Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usual...Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usually suffer abdominal distension, intestinal obstruction and various complications before they succumb after a median of 3 - 6 months. Although not adopted in most international treatment guidelines, intraperitoneal chemotherapy has growing evidence compared with conventional systemic chemotherapy for the treatment of peritoneal carcinomatosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is well-established for clinical benefit but is technically demanding with substantial treatment-related morbidities and mortality. On the other hand, normothermic intraperitoneal chemotherapy in the form of bidirectional neoadjuvant treatment is promising with various newer chemotherapeutic agents. Regardless of the treatment technique applied, the essential element of success is meticulous patient selection and availability of expertise. Future direction is along the line of personalized treatment with the application of translational science.展开更多
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 ...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.展开更多
Introduction: A practical staging classification that has prognostic significance in mucinous appendiceal neoplasms represents an unmet need in oncology. The purpose of this study is to present a second edition of the...Introduction: A practical staging classification that has prognostic significance in mucinous appendiceal neoplasms represents an unmet need in oncology. The purpose of this study is to present a second edition of the PSDSS in mucinous appendiceal neoplasms with or without peritoneal dissemination based on the AJCC/TNM 8<sup>th</sup> edition. Materials and Methods: We analyzed 229 patients based on the AJCC/TNM 8<sup>th</sup> edition incorporating G (grade) and E (extent of disease). The impact of these 5 clinicopathological variables (T, N, M, G, E) is scored as stages 0 to IV and is reported as the Esquivel Peritoneal Surface Disease Severity Score (E-PSDSS). Results: One hundred and seventy-three patients underwent cytoreductive surgery (CRS) and HIPEC. There were 30 (13.1%), 56 (24.4%), 48 (20.9%), 20 (8.7%) and 75 (32.7%) patients with E-PSDSS 0, I, II, III, and IV, respectively. Five-year overall survival was 100%, 100%, 84.46%, 52.29% and 12.92% for E-PSDSS 0, I, II, III and IV, respectively (p Conclusion: The E-PSDSS combines specimen examination and reporting according to the College of American Pathologists with the pTNM requirements from the AJCC staging manual. It represents an important prognostic indicator in patients with mucinous appendiceal neoplasms.展开更多
目的:探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)对胃癌腹膜转移[腹膜癌指数(peritoneal cancer index,PCI≤7)]患者预后及术后并发症的影响。方法:回顾性分析2019年1月至2021年1月就诊于山西医科大学第五...目的:探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)对胃癌腹膜转移[腹膜癌指数(peritoneal cancer index,PCI≤7)]患者预后及术后并发症的影响。方法:回顾性分析2019年1月至2021年1月就诊于山西医科大学第五临床医学院的124例胃癌腹膜转移(PCI≤7)患者的临床资料,根据是否行HIPEC将患者分为干预组和对照组,并对患者进行随访。采用Cox分析方法探究HIPEC与患者术后生存率的关系;Kaplan-Meier方法绘制生存曲线,采用Log-rank检验法进行组间生存率对比;χ2检验分析HIPEC对患者生活质量及术后并发症发生情况的影响。结果:干预组1年、2年累积生存率分别为92.1%、81.2%;对照组分别为75%、63.3%。干预组1年(P=0.011)、2年(P=0.024)总体生存率明显高于对照组,差异有统计学意义。Cox多因素分析结果提示HIPEC可以降低胃癌腹膜转移患者的死亡风险(P=0.004),2年死亡风险降低为对照组的0.341倍。两组之间生活质量卡氏评分(KPS)提高水平无显著差异(P=0.602)。HIPEC降低了发热并发症出现的概率(P<0.05),其他并发症无显著差异。结论:HIPEC在不影响患者生活质量的前提下明显提高胃癌腹膜转移(PCI≤7)患者的1年、2年生存率,且不增加术后并发症的发生风险。展开更多
文摘Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usually suffer abdominal distension, intestinal obstruction and various complications before they succumb after a median of 3 - 6 months. Although not adopted in most international treatment guidelines, intraperitoneal chemotherapy has growing evidence compared with conventional systemic chemotherapy for the treatment of peritoneal carcinomatosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is well-established for clinical benefit but is technically demanding with substantial treatment-related morbidities and mortality. On the other hand, normothermic intraperitoneal chemotherapy in the form of bidirectional neoadjuvant treatment is promising with various newer chemotherapeutic agents. Regardless of the treatment technique applied, the essential element of success is meticulous patient selection and availability of expertise. Future direction is along the line of personalized treatment with the application of translational science.
文摘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.
文摘Introduction: A practical staging classification that has prognostic significance in mucinous appendiceal neoplasms represents an unmet need in oncology. The purpose of this study is to present a second edition of the PSDSS in mucinous appendiceal neoplasms with or without peritoneal dissemination based on the AJCC/TNM 8<sup>th</sup> edition. Materials and Methods: We analyzed 229 patients based on the AJCC/TNM 8<sup>th</sup> edition incorporating G (grade) and E (extent of disease). The impact of these 5 clinicopathological variables (T, N, M, G, E) is scored as stages 0 to IV and is reported as the Esquivel Peritoneal Surface Disease Severity Score (E-PSDSS). Results: One hundred and seventy-three patients underwent cytoreductive surgery (CRS) and HIPEC. There were 30 (13.1%), 56 (24.4%), 48 (20.9%), 20 (8.7%) and 75 (32.7%) patients with E-PSDSS 0, I, II, III, and IV, respectively. Five-year overall survival was 100%, 100%, 84.46%, 52.29% and 12.92% for E-PSDSS 0, I, II, III and IV, respectively (p Conclusion: The E-PSDSS combines specimen examination and reporting according to the College of American Pathologists with the pTNM requirements from the AJCC staging manual. It represents an important prognostic indicator in patients with mucinous appendiceal neoplasms.
文摘目的:探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)对胃癌腹膜转移[腹膜癌指数(peritoneal cancer index,PCI≤7)]患者预后及术后并发症的影响。方法:回顾性分析2019年1月至2021年1月就诊于山西医科大学第五临床医学院的124例胃癌腹膜转移(PCI≤7)患者的临床资料,根据是否行HIPEC将患者分为干预组和对照组,并对患者进行随访。采用Cox分析方法探究HIPEC与患者术后生存率的关系;Kaplan-Meier方法绘制生存曲线,采用Log-rank检验法进行组间生存率对比;χ2检验分析HIPEC对患者生活质量及术后并发症发生情况的影响。结果:干预组1年、2年累积生存率分别为92.1%、81.2%;对照组分别为75%、63.3%。干预组1年(P=0.011)、2年(P=0.024)总体生存率明显高于对照组,差异有统计学意义。Cox多因素分析结果提示HIPEC可以降低胃癌腹膜转移患者的死亡风险(P=0.004),2年死亡风险降低为对照组的0.341倍。两组之间生活质量卡氏评分(KPS)提高水平无显著差异(P=0.602)。HIPEC降低了发热并发症出现的概率(P<0.05),其他并发症无显著差异。结论:HIPEC在不影响患者生活质量的前提下明显提高胃癌腹膜转移(PCI≤7)患者的1年、2年生存率,且不增加术后并发症的发生风险。
