Controversies around the treatment of peritoneal metastases of colorectal cancer

In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in the medical oncology community.A randomized trial(PRODIGE 7)on cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin.Nevertheless,isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver.Another tool is required in those patients to achieve more local control of the disease.Surgical groups in peritoneal surgery continue to use HIPEC in their procedures,using other agents than oxaliplatin for peritoneal cavity infusion,such as mitomycin C.These patients present with complex surgical issues to manage,and consequently a large burden of complications has to be anticipated.Therefore,identifying patients who will benefit from CRS with or without HIPEC would be of great interest.

Early detection of pancreatic cancer

The diagnosis of pancreatic cancer associates an appalling significance.Detection of preinvasive stage of pancreatic cancer will ameliorate the survival of this deadly disease.Premalignant lesions such as Intraductal Papillary Mucinous Neoplasms or Mucinous Cystic Neoplasms of the pancreas are detectable on imaging exams and this permits their management prior their invasive development.Pancreatic intraepithelial neoplasms(PanIN)are the most frequent precursors of pancreatic adenocarcinoma(PDAC),and its particular type PanIN high-grade represents the malignant non-invasive form of PDAC.Unfortunately,PanINs are not detectable on radiologic exams.Nevertheless,they can associate indirect imaging signs which would rise the diagnostic suspicion.When this suspicion is established,the patient will be enrolled in a follow-up strategy that includes performing of blood test and serial imaging test such as computed tomography or magnetic resonance imaging,which will cost in the best-case scenario a burden of healthcare systems,and potential mortality in the worst-case scenario when the patient underwent resection surgery,worthless when there is no moderate or high grade dysplasia in the final histopathology.This issue will be avoid having at its disposal a diagnostic technique capable of detecting high-grade PanIN lesions,such is the cytology of pancreatic juice obtained by nasopancreatic intubation.Herein,we review the possibility of detection of early malignant lesions before they become invasive PADC.

Colorectal cancer lymph node dissection and disease survival

The debate regarding the two possible roles of lymphadenectomy in surgical oncology,prognostic or therapeutic,is still ongoing.Furthermore,the use of lymphadenectomy as a proxy for the quality of the surgical procedure is another feature of discussion.Nevertheless,this reckoning depends on patient conditions,aggressiveness of the tumor,the surgeon,and the pathologist,and then it is not an absolute surrogate for the surgical quality.The international guidelines recom-mend a minimum of 12 lymph nodes harvested for pathological examination in colorectal cancer(CRC)surgery.There is a growing literature on reporting better survival when the lymph node yield is high,even when these nodes are negative for malignancy.On the other hand,there are studies reporting no survival benefit with high lymph node yield in stage I-II of CRC.Herein we review the roles of the lymphadenectomy in CRC,and discuss the results of studies on lymph node harvesting.

History of pseudomyxoma peritonei from its origin to the first decades of the twenty-first century

Pseudomyxoma peritonei(PMP)is a disease surrounded by misunderstanding and controversies.Knowledge about the etymology of pseudomyxoma is useful to remove the ambiguity around that term.The word pseudomyxoma derives from pseudomucin,a type of mucin.PMP was first described in a case of a woman alleged to have a ruptured pseudomucinous cystadenoma of the ovary,a term that has disappeared from today’s classifications of cystic ovarian neoplasms.It is known today that in the majority of cases,the origin for PMP is an appendiceal neoplasm,often of low histological grade.Currently,ovarian tumors are wrongly being considered a significant recognized etiology of PMP.PMP classification continues to be under discussion,and experts’panels strive for consensus.Malignancy is also under discussion,and it is shown in this review that there is a long-standing historical reason for that.Surgery is the main tool in the treatment armamentarium for PMP,and the only therapy with potential curative option.