performed, postoperative complications and hospital mortality, as well as long-term treat- ment results in two groups is presented. It was shown that with significantly worse results in terms of cytoreduction completeness obtained in the IOPDT group compared to the HIPEC group, the 5-year survival rate in the HIPEC group was 86.6%, with IOPDT - 65.2%. At the same time, in the IOPDT group, the rate of postoperative complications was significantly lower (11.1%), and there was no mortality; in the HIPEC group, these indicators were 23.8% and 12.0%, respectively. The results obtained indicate that the IOPDT method is an effective and promising direction in the surgical treatment of peritoneal pseudomyxoma.

Defining optimal selection criteria to improve prognosis and avoid futility in surgical resection of colorectal peritoneal metastases.

36 Background: Surgical resection of peritoneal metastases of colorectal cancer (CRC PM) may benefit some patients similar to hepatic metastases. This approach remains controversial in part due to inconsistent selection criteria and reported outcomes. The impact of preoperative clinical characteristics and tumor molecular profiles on survival among surgically treated patients is incompletely understood. The aim of this study was to investigate the relationship between possible predictive variables and survival in a large cohort of patients treated on a standardized clinical pathway and to develop a clinically useful patient selection tool. Methods: This retrospective cohort study utilized the database of the Catalonian peritoneal metastases regional program, established in 2006. The program provides treatment for all PM patients within an autonomous region with a population of 7.5 million and includes a single dedicated high volume surgical unit. We included all adult patients with surgically resected CRC PM. The clinical pathway includes the administration of perioperative (neoadjuvant and adjuvant) systemic chemotherapy and has historically included a dose of heated intraoperative intraperitoneal chemotherapy (HIPEC) at the time of surgery. Demographic and clinical data was analyzed with descriptive statistics. Survival and the associated predictors were analyzed with the Cox proportional hazard model with HRs used to create a predictive nomogram. Results: A total of 538 patients (mean age 59) have been treated with surgery and a complete resection (CC0) was achieved in 94% of cases. Planned preoperative systemic chemotherapy was delivered in 95% of cases, consistent with the clinical pathway. Surgical morbidity was low (urgent reoperation 6.1%, postoperative return to the ICU 2.4%, 30-day readmission 4.3%) as was 30-day mortality (0.4%). After a median follow up of 27.5 months, the median overall survival (OS) was 43.1 months. It varied considerably by subgroup: patients with low peritoneal tumor burden had the highest OS (median 49 months) and those with signet ring cell subtype the lowest (median 19 months). Factors independently associated with survival were: N stage at diagnosis, histological subtype, quantified peritoneal tumor burden (PCI score) and presence of visceral involvement. A selection tool and predictive nomogram were designed incorporating the results of the multivariable analysis. Conclusions: A set of clinical variables can be identified that independently influences patient survival after surgical resection of CRC PM that should be used as selection criteria when considering surgery. With optimized patient selection and treatment within a specialized center, excellent survival and low morbidity can be anticipated following surgery for CRC PM.

Some features of intraoperative infusion-transfusion therapy when performing cytoreductive operations with the use of hyperthermic intraperitoneal chemotherapy in patients with ovarian cancer: retrospective cohort study

Introduction. Сytoreductive operations with using hyperthermic intraoperative intraperitoneal chemotherapy(CR + HIPEC) is an effective technology in the treatment of locally advanced and metastatic ovarian cancer, the relevance of the treatment of this one’s is beyond doubt. The neсessity of protection organs and systems of the body from a stress response, correction of water and electrolyte balance, blood loss, volemia, and prevention of the toxic effects of chemotherapy make infusion-transfusion therapy (ITT) one of the main components of anesthesia during such operations. Objectives. An analyze the qualitative and quantitative composition of perioperative infusion-transfusion therapy in patients with advanced stages of ovarian cancer during cytoreductive operation with the addition of HIPEC of the abdominal cavity. Materials and methods. In retrospective study 84 patients, 2 types of surgical interventions and anesthetic accompaniment were analyzed, depending on the availability of HIPEC. The duration of the anesthetic treatment, the doses of the anesthetics, the volume of blood loss, the volume and quality of intraoperative infusion therapy were assessed. Results. With ITT carried out with cytoreduction using GIIH, the volume of administration of crystalloid solutions increases by 2.3 times; the average value of the infusion volume increases by 16 (10,5–20) ml/kg/hour. When analyzing the proportional ratio of crystalloid and colloidal solutions, their qualitative composition with CR + GIIH consists of: erythrocyte suspension 3.1 %, FFP 13.6 %, colloidal solutions 8.52 %, crystalloid solutions 74.6 % of total infusion’s volume. Conclusions. Perioperative ITT performed with cytoreduction using GIIH differs significantly from ITT without that. The necessity for high-volume infusion-transfusion therapy by increasing the introduction of crystalloids during cytoreductive operations with hyperthermic intraoperative intraperitoneal chemotherapy was revealed. This technique had no complications and allowed maintaining the stability of hemodynamics, volumetric volume and the required volume of diuresis. The use of a “balanced electrolyte solution” is preferable for intraoperative high-volume ITT.