Efficacy of continuous arterial perfusion chemotherapy combined with transarterial chemoembolization regional arterial thermal perfusion in the treatment of pancreatic cancer with liver metastases

Background:The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization(TACE)for the treatment of advanced pancreatic cancer with liver metastasis.Methods:Sixty patients with advanced pancreatic cancer and liver metastases were enrolled in this study.In the treatment group,31patients underwent continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial thermal perfusion,whereas 29 patients included in the control group received intravenous chemotherapy with gemcitabine and S-1.All patients received maintenance chemotherapy with S-1 after 4 cycles of the study regimen.Treatment efficacy,quality of life,survival,and toxicity were evaluated.Results:Efficacy was better in the treatment group than in the control group,as reflected by the objective remission,partial remission,and disease progression rates(all P<0.05).The Eastern Cooperative Oncology Group and Numerical Rating Scale pain scores were also higher in the treatment group(both P<0.05).In survival analysis,the 1-year overall survival rates in the treatment and control groups were64.516%and 10.345%,respectively,whereas the median overall survival times were 16 and 6 months,respectively(both P<0.05).The6-month progression-free survival rates in the treatment and control groups were 77.419%and 13.790%,respectively,and the median progression-free survival times were 12 and 3 months,respectively(both P<0.05).The rates of hematological and nonhematological toxicological adverse effects were also lower in the treatment group(both P<0.05).Although the rate of liver dysfunction was higher in the treatment group,this finding had no adverse effects on prognosis.Conclusions:Continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial perfusion chemotherapy resulted in better efficacy and safety outcomes in patients with pancreatic cancer and liver metastasis,suggesting its utility as a reference method for the clinical treatment of advanced pancreatic cancer.

Regional chemotherapy for uveal melanoma liver metastases

Chemotherapy remains an important approach for the treatment of liver metastases from uveal melanoma(UM).Compared with systemic chemotherapy,regional chemotherapy has similar efficacy and fewer systemic adverse effects.Regional chemotherapy for UM liver metastases includes hepatic ar ter y infusion(HAI),transarterial chemoembolization(TACE),and isolated hepatic perfusion(IHP).In this review,we aim to examine the efficacy of regional chemotherapy and compare HAI,TACE,and IHP in terms of overall survival(OS).The three approaches showed no obvious difference in OS results.

Effects of cytoreductive surgery combined with hyperthermic perfusion chemotherapy on prognosis of patients with advanced gallbladder cancer

BACKGROUND Gallbladder cancer(GC)is a common malignant tumor and one of the leading causes of cancer-related death worldwide.It is typically highly invasive,difficult to detect in the early stages,and has poor treatment outcomes,resulting in high mortality rates.The available treatment options for GC are relatively limited.One emerging treatment modality is hyperthermic intraperitoneal chemotherapy(HIPEC).HIPEC involves delivering heated chemotherapy directly into the abdominal cavity.It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions,aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity.AIM To determine the effects of cytoreductive surgery(CRS)combined with HIPEC on the short-term prognosis of patients with advanced GC.METHODS Data from 80 patients treated at the Punan Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed.The control group comprised 44 patients treated with CRS,and the research group comprised 36 patients treated with CRS combined RESULTS The baseline data of the research and control groups were similar(P>0.05).Six days after surgery,the alanine aminotransferase,aspartate aminotransferase,total bilirubin,and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups(P<0.05).However,the values did not differ between the two groups six days postoperatively(P>0.05).Similarly,the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups(P<0.05),but they did not differ between the groups six days postoperatively(P>0.05).Furthermore,the research group had fewer postoperative adverse reactions than the control group(P=0.027).Finally,a multivariate Cox analysis identified the tumor stage,distant metastasis,and the treatment plan as independent factors affecting prognosis(P<0.05).The three-year survival rate in the study group was higher than that in the control group(P=0.002).CONCLUSION CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.

Effect of systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization on the malignancy of locally advanced gastric cancer

Objective:To study the effect of systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization on the malignancy of locally advanced gastric cancer. Methods:A total of 90 patients with primary gastric cancer who received treatment in Tianyou Hospital Affiliated to Wuhan University of Science & Technology between January 2014 and May 2016 were collected and divided into control group and observation group according to the random number table method, 45 cases in each group. The control group of patients received routine systemic intravenous chemotherapy + surgical treatment, and the observation group of patients received systemic intravenous chemotherapy combined with local arterial perfusion chemoembolization + surgical treatment. Levels of tumor markers and angiogenesis factors in serum as well as the expression of oncogenes and tumor suppressor genes in gastric cancer tissue were compared between the two groups of patients before and after chemotherapy.Results:Before chemotherapy, the levels of tumor markers and angiogenesis factors in serum as well as the expression of oncogenes and tumor suppressor genes in gastric cancer tissue were not significantly different between the two groups of patients;after chemotherapy, serum CEA, CA724, CA242, AFP, VEGF, Ang-2, COX2 and PD-ECGF levels of observation group were lower than those of control group, andiASPP, p130Cas, ERBB2 and C-myc mRNA expression in gastric cancer tissue were lower than those of control group while GKN1, p16, PTEN, TSPYL5 and merlin mRNA expression in gastric cancer tissue were higher than those of control group.Conclusions: Preoperative systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization can effectively reduce the malignancy of locally advanced gastric cancer and provide favorable conditions for the operation.

Chemotherapy with laparoscope-assisted continuous circulatory hyperthermic intraperitoneal perfusion for malignant ascites

AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritoneal carcinomatosis from gastric cancers. METHODS: From August 2006 to March 2008, the laparoscopic approach was used to perform CHIPC on 16 patients with malignant ascites induced by gastric cancer or postoperative intraperitoneal seeding. Each patient underwent CHIPC three times after laparoscopeassisted perfusion catheters placing. The first session was completed in operative room under general anesthesia, 5% glucose solution was selected as perfusion liquid, and 1500 mg 5 fluorouracil (5FU) and 200 mg oxaliplatin were added in the perfusion solution. The second andthird sessions were performed in intensive care unit, 0.9% sodium chloride solution was selected as perfusion liquid, and 1500 mg 5FU was added in the perfusion solution alone. CHIPC was performed for 90 min at a velocity of 450600 mL/min and an in flow temperature of 43 ± 0.2℃.RESULTS: The intraoperative course was uneventful in all cases, and the mean operative period for laparoscopeassisted perfusion catheters placing was 80 min for each case. No postoperative deaths or complications related to laparoscopeassisted CHIPC occurred in this study. Clinically complete remission of ascites and related symptoms were achieved in 14 patients, and partial remission was achieved in 2 patients. During the followup, 13 patients died 29 mo after CHIPC, with a median survival time of 5 mo. Two patients with partial remission suffered from port site seeding and tumor metastasis,and died 2 and 3 mo after treatment. Three patients who are still alive today survived 4, 6 and 7 mo, respectively. The Karnofsky marks of patients (5090) increased significantly (P < 0.01) and the general status improved after CHIPC. Thus satisfactory clinical efficacy has been achieved in these patients treated by laparoscopic CHIPC. CONCLUSION: Laparoscopeassisted CHIPC is a safe, feasible and effective procedure in the treatment of debilitating malignant ascites induced by unresectable gastric cancers.

The value of postoperative hepatic regional chemotherapy in prevention of recurrence after radical resection of primary liver cancer

INTRODUCTIONIn China,primary liver cancer (PLC) ranks secondin cancer mortality since the 1990s.In the field ofPLC treatment,surgical resection remains the best,which includes large PLC resection,small PLCresection,re-resection of subclinical recurrence,aswell as cytoreduction and sequential resection forunresectable PLC.However,recurrence

Perfusion CT findings in liver of patients with tumor during chemotherapy

AIM: To investigate the microcirculation changes in liver of patients with tumor during chemotherapy by perfusion computed tomography (CT). METHODS: Sixty patients with tumor and 20 controls were enrolled in this study. Perfusion CT parameters of patients and controls were compared, including hepatic perfusion index (HPI), mean transit time (MTT), and permeability-surface area product (PS). Correlation between perfusion CT parameters, treatment cycle and alanine aminotransferase (ALT) level was studied. RESULTS: No difference was found in HPI (25.68% ± 7.38% vs 26.82% ± 5.13%), MTT (19.67 ± 5.68 s vs21.70 ± 5.43 s) and PS (17.00 ± 4.56 mL/100 mL per min vs 19.92 ± 6.35 mL/100 mL per min) between pa- tients and controls. The HPI and MTT were significantly higher in patients undergoing 2 cycles of chemotherapy than in controls and those undergoing 1 cycle of che- motherapy (29.76% ± 5.87% vs 25.68% ± 7.38% and 25.35% ± 4.05%, and 25.61 ± 5.01 s vs 19.67 ± 5.68 s and 19.74 ± 4.54 s, respectively, P < 0.05). The HPI was higher in patients with hepatic steatosis than in controls and those without hepatic steatosis (30.85% ± 6.17% vs 25.68% ± 7.38% and 25.70% ± 4.24%, P < 0.05). Treatment cycle was well correlated with HPI and MTT (r = 0.40, r = 0.50, P < 0.01). ALT level was not correlated with perfusion CT parameters. CONCLUSION: HPI and MTT are significantly increased in patients with tumor during chemotherapy and well correlated with treatment cycle. Chemotherapy affects hepatic microcirculation in patients with tumor. Changes in hepatic microcirculation can be quantitatively assessed by perfusion CT.

COMBINATION OF CHOLECYSTOJEJUNOSTOMY OR CHOLEDOCHJEJUNOSTOMY PERFUSION CHEMOTHERAPY AND RADIOTHERAPY FOR CANCER OF THE PANCRE

patients with unresectable cancer of the pancreatic head were admitted in our hospital form 1989 to 1995. 21 cases were treated by radiotherapy (Group A). 23 cases were treated by cholecystojejunostomy or choledojejunostomy (Group B). 20 cases were treated by cholecystojejunostomy or cholecystojejunostomy combined with superior panreatocoduodenal artery ADM,5-Fu perfusion with multifunctional implantable drugdelivery system and radiotherapy (Group C). The l-year survival rates of these three groups were 0%, 0% and 4% respectively. The authors believe that combined treatment of Group C is recommended for unresectable cancer of the pancreatic head.

Application of Regional Arterial Infusion Chemotherapy in Advanced Gastric Cancer

Gastric cancer ranks as the fifth most common malignant tumor worldwide and is the third most common cause of cancer-related death. For advanced gastric cancer (AGC), neoadjuvant chemotherapy (NAC) can reduce its stage, increase the rate of radical resection, improve response to treatment, reduce the risk of local recurrence and improve survival rate. Regional arterial infusion chemotherapy (RAIC) is a form of NAC that involves directly injecting chemotherapeutic drugs into the tumor site through the tumor-feeding artery. RAIC increases the local drug concentration around the tumor, thereby improving the therapeutic responses and reducing the adverse effects of the drugs. In recent years, RAIC has attracted increasing attention. This article summarizes the basic principles, procedure, chemotherapy regimens, adverse drug reactions and complications, clinical applications and response evaluation of RAIC in the treatment of AGC.

PERIPANCREATIC ARTERIAL LIGATION COMBINED WITH ARTERIAL INFUSION REGIONAL CHEMOTHERAPY FOR TREATING PATIENTS WITH ADVANCED PANCREATIC CARCINOMA

Objective To find out a new treatment method for advanced pancreatic carcinoma. Methods Twenty nine patients with advanced pancreatic carcinoma and liver metastases were randomly divided into 2 groups.Group A ( n =11) underwent bilio enterostomy and/or gastro enterostomy combined with systemic chemotherapy after operation;Group B( n =18) underwent bilio enterostomy and/or gastro enterostomy combined with peripancreatic arterial ligation and arterial infusion regional chemotherapy.The alleviation of clinical symptom,the change of carcinoma volume by BUS and CT scan,survival period and serum CEA were observed in two groups. Results The symptoms were alleviated apparently in most cases in Group B;BUS and CT scan showed that the tumor volume decreased apparently in Group B;The response rate was 67.7% in Group B,and 18.2% in Group A,respectively( P <0.01);the mean survival period was (4.8±0.6) months in Group A,and (12.5±1.2) months in Group B,respectively( P <0.01),there was significant difference between the two groups.The decrease of serum CEA was 54% in Group A and 60% in Group B,but the difference was not significant( P >0.05). Conclusion Peripancreatic arterial ligation combined with arterial infusion regional chmotherapy is believed to be effective against both pancreatic carcinoma and liver metastases,and it can alleviate the clinical symptoms,postpone the growth speed of tumor,and prolong the survival period.

A Totally Absorbable Multilayer PLGA Implant Device Containing Doxorubicin Inhibited Tumor Growth and Metastasis without Systemic Toxicity in Murine Breast Cancer and an Ideal Pharmacological Paradigm for Regional Chemotherapy

We hypothesize that a cylinder implant made of multilayer Poly-lactic-co-glycolic-acid (PLGA) membrane can be a method for controlled and extended drug release. We fashioned a multilayer cylindrical implant termed STID100 that released doxorubicin for 3 weeks in an orthotopic 4T1 breast cancer model in Balb/C mice. This implant starts as a thin doxorubicin-embedded PLGA membrane, and is then rolled into a cylinder containing an air gap between the membrane layers. Its controlled sustained release delivered 2× the amount of the intravenous (IV) equivalent of doxorubicin, inhibited the primary tumor, and prevented lung metastasis. Importantly it did not cause weight loss, splenomegaly, or cardiac toxicity vs systemically administrated doxorubicin. This favorable safety profile is further substantiated by the finding of no detectable plasma doxorubicin in multiple time points during the 3-week period, and low tumor doxorubicin concentration. The implant system delivered to the specification of an ideal pharmacological paradigm might offer a better coverage of the local tumor, significantly preventing metastatic spread with less drug toxicity to many vital organs, compared to the traditional pharmacology of IV route. The profile of STID made it an attractive therapeutic alternative in metastatic tumor prevention, pain management and many other diverse clinical scenarios.

Effect of hyperthermia perfusion chemotherapy combined with systemic chemotherapy on the expression and secretion of malignant molecules in advanced bladder cancer

Objective: To study the effect of hyperthermia perfusion chemotherapy combined with systemic chemotherapy on the expression and secretion of malignant molecules in advanced bladder cancer. Methods: Patients who were diagnosed with advanced bladder cancer in Gongan County People's Hospital between March 2015 and December 2017 were chosen and randomly divided into two groups, experimental group accepted hyperthermia perfusion chemotherapy combined with systemic chemotherapy, and control group accepted routine infusion chemotherapy combined with systemic chemotherapy. The expression levels of proliferation and invasion genes in the lesions as well as the secretion of cytokines in the urine were measured before chemotherapy and 3 months after chemotherapy. Results: Livin, Bcl-2, TRAP1 and MMP9 mRNA expression in lesions as well as VEGF, TGF-β1, MCP-1 and CEACAM1 secretion in urine of both groups after chemotherapy were lower than those before chemotherapy whereas Bad, LRIG3, Beclin1, KLF4, CHD13 and E-cadherin mRNA expression in lesions as well as IFN-γ and IL-2 secretion in urine were higher than those before chemotherapy, and Livin, Bcl-2, TRAP1 and MMP9 mRNA expression in lesions as well as VEGF, TGF-β1, MCP-1 and CEACAM1 secretion in urine of experimental group were significantly lower than those of control group whereas Bad, LRIG3, Beclin1, KLF4, CHD13 and E-cadherin mRNA expression in lesions as well as IFN-γ and IL-2 secretion in urine were significantly higher than those of control group. Conclusion: Hyperthermia perfusion chemotherapy combined with systemic chemotherapy can be more effective than routine infusion chemotherapy combined with systemic chemotherapy to regulate the expression and secretion of malignant molecules in advanced bladder cancer.

Influence of intraperitoneal perfusion chemotherapy combined with deep hyperthermia on the malignant molecule expression in ascites of patients with ovarian cancer complicated by ascites

Objective: To explore the influence of intraperitoneal perfusion chemotherapy combined with deep hyperthermia on the malignant molecule expression in ascites of patients with ovarian cancer complicated by ascites. Methods: A total of 80 patients with ovarian cancer complicated by ascites who were treated in this hospital between March 2015 and January 2017 were retrospectively analyzed and divided into the control group (n=43) and the study group (n=37). Control group received intraperitoneal perfusion chemotherapy and study group underwent intraperitoneal perfusion chemotherapy combined with deep hyperthermia. The differences in the expression of proliferation, invasion, autophagy and other malignant molecules in ascites were compared between the two groups before and after treatment. Results: Before treatment, the differences in the expression of proliferation, invasion, autophagy and other malignant molecules in ascites were not statistically significant between the two groups. After treatment, proliferation gene TCEAL7 mRNA expression in ascites of study group was higher than that of control group whereas Clusterin, HOTAIR, ROCK and TNFAIP8 mRNA expression were lower than those of control group;invasion gene DUSP10 mRNA expression in ascites was higher than that of control group whereas MTA1, Nek2, Stathmin and IFITM1 mRNA expression were lower than those of control group;autophagy genes LC3-Ⅱ, Beclin1 and PTEN mRNA expression in ascites were higher than those of control group. Conclusion:Intraperitoneal perfusion chemotherapy combined with deep hyperthermia can effectively balance the expression of proliferation, invasion and autophagy genes in ascites, and ultimately reduce the malignancy of the tumor in patients with ovarian cancer complicated by ascites.

Assessment of the efficacy and safety of bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer

Objective:To study the efficacy and safety of bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer. Methods:Patients with advanced non-small cell lung cancer who were treated in Navy General Hospital between May 2014 and October 2016 were selected and randomly divided into two groups, the observation group received bronchial arterial infusion chemotherapy combined with high-frequency hyperthermia, and the control group received bronchial arterial infusion chemotherapy. Before and after treatment, the expression of tumor activity indexes and liver and kidney function indexes in serum as well as and proliferation and invasion genes in tumor lesions were detected respectively.Results: 5 d and 7 d after treatment, serum CEA, MIF, CYFRA21-1 and HE4 levels of both groups of patients were significantly lower than those before treatment and serum CEA, MIF, CYFRA21-1 and HE4 levels of observation group were significantly lower than those of control group;7 d after treatment, MEF2D, c-myc, Survivin, Bcl-2, Vimentin, N-cadherin and Slug expression in tumor lesions of both groups of patients were significantly lower than those before treatment and MEF2D, c-myc, Survivin, Bcl-2, Vimentin, N-cadherin and Slug expression in tumor lesions of observation group were significantly lower than those of control group;serum Scr, BUN, ALT and AST levels were not significantly different between two groups of patients before and after treatment. Conclusion:Bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer can significantly inhibit the tumor proliferation and invasion and is with ideal safety.

INTERNAL DRAINAGE COMBINED WITH INTRAOPERATIVE RADIOTHERAPY AND CHEMOTHERAPY FORPANCREATIC HEAD CARCINOMA

Abstract: To improve the palliative effect on intermediate or advanced pancreatic head carcinoma. Methods: Operations were performed in 26 patients with intermediated or advanced pancreatic head carcinoma. Cholecystojejunostomy or choledochojejunostomy combined with intraoperative radiotherapy with an electron beam on carcinoma were performed from May, 1996 to May, 1998. Meanwhile the catheter of multifunctional implantable drug delivery system was inserted via gastroduodenal artery for postoperative perfusion chemotherapy. Result: The 3–27 month follow-up survey suggested that the tumors shrank in different degrees after the course of treatment. All patients were relieved of pain. The 6-month, 12-month and 24-month survival rates were 100%, 93.9% and 20% respectively. The average survival time of the 5 dead patients was 17.8 months. Conclusion: This operation is very effect to prolong the life of the patients with intermediate or advanced pancreatic head carcinoma.

Conversion of Unresectable to Resectable Liver Metastases from Colorectal Carcinoma Using Hepatic Arterial Chronomodulated Chemotherapy: A Case Report and Short Literature Review

Background: The regional chronomodulated hepatic arterial infusion chemotherapy (HAIC) is an effective regimen for the treatment of patients with unresectable liver metastases from colorectal cancer, especially for the conversion into resectability. Aim: To demonstrate that chronomodulated HAI triplet chemotherapy according to OPTILIV protocol is well tolerated and displayed high antitumor activity in this heavily-pretreated patient. Case Presentation: A 54 years old patient from Russia was treated for a tumor in the ascending colon presented with 13 hepatic metastases ranging from 0.3 to 2.7 cm in diameter. He underwent a laparoscopic right hemicolectomy, 12 cycles of FOLFIRINOX combined to bevacizumab for the last 5 cycles, resulting in a partial response according to CT scan. It was decided to perform a two-stage hepatectomy at Paul Brousse hospital: left partial hepatectomy allowed the excision of 9 lesions. Radio frequency ablation was performed in 2 nodular lesions. Afterwards, the patient received 5 cycles of chronomodulated triplet chemotherapy into the hepatic artery, according to the OPTILIV protocol design, yet without cetuximab, because of the KRAS mutation in the liver metastases, with a partial re-sponse. The patient could then undergo the second stage of the planned right hepatectomy, which turned out to be an R0 resection followed by receiving three courses of chronomodulated HAIC. Disease progression was documented after 3 months. Chronomodulated FOLFIRI chemotherapy was re-started intravenously, in combination with Aflibercept and it was associated with further disease progression. The genetic analysis of our patient’s cancer revealed a high level of MSI. The patient was included in the Phase 2 CheckMate-142 trial and received nivolumab 3 mg/kg every 2 weeks within 3 months. Treatment was discontinued due to ineffectiveness. Then the patient underwent radiotherapy geared towards reduction of pain. Afterwards, the patient died from the disease progression 2 years after the beginning of treatment. Conclusion: In this article, the authors report a clinical case with chronomodulated HAIC as rescue therapy in a heavily pretreated patient with metastatic colorectal cancer, allowing to achieve an objective response despite prior progression on FOLFIRINOX (the same triplet chemo by IV route). This strategy permitted to overcome drug resistance and to perform further complete resection of the liver me-tastases with prolonged patient survival. Thus, chronomodulated HAI is useful in patients with liver metastases from colorectal cancer and de-serves to be further assessed prospectively in clinical trials chemotherapy.

Performance of the Multiprofessional Team in Cytoreductive Surgeries with Intraperitoneal Hyperthermic Chemotherapy:Experience Reporting

Purpose:This study aims at reporting the experience of a cancer hospital’s multiprofessional team with surgery patients in performing cytoreductive surgeries associated with hyperthermic intraperitoneal chemotherapy.Methods:It is a reporting about the experience of the multiprofessional team at AC Camargo Cancer Center’s surgery center,which operates in cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy,thus guaranteeing the surgery patient’s safety.Results:No safety report for the surgery patient subjected to intraperitoneal hypothermic chemotherapy was found in the literature.Therefore,the surgery center’s multiprofessional team’s practice was based on standards for manipulating chemotherapeutic agents and for safely administering medication.A checklist was elaborated for cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy based on the surgery patient safety protocol and the institution’s multiprofessional team’s experience.Conclusions:From the multiprofessional team’s experiences in cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy,the importance of elaborating a checklist to promote the quality of assistance and guarantee patient safety during the entire intraoperative phase became evident.

Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities

To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams.

Cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis from pseudomixoma peritonei

AIM:To investigate the most important aspects of hyperthermic intraperitoneal chemotherapy (HIPEC) that has been accepted as the standard treatment for pseudomyxoma peritonei (PMP),with special regard to morbidity,overall survival (OS) and disease free survival (DFS) over 10 years. METHODS:Fifty-three patients affected by PMP underwent cytoreduction (CCR) and HIPEC with a "semi-closed" abdomen technique in our institution. The peritonectomy procedure and completeness of CCR were classifi ed according to Sugarbaker criteria. Preoperative evaluation always included thoracic and abdominal CT scan to stage peritoneal disease and exclude distant metastases. Fifty-one patients in our series were treated with a protocol based on administration of cisplatinum 100 mg/m2 plus mitomycin C 16 mg/m2,at a temperature of 41.5℃ for 60 min. Anastomoses were always performed at the end of HIPEC. The mean duration of surgery was 12 h including HIPEC. Continuous monitoring of hepatic and renal functions and hydroelectrolytic balance was performed in the postoperative period. RESULTS:Twenty-four patients presented with postoperative complications:surgical morbidity was observed in 16 patients and 6 patients were re-operated. All complications were successfully treated and no postoperative deaths were observed. Risk factors for postoperative morbidity were considered to be gender,age,body surface,duration of surgery,Peritoneal Cancer Index (PCI) and tumor residual value (CC score). No statistically signifi cant correlation was found during the multivariate analysis:only the CC score was statistically significant. The OS in our experience was 81.8%,with a DFS of 80% at 5 years and of 70% at 10 years. CONCLUSION:In our experience,even if HIPEC combined with cytoreductive surgery involves a high risk of morbidity,postoperative complications can be resolved favorably in most cases with correct patient selection and adequate postoperative care,thus minimizing mortality. The association of CCR and HIPEC can be considered as the standard treatment for PMP. The OS and DFS results confi rm the validity of this combined approach for the treatment of this rare neoplasm. The impact of preoperative chemotherapy on OS,in our opinion,is due to a major aggressiveness of tumors in treated patients.