Aggressive Surgical Management of Peritoneal Carcinomatosis With Low Mortality in a High-Volume Tertiary Cancer Center
ABSTRACT Cytoreductive surgery (CS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinomatosis (PC) traditionally involves high perioperative morbidity and mortality. We report our experience performing CS-HIPEC in a high-volume regional perfusion program designed to limit morbidity and mortality.
A total of 122 patients underwent 124 CS-HIPEC procedures. Common tumors treated with CS-HIPEC included appendiceal (38.5%), colorectal (24.6%), and ovarian cancers (13.1%), and peritoneal mesothelioma (12.3%). Complete cytoreduction was performed in all patients, with organ resections performed as necessary.
R0 resection was achieved in 28.7% of cases, R1 in 54.9%, and R2 in 16.4%. Median operative time was 460 minutes (range, 250-840 minutes), and median blood loss was 1150 mL (range, 10-14,000 mL). Median hospital and intensive care unit stays were 12 days (range, 6-50 days) and 3 days (range, 0-41 days), respectively. Grade 3 or 4 morbidity by National Cancer Institute criteria (major morbidity) was seen in 29.8% of cases, with overall morbidity 56.5%. Independent prognostic variables for major morbidity included number of anastomoses and degree of cytoreduction. In-hospital and 30-day mortality rates were 0% and 1.6%, respectively. The most favorable diagnosis was appendiceal cancer, for which 2-year survival was 66.7%, with lower-grade histologic subtypes of appendiceal cancer reaching 85.7% 2-year survival. Colorectal cancer had 2-year survival of 36.7%.
In a high-volume center with extensive experience treating peritoneal malignancies, perioperative mortality can be lowered to nearly zero, although morbidity remains high. CS-HIPEC procedures should be studied further in a controlled manner to help define their important role in the care of patients with PC.
- SourceAvailable from: Wenceslao Vásquez Jiménez[Show abstract] [Hide abstract]
ABSTRACT: La Enfermedad Peritoneal Maligna (EPM), se define cómo el crecimiento de tejido neoplásico en el peritoneo, ya sea originado de forma, primario, en el mismo peritoneo (mesotelioma, adenocarcinoma primario peritoneal) ó secundario a la diseminación de tumores digestivos o ginecológicos ó invasión de sarcomas. Los objetivos principales de este estudio son tres. En primer lugar, determinar la supervivencia global y libre de enfermedad en pacientes con Enfermedad Peritoneal Maligna, tratados con Citoreducción máxima y quimioterapia perioperatoria. En segundo lugar, estimar la morbilidad y mortalidad asociada a los procedimientos de Citoreducción y quimioterapia perioperatoria. Y por último, establecer factores pronósticos asociados a mortalidad y a complicaciones mayores, de los procedimientos de Citoreducción y quimioterapia intraperitoneal perioperatoria.
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ABSTRACT: A peritoneal surface malignancy is one of an assortment of tumors that result in widespread peritoneal involvement, can affect multiple organs, and may arise from the appendix, colon, rectum, stomach, ovaries, or peritoneal lining. The combined treatment modality of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has gained recognition as a promising, potentially life-extending surgical treatment option for the management of peritoneal surface malignancies. This type of surgical treatment is not without risks and complications, often resulting in the formation of fistulas and the need for a diverting ostomy. This article presents a review of peritoneal surface malignancies, cytoreductive surgery, the perioperative management of the surgical patient with focus on complications and implications for the WOC nurse providing care for patients undergoing this complex surgical treatment.Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 07/2010; 37(4):379-85. DOI:10.1097/WON.0b013e3181e399fe · 1.00 Impact Factor
Conference Paper: Perturbation effects on filters having multiple poles[Show abstract] [Hide abstract]
ABSTRACT: It is well known that the actual poles implemented in digital filters are increasingly sensitive to decreasing pole separation and that practical filters are implemented usually as a cascade of second order sections to avoid this sensitivity. This paper considers the case of filters implemented in direct form and having multiple poles. An expression for the sensitivity for such filters to parameter perturbation is developed. The usual concept of pole position sensitivity for simple poles is an infinitesimal measure which becomes very conservative for practical quantization errors. The multiple pole result can be interpreted for the case of simple poles to provide a working estimate for pole sensitivityAcoustics, Speech, and Signal Processing, 1994. ICASSP-94., 1994 IEEE International Conference on; 05/1994