Morbidity and mortality assessment of cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma--a prospective study of 70 consecutive cases.
ABSTRACT Although many reports regarding morbidity and mortality of cytoreductive surgery plus perioperative intraperitoneal chemotherapy are available, there are no prospective data on morbidity and mortality limited to patients with diffuse malignant peritoneal mesothelioma (DMPM).
This prospective morbidity and mortality assessment was performed on 70 consecutive cytoreductive procedures with perioperative intraperitoneal chemotherapy for DMPM. Forty-seven adverse events by eight categories were rated from grades I to IV with increasing severity. Grade I morbidity was self-limiting; grade II required medical treatments; grade III required an invasive intervention; grade IV required returning to the operating room or intensive care management. Risk factors for grades III and IV morbidity were determined.
The perioperative mortality rate was 3%. The grades III and IV morbidity rates were 27 and 14%, respectively. Primary colonic anastomosis (P = 0.028), more than four peritonectomy procedures (P = 0.015), duration of the operation of more than 7 h (P = 0.027) were the risk factors for grade IV morbidity. Survival analysis of these 70 patients was provided.
The morbidity and mortality results for cytoreductive surgery and perioperative intraperitoneal chemotherapy for patients with DMPM were within the acceptable range for major gastrointestinal surgery. Grade IV morbidity was associated with more extensive cytoreduction.
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ABSTRACT: Cystic mesothelioma is a rare disease that results in abdominal distention and poorly defined abdominal pain. Diagnosis has always been made by tissue biopsy rather than by radiologic studies. Our experience with 7 patients with cystic mesothelioma includes 4 patients who had not had prior surgery before the performance of a high resolution CT scan. A special review of the radiology of these cases was performed in order to identify any pathognomonic signs of this disease. In all patients who did not have a distortion of the radiologic images (as a result of surgical interventions) prior to the performance of a high resolution CT scan at our institution, a pathognomonic thin-wall cystic structure located within the gelatinous appearing mass was observed. These thin-walled cysts were of variable size and preferentially located within the greater omentum, pelvis and beneath the right hemidiaphragm. Cystic mesothelioma can be diagnosed preoperatively by a high resolution abdominal and pelvic CT. The thin-walled cysts with great variation in size are located beneath the right hemidiaphragm, within the greater omentum and in the pelvis. No other disease with these radiologic findings has been identified.Tumori 94(1):14-8. · 1.09 Impact Factor
Article: Peritonealkarzinose[Show abstract] [Hide abstract]
ABSTRACT: Das kolorektale Karzinom ist die zweithäufigste maligne Erkrankung und für einen nicht unerheblichen Teil aller Krebstodesfälle verantwortlich. Über 10% der betroffenen Patienten zeigen bereits bei Diagnosestellung eine peritoneale Metastasierung. Hinzu kommen weitere Patienten mit Peritonealkarzinose im Rahmen eines Tumorrezidivs. Für einen hoch selektionierten Teil dieser Patienten steht mit der zytoreduktiven Chirurgie und hyperthermen intraperitonealen Chemotherapie ein neues Therapieregime zur Verfügung, durch dessen Einsatz sich das Überleben dieser Patienten signifikant verbessern lässt. Trotz des aggressiven Vorgehens sind die Eingriffe in spezialisierten Zentren insbesondere nach Abschluss der Lernkurve mit einer vertretbaren Morbidität und niedriger Letalität durchführbar. Entscheidend für den Therapieerfolg sind eine konsequente präoperative Diagnostik zur Selektion geeigneter Patienten sowie die Einbindung des Therapieregimes in ein interdisziplinäres Behandlungskonzept. In der vorliegenden Arbeit wird das Therapieregime vorgestellt und das Patientenoutcome anhand publizierter Studien und eigener Daten aufgezeigt. Colorectal cancer is a common malignant disease with increasing incidence and a significant cause of death in cancer patients. More than 10% of patients with colorectal cancer show peritoneal carcinomatosis at initial diagnosis. Moreover, peritoneal metastasis is a common sign of recurrence. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a new treatment strategy for highly selected patients with peritoneal carcinomatosis. Numerous studies show prolonged survival after CRS and HIPEC with acceptable morbidity and mortality rates. Accurate preoperative diagnostics and patient selection play a pivotal role in postoperative patient outcome. This promising treatment strategy is discussed regarding surgical technique, intraperitoneal chemotherapy, and patient outcome.Der Chirurg 12/2007; 78(12):1100-1110. DOI:10.1007/s00104-007-1419-0 · 0.52 Impact Factor
Article: Peritoneal mesothelioma[Show abstract] [Hide abstract]
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