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Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis:Does it really save lives?

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World Journal of Gastroenterology 2017年第3期23卷 377-381页

作者： Delia Cortes-Guiral Dominique Elias Pedro Antonio Cascales-Campos Alfredo Badía Yébenes Ismael Guijo Castellano Ana Isabel León Carbonero JoséIgnacio Martín Valadés Jesus Garcia-Foncillas Damian Garcia-Olmo Department of General Surgery(Peritoneal Surface Surgical Oncolongy) Fundación Jiménez Díaz Hospital28050 MadridSpain Department of Surgical Oncology Institut Gustave Roussy94805 VillejuifCédexFrance Department of General Surgery(Peritoneal Surface Surgical Oncolongy) Virgen de la Arrixaca30120 MurciaSpain Department of Medical Oncology Fundación Jiménez Díaz Hospital28050 MadridSpain

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.

关键词： Second-look surgery High-risk patients Peritoneal carcinomatosis hyperthermic intraperitoneal chemotherapy Colo-rectal cancer

Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

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World Journal of Gastrointestinal Oncology 2010年第1期2卷 36-43页

作者： Dario Baratti Shigeki Kusamura Barbara Laterza Maria Rosaria Balestra Marcello Deraco Department of Surgery National Cancer Institute Via Venezian 1

Peritoneal surface malignancies have been traditionally regarded as end-stage conditions amenable to merely palliative options. The combination of aggressive cytoreductive surgery (CRS), involving peritonectomy procedures and multivisceral resections, with intra-operative hyperthermic intra-peritoneal chemotherapy (HIPEC) and/or early postoperative intra-peritoneal chemotherapy (EPIC) to treat the microscopic residual tumor is a new concept. In recent years, promising results have been reported for peritoneal mesothelioma and carcinomatosis of gastrointestinal and gynaecologic origin treated by this combined protocol. However, CRS with HIPEC and/or EPIC is a complex procedure associated with high rates of potentially life-threatening complications. Furthermore, disease progression following comprehensive treatment is not uncommon and represents a relevant cause of treatment failure. The present paper reviews the available information on early postoperative management and long-term follow-up in patients treated with CRS and intraperitoneal chemotherapy. The peculiar clinical and biological alterations that can be expected during an uncomplicated postoperative course, as compared to standard digestive surgery, are discussed. Early recognition and appropriate management of the most common adverse events are addressed, in order to minimize the impact of treatment-related morbidity on survival and quality of life results. Since re-operative surgery with additional HIPEC, has proven to be useful in selected patients with recurrent disease, long-term surveillance aiming at early detection of postoperative disease progression has become a relevant issue. Current results on follow-up investigations are presented.

关键词： Peritoneal surface malignancies Cytoreductive surgery hyperthermic intraperitoneal chemotherapy hyperthermic intra-peritoneal chemotherapy Follow-up

hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Intraoperative Electrolyte Disturbances—Implications for Anesthetic Management

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Open Journal of Anesthesiology 2014年第10期4卷 240-243页

作者： John L. Raytis Michael W. Lew Department of Anesthesiology City of Hope Duarte USA

The administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is often associated with significant intraoperative electrolyte changes. We retrospectively examined the pre-HIPEC and post-HIPEC intraoperative basic metabolic panel (BMP) values of the 20 patients who underwent HIPEC at our institution between December 2009 and January 2012. For the five patients who underwent HIPEC with oxaliplatin in 5% dextrose in water (D5W), there were statistically significant changes between the pre- and post-HIPEC values of sodium (135 to 124 mmol/L), chloride (105 to 94 mmol/L), glucose (143 to 388 mg/dl) and sodium corrected for hyperglycemia (135 to 127 mmol/L). For the 14 patients who received HIPEC with mitomycin C in normal saline (NS), there were statistically significant changes in bicarbonate (24 to 21 meQ/L), blood urea nitrogen (BUN) (10 to 9 mg/dl) and glucose (158 to 134 mg/dl). The BMP changes for the one patient who received doxorubicin/cisplatin in peritoneal dialysate are reported separately.

关键词： hyperthermic Intraperitoneal Chemotherapy HIPEC Electrolyte Disturbances Hyponatremia Hyperglycemia

Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion:The University of Arizona early experience

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World Journal of Gastrointestinal Surgery 2012年第6期4卷 135-140页

作者： Ioannis T Konstantinidis Christine Young Vassiliki L Tsikitis Ellyn Lee Evan S Ong Department of Surgery The University of Arizona College of Medicine1501 N.Campbell Av.PO Box 245131TucsonAZ 85724-5131United States Department of Medicine The University of Arizona College of Medicine1501 N.Campbell Av.PO Box 245131TucsonAZ 85724-5131United States

AIM:To evaluate the safety and effectiveness of our new cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemoperfusion(HIPEC)***:Retrospective review of patients with gastrointestinal malignancies who were suitable candidates for CRS and HIPEC between 12/1/2009 and 10/1/*** clinicopathologic data were reviewed with a special focus on the surgical outcome and the postoperative morbidity and ***:Fourteen patients were *** age was 64 years;seven were *** primary tumors were:colonic(29%),appendiceal(36%),peritoneal mesothelioma(14%),gastric(7%),adenocarcinoma of unknown primary(7%),and gastrointestinal stromal tumor(7%).Eleven patients(79%)received CRS/HIPEC,three for *** patients that did not undergo CRS/HIPEC had an average peritoneal cancer index(PCI)of *** eight patients that underwent curative CRS/HIPEC had an average PCI of 10 and a completeness of cytoreduction score of 0(87.5%) or 1(12.5%).Postoperative morbidity was 36%;the worst adverse event was Grade 3 *** rate was 0%.CONCLUSION:CRS with HIPEC is safe and feasible at tertiary institutions with fledgling *** is an accurate predictor of surgical outcomes.

关键词： Cytoreductive surgery hyperthermic intraperitoneal chemoperfusion Peritoneal carcinomatosis Early outcomes

Outcomes of Quality of Life Regarding the Next-Generation Thoracoscopic Intrapleural hyperthermic Chemotherapy of Non-Small Cell Lung Cancer with Dissemination

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Journal of Cancer Therapy 2016年第1期7卷 63-77页

作者： Takanori Ayabe Masaki Tomita Eiichi Chosa Kosuke Mori Kunihide Nakamura Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

Background: We have developed a new next-generation intrapleural hyperthermic chemotherapy (IPHC) for non-small cell lung cancer with dissemination, which is a hybrid chemotherapy combined with oral S-1 medication plus conventional cisplatin-based IPHC. We now report the preliminary feasibility and outcome of quality of life (QOL) regarding this hybrid IPHC. Methods: The patient was a 76-year-old male with a 2-cm nodule in the left upper lobe. After partial resection by video-assisted thoracic surgery (VATS), which was diagnosed with advanced pulmonary adenocarcinoma with intrapleural dissemination. We initially performed two regimens of systemic chemotherapy, S-1 (day 1 - 21, 100 mg 2X/day) + CDDP (day 8, 60 mg/m2) and S-1 (day 1 - 14,100 mg 2X/day) + CBDCA (day 1, AUC 5). The regimen of next-generation IPHC is oral S-1 medication (day 1 - 21, 100 mg/day) + intrapleural hyperthermic perfusion of cisplatin (200 mg/m2) with VATS (day 8,43°C, 2 hours). Adverse outcomes, QOL, and pleural effusion were assessed in three regimens. To investigate the outcomes of the QOL, the European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30 and QLQ-LC13), the QOL questionnaire for cancer patients treated with anticancer drugs (QOL-ACD), the Cancer Dyspnea Score (CDS), and the St. George’s Respiratory Questionnaire (SGRQ) were used. Results: During the IPHC treatment course, grade 3 neutropenia, anemia, and diarrhea were observed. The physical function after IPHC became worse compared to that before the IPHC. Fatigue during chemotherapy (CBDCA+S-1) was more pronounced than that during the IPHC. Nausea, vomiting, and diarrhea during the IPHC were prevalent than those of chemotherapy. The overall QOL after the IPHC was improved compared to that before the IPHC. Regarding before and after the IPHC, the physical function after the IPHC became worse compared to that before the IPHC, on the other hand, the global QOL before and afte

关键词： Non-Small Cell Lung Cancer Intrapleural hyperthermic Chemotherapy Cisplatin S-1 Quality of Life

Clinical Outcomes, Safety and Efficacy of Intrapleural hyperthermic Chemotherapy for Thoracic Malignant Diseases with Pleural Effusion

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Journal of Cancer Therapy 2016年第3期7卷 203-215页

作者： Takanori Ayabe Masaki Tomita Eiichi Chosa Hiroki Mori Kunihide Nakamura Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

Background: We have performed the cisplatin-based intrapleural hyperthermic chemotherapy (IPHC) for advanced lung cancer with pleural effusion and for malignant pleural mesothelioma (MPM). Retrospectively, the outcomes of the IPHC were evaluated. Methods: For 14 years from February, 2000 to February, 2014, we performed 14 cases of IPHC including 8 lung cancers (staged-IV) and 6 MPMs (staged-III: 5;IV: 1). We divided these cases in two groups;the lung cancer group (LC group) and MPM group, and assessed the perioperative factors, toxicities, and effectiveness. Results: The patient age averaged 66.5 ± 11.1 years old (11 males and 3 females). The pathology was 7 pulmonary adenocarcinomas, 1 pulmonary angiosarcoma, and 6 epithelial type MPMs. The regimens of the IPHC were CDDP (300 mg) plus saline (n = 12), CDDP (100 mg) plus saline (n = 1), and CDDP (300 mg) plus distilled water (n = 1). The operation and IPHC time was 204 ± 70 and 59 ± 19 minutes, respectively. Intraoperative complication was observed in 2 lung injuries due to exfoliation of the pleural adhesion in the LC group. Blood loss was 292 ± 365 ml. The postoperative complication, i.e., subcutaneous emphysema, was observed as grade 2 pulmonary fistula (7.1%, 1/14), which was significantly observed in the LC group (1/8, 12.5%) compared to the MPM group (0/8, 0%) (p = 0.040). The hematological toxicity of more than grade 3 was observed in only one case of anemia (7.1%, 1/14) and in the LC group (25%, 1/8). The grade 3 anemia (25%, 1/8) and grade 2 neutropenia (25%, 1/8) in the LC group were significantly observed compared to those in the MPM group (0%, 0/6), respectively (p = 0.040). The postoperative cytology of the malignant cells in the pleural effusion resulted in the negative (n = 6), positive (n = 7), and not evaluated (n = 1), and the control rate was calculated to be 46.2% (6/13). There was no significant difference between the two groups (p = 0.083), that is, 42.9% (3/7) in the LC group and 50.0% (3/6) i

关键词： Intrapleural hyperthermic Chemotherapy Lung Cancer Mesothelioma Thoracic Malignancies

Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

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World Journal of Critical Care Medicine 2017年第2期6卷 116-123页

作者： Sumit Kapoor Adel Bassily-Marcus Rafael Alba Yunen Parissa Tabrizian Sabrine Semoin Joseph Blankush Daniel Labow John Oropello Anthony Manasia Roopa Kohli-Seth Department of Pulmonary Critical Care and SleepBaylor College of Medicine Department of Surgery Critical Care DivisionIcahn School of Medicine at Mount Sinai Department of Pulmonary and Critical Care Medical College of GeorgiaAugusta University Department of Surgery Icahn School of Medicine at Mount Sinai General Surgery Resident Vanderbilt University Medical Center

AIM To study the early postoperative intensive care unit(ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC).METHODS Our study is a retrospective, observational study per-formed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied. Fifty-one patients came to the ICU postoperatively out of 170 who underwent CRS and HIPEC therapy during the study period. Data analysis was performed using descriptive *** Of the 170 patients who underwent CRS and HIPEC therapy, 51(30%) came to the ICU postoperatively. Mean ICU length of stay was 4 d(range 1-60 d) and mean APACHE Ⅱ score was 15(range 7-23). Thirtyone/fifty-one(62%) patients developed postoperative complications. Aggressive intraoperative and postoperative fluid resuscitation is required in most patients. Hypovolemia was seen in all patients and median amount of fluids required in the first 48 h was 6 L(range 1-14 L). Thirteen patients(25%) developed postoperative hypotension with seven requiring vasopressor support. The major cause of sepsis was intraabdominal, with 8(15%) developing anastomotic leaks and 5(10%) developing intraabdominal abscess. The median survival was 14 mo with 30 d mortality of 4%(2/51) and 90 d mortality of 16%(8/51). One year survival was 56.4%(28/51). Preoperative medical co morbidities, extent of surgical debulking, intraoperative blood losses, amount of intra op blood products required and total operative time are the factors to be considered while deciding ICU vs non ICU *** Overall, ICU outcomes of this study population are excellent. Triage of these patients should consider preoperative and intraoperative factors. Intensivists should be vigilant to aggressive postop fluid resuscitation,

关键词： hyperthermic Abdominal sepsis Cytoreduction Carcinomatosis Respiratory failure Vasopressors

Pneumonectomy of Primary Pulmonary Angiosarcoma with Malignant Effusion and Intrapleural Hypotonic hyperthermic Chemotherapy: Case Report and Review of the Literature

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Journal of Cancer Therapy 2015年第2期6卷 227-236页

作者： Takanori Ayabe Masaki Tomita Eiichi Chosa Katsuya Kawagoe Kunihide Nakamura Department of Surgery II Faculty of Medicine University of Miyazaki Miyazaki Japan

Background: Primary pulmonary angiosarcoma is extremely rare and the prognosis is very poor. We report a combination therapy of pneumonectomy and intrapleural hypotonic hyperthermic chemotherapy (IPHHC). Case report: A 48-year-old male with exertional dyspnea was found to have a left massive pleural effusion. Bronchoscopic examination displayed endobronchial stenosis of the left lower bronchus B8,9,10?and diagnosed with pulmonary angiosarcoma. Chest computed-tomographic scanning revealed a 5-cm mass in the left inferior lobe, which invaded the left upperbronchus. Intrapleural dissemination and malignant pleural effusion were also suspected (cT3N1M1a,?c-stage IV). As a palliative initial therapy, we performed a pneumonectomy. On the 7th?postoperative day, under general anesthesia, we performed video-assisted IPHHC (43°C, 60 min, 200 mg/m2?of CDDP). After the IPHHC, there was no major adverse event (more than Grade 3) during the postoperative course. Histological examination of the resected specimen revealed a highly-cellular growth of atypical spindle cells with a storiform pattern. By immunohistochemical testing, the tumor cells stained positive for markers including CD31 and the factor VIII related antigen, and the diagnosis of pulmonary angiosarcoma was made. No adjuvant chemoradiotherapy was given, and the postoperative clinical course was uneventful. Although there had been a recurrence in the chest wall, the patient eventually died twenty-one months later. Conclusion: As a new therapeutic option, we performed IPHHC after the pneumonectomy for an advanced pulmonary angiosarcoma with malignant pleural effusion. Although the patient had a recurrence in the chest wall, he had a reasonable postoperative outcome, that is, he returned to a work, retained a good quality of life and had a longer survival in spite of the poor prognosis of the pulmonary angiosarcoma.

关键词： Pneumonectomy Intrapleural Hypotonic hyperthermic Chemotherapy Pulmonary Angiosarcoma

Can hyperthermic intraperitoneal chemotherapy effectively control gastric cancer-associated peritoneal carcinomatosis?

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World Journal of Surgical Procedures 2019年第1期9卷 7-11页

作者： Chong-Chi Chiu Chao-Jung Tsao Jhi-Joung Wang Yutaka Yonemura Department of General Surgery Chi Mei Medical CenterLiouying 73657 and Tainan 71004Taiwan Department of Electrical Engineering Southern Taiwan University of Science and TechnologyTainan 71005Taiwan Department of Oncology Chi Mei Medical CenterLiouying 73657Taiwan Department of Medical Research Chi Mei Medical CenterTainan 71004 Taiwan AI Biomed Center Southern Taiwan University of Science and Technology Tainan 71005Taiwan Peritoneal Surface Malignancy Center Kishiwada Tokushukai Hospital KishiwadaOsaka 596-8522Japan

Gastric cancer-associated peritoneal carcinomatosis leads to a poor prognosis and low quality of life. The current systemic chemotherapy processes cannot effectively improve survival. hyperthermic intraperitoneal chemotherapy (HIPEC) has been used as an alternative treatment to control this disease through recurrence prevention, definitive therapeutic modality, and symptom palliation. Although HIPEC has been demonstrated to yield favorable results mainly in some Asian studies, widespread adoption of this treatment is still debatable before larger prospective randomized controlled clinical trials confirm its effectiveness.

关键词： hyperthermic intraperitoneal chemotherapy Gastric cancer Peritoneal carcinomatosis