Impact of preoperative inflammatory and nutritional markers on the prognosis of patients with peritoneal metastasis of colorectal cancer

BACKGROUND Identifying patients with peritoneal metastasis(PMs)of colorectal cancer(CRC)who will benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is crucial before surgery.Inflammatory and nutritional indicators play essential roles in cancer development and metastasis.AIM To investigate the association of preoperative inflammatory and nutritional markers with prognosis in patients with CRC-PM.METHODS We included 133 patients diagnosed with CRC-PM between July 2012 and July 2018.Patients’demographics,overall survival(OS),and preoperative inflammatory and nutritional markers were evaluated.The Kaplan-Meier method and log-rank test were used to estimate differences.RESULTS Of the 133 patients,94(70.6%)had normal hemoglobin(Hb)and 54(40.6%)had a high neutrophil-to-lymphocyte ratio(NLR).The median OS(mOS)was significantly lower for patients with high NLR(7.9 months)than for those with low NLR(25.4 months;P=0.002).Similarly,patients with normal Hb had a longer mOS(18.5 months)than those with low Hb(6.3 months;P<0.001).Multivariate analysis identified age,carbohydrate antigen 199 levels,NLR,Hb,and peritoneal cancer index as independent predictors of OS.Based on these findings,a nomogram was constructed,which demonstrated a good capacity for prediction,with a C-index of 0.715(95%confidence interval:0.684-0.740).Furthermore,the 1-and 2-year survival calibration plots showed good agreement between predicted and actual OS rates.The areas under the curve for the 1-and 2-year survival predictions of the nomogram were 0.6238 and 0.6234,respectively.CONCLUSION High NLR and low Hb were identified as independent predictive risk factors for poor prognosis in patients with CRC-PM.The established nomogram demonstrated high accuracy in predicting OS for patients with CRC-PM,indicating its potential as a valuable prognostic tool for this patient population.

BMSC-derived Exosomes Ameliorate Peritoneal Dialysis-associated Peritoneal Fibrosis via the Mir-27a-3p/TP53 Pathway

Objective:Peritoneal fibrosis(PF)is the main cause of declining efficiency and ultrafiltration failure of the peritoneum,which restricts the long-term application of peritoneal dialysis(PD).This study aimed to investigate the therapeutic effects and mechanisms of bone marrow mesenchymal stem cells-derived exosomes(BMSC-Exos)on PF in response to PD.Methods:Small RNA sequencing analysis of BMSC-Exos was performed by second-generation sequencing.C57BL/6J mice were infused with 4.25%glucose-based peritoneal dialysis fluid(PDF)for 6 consecutive weeks to establish a PF model.A total of 36 mice were randomly divided into 6 groups:control group,1.5%PDF group,2.5%PDF group,4.25%PDF group,BMSC-Exos treatment group,and BMSC-Exos+TP53 treatment group.Reverse transcription quantitative polymerase chain reaction(RT-qPCR)was performed to measure the expression level of miR-27a-3p in BMSC-Exos and peritoneum of mice treated with different concentrations of PDF.HE and Masson staining were performed to evaluate the extent of PF.The therapeutic potential of BMSC-Exos for PF was examined through pathological examination,RT-qPCR,Western blotting,and peritoneal function analyses.Epithelial-mesenchymal transition(EMT)of HMrSV5 was induced with 4.25%PDF.Cells were divided into control group,4.25%PDF group,BMSC-Exos treatment group,and BMSC-Exos+TP53 treatment group.Cell Counting Kit-8 assay was used to measure cell viability,and transwell migration assay was used to verify the capacity of BMSC-Exos to inhibit EMT in HMrSV5 cells.Results:Small RNA sequencing analysis showed that miR-27a-3p was highly expressed in BMSC-derived exosomes compared to BMSCs.The RT-qPCR results showed that the expression of miR-27a-3p was upregulated in BMSC-Exos,but decreased in PD mice.We found that PF was glucose concentration-dependently enhanced in the peritoneum of the PD mice.Compared with the control mice,the PD mice showed high solute transport and decreased ultrafiltration volume as well as an obvious fibroproliferative response,with markedly increased peritoneal thickness and higher expression ofα-SMA,collagen-I,fibronectin,and ECM1.The mice with PD showed decreased miR-27a-3p.Peritoneal structural and functional damage was significantly attenuated after BMSC-Exos treatment,while PF and mesothelial damage were significantly ameliorated.Additionally,markers of fibrosis(α-SMA,collagen-I,fibronectin,ECM1)and profibrotic cytokines(TGF-β1,PDGF)were downregulated at the mRNA and protein levels after BMSC-Exos treatment.In HMrSV5 cells,BMSC-Exos reversed the decrease in cell viability and the increase in cell migratory capacity caused by high-glucose PDF.Western blotting and RT-qPCR analysis revealed that BMSC-Exos treatment resulted in increased expression of E-cadherin(epithelial marker)and decreased expression ofα-SMA,Snail,and vimentin(mesenchymal markers)compared to those of the 4.25%PDF-treated cells.Importantly,a dual-luciferase reporter assay showed that TP53 was a target gene of miR-27a-3p.TP53 overexpression significantly reversed the decreases in PF and EMT progression induced by BMSC-Exos.Conclusion:The present results demonstrate that BMSC-Exos showed an obvious protective effect on PD-related PF and suggest that BMSC-derived exosomal miR-27a-3p may exert its inhibitory effect on PF and EMT progression by targeting TP53.

Solitary extraovarian primary peritoneal carcinoma with direct invasion into the liver,diaphragm and lung without peritoneal dissemination or distant metastasis

To the Editor:Extraovarian primary peritoneal carcinoma(EOPPC)is an uncommon malignancy with many similarities to epithelial ovarian carcinoma in histological,clinical,and etiological aspects[1].This phenomenon is explained by their common embryonal origin,in which both develop from the coelomic epithelium in the early embryological stage.Despite their similarities,the incidence of EOPPC is significantly lower than that of epithelial ovarian carcinoma(6.78 cases per million vs.120.5 cases per million)[1].

Peritoneo-Vaginal Leaks in Peritoneal Dialysis: A Report of 3 Cases

Introduction: Peritoneal dialysis (PD) is an extra-renal purification technique indicated for patients with end-stage kidney disease (ESKD). Although it has many advantages, it also has a number of complications, such as peritoneo-vaginal leakage of dialysate. Cases Reports: Three male patients, aged 70, 50 and 77 respectively, with ESKD were placed on PD. All three patients presented with inadequate drainage and the progressive appearance of bilateral hydrocele, which occurred one year (late leakage), two and four days (early leakage) respectively after the initiation of exchanges. The etiological investigation led to the conclusion of a peritoneo-vaginal leak associated with an inguinal hernia in only one case. The two cases of early leakage were treated by temporary suspension of PD, with a good response in one case and failure in the second, leading to hisdefinitive transfer to hemodialysis (HD);however, the hernia repair enabled immediate resumption of PD in the third patient. Discussion and Conclusion: Peritoneo-vaginal leakage is a rare mechanical complication in PD. The clinical examination plays an essential role in confirming the diagnosis and in the therapeutic decision. If the diagnosis is uncertain, or if there is a clinical need to show the anatomy of the leak, an imaging approach becomes desirable. This complication should not prevent the progression of PD in the management of patients with ESKD.

Genomic characterization of peritoneal lavage cytology-positive gastric cancer

Objective: Positive peritoneal lavege cytology(CY1) gastric cancer is featured by dismal prognosis, with high risks of peritoneal metastasis. However, there is a lack of evidence on pathogenic mechanism and signature of CY1and there is a continuous debate on CY1 therapy. Therefore, exploring the mechanism of CY1 is crucial for treatment strategies and targets for CY1 gastric cancer.Methods: In order to figure out specific driver genes and marker genes of CY1 gastric cancer, and ultimately offer clues for potential marker and risk assessment of CY1, 17 cytology-positive gastric cancer patients and 31matched cytology-negative gastric cancer patients were enrolled in this study. The enrollment criteria were based on the results of diagnostic laparoscopy staging and cytology inspection of exfoliated cells. Whole exome sequencing was then performed on tumor samples to evaluate genomic characterization of cytology-positive gastric cancer.Results: Least absolute shrinkage and selection operator(LASSO) algorithm identified 43 cytology-positive marker genes, while Mut Sig CV identified 42 cytology-positive specific driver genes. CD3G and CDKL2 were both driver and marker genes of CY1. Regarding mutational signatures, driver gene mutation and tumor subclone architecture, no significant differences were observed between CY1 and negative peritoneal lavege cytology(CY0).Conclusions: There might not be distinct differences between CY1 and CY0, and CY1 might represent the progression of CY0 gastric cancer rather than constituting an independent subtype. This genomic analysis will thus provide key molecular insights into CY1, which may have a direct effect on treatment recommendations for CY1and CY0 patients, and provides opportunities for genome-guided clinical trials and drug development.

Hyperkalemia in Patients on Peritoneal Dialysis: Clinical Use Experience with New Potassium-Binders

Background: Patients with end-stage kidney disease (ESKD) on maintenance dialysis have a high risk of developing hyperkalemia. In addition to traditional approaches, a new option for the management of patients on dialysis includes the use of a potassium binder, sodium zirconium cyclosilicate (SZC). We evaluated the effect and safety of SZC in patients with chronic PD. Objective: To present a case series that illustrates the real-world use of new potassium-binders in hyperkalemic patients on peritoneal dialysis. Methods: This case series collected 9 patients on PD with baseline potassium values > 5.5 mmol/l and who were treated with SZC 5 g once a day. Data were collected at baseline and at 1, 2, and 3 months after initiation of treatment. Results: The median age of patients was 64.5 years and the median duration of observation was 90 ± 5 days. It was observed that median serum potassium decreased (5.8 mmol/l at baseline with a range of 5.8 mmol/L - 6.8 mmol/L versus 4.5 in the third month with a range of 3.6 mmol/L - 5.3 mmol/L) after SZC treatment. Adverse events were observed in 2 (22.2%). The unique adverse event was constipation and presented in 2 patients (22.2%). Constipation was mild and transient during the observation period. No adverse events of special interest were reported. Conclusion: Normokalemia was established and maintained in this series of patients treated with SZC. No episodes of hyper- or hypo-kalemia were observed. SCZ had a good safety profile and was well tolerated over 3 months.

Prognostic factors of early recurrence after complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary significantly.AIM To identify the clinical factors associated with progression-free survival(PFS)after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal,ovarian,and gastric cancers.METHODS We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival(OS)in patients recruited between 2015 and 2020.Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year.Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS.RESULTS Of the 80 enrolled patients,39 had an unfavorable PFS(<1 year)and 41 had a favorable PFS(≥1 year).Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0(CC-0)or length of CRS≤6 h had a favorable PFS[odds ratio(OR)=0.141,P=0.004;and OR=0.361,P=0.027,respectively].In multiple logistic regression,achieving CC-0 was the strongest prognostic factor for a favorable PFS(OR=0.131,P=0.005).A peritoneal cancer index score>12 was associated with a lower rate of achieving CC-0(P=0.027).The favorable PFS group had a significantly longer OS(median 81.7 mo vs 17.0 mo,P<0.001).CONCLUSION Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival.This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.

Continuous ambulatory peritoneal dialysis telemonitoring and education:A scoping review

The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods that enable remote monitoring and patient care.This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care.This study is a scoping review(ScR)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method.Article searches were carried out on ProQuest,PubMed,and ScienceDirect with a time range of 2018-2023.Data extraction was performed regarding knowledge level,quality of life,clinical outcomes(peritonitis),and risk of hospitalization.Of the 12 articles and studies included,6 articles were related to the effect of telemonitoring on CAPD patient outcomes,and 6 articles were associated with the effect of education on CAPD patient outcomes.Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders,reduce the potential for peritonitis and dialysis complications,and improve the quality of life of patients with CAPD.CAPD patients who received telemonitoring had a better quality of life,good clinical outcomes,and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits.In summary,the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks.

Spontaneous dislodgment of a peritoneal dialysis catheter inserted using the Seldinger technique:A case report

BACKGROUND Peritoneal dialysis(PD)is an important renal replacement therapy in patients with end-stage renal disease.PD catheters remain the lifeline for patients undergoing PD.The catheter technique survival rate is considered a core PD outcome domain.CASE SUMMARY The PD catheter spontaneously dislodged in a patient undergoing PD during regular fluid exchange without pain.Abdominal computed tomography showed a tunnel infection.A double-cuff straight Tenckhoff catheter had been inserted using the Seldinger technique.Before this incident,the patient had a history of tunnel infections.We speculate that recurrent tunnel infections and catheter insertion using the Seldinger technique may have led to catheter dislodgement.CONCLUSION The present case suggests that clinicians should more rigorously assess the persistence of catheter-related infections concerning the potential complications arising from catheter dislodgement associated with the Seldinger technique.

Tuberculous peritonitis complicated by an intraperitoneal tuberculous abscess: A case report

BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by hematogenous dissemination.The former is more common,such as intestinal TB,mesenteric lymphatic TB,fa-llopian tube TB,etc.,and can be the direct primary lesion of the disease.CASE SUMMARY We present an older male patient with TBP complicated by an abdominal mass.The patient's preoperative symptoms,signs and imaging data suggested a poss-ible abdominal tumor.After surgical treatment,the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by com-bining past medical history,postoperative pathology,and positive results of TB-related laboratory tests.The patient's symptoms were significantly reduced after surgical treatment,and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.CONCLUSION This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.

Impact of hyperthermic intraperitoneal chemotherapy on gastric cancer survival: Peritoneal metastasis and cytology perspectives

BACKGROUND Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects.The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy(HIPEC)has been shown to increase survival rates in these patients.Despite these advancements,debates persist regarding the magnitude of survival improvement attributed to this treatment modality.The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis,and it took a comparative analysis of patients exhibiting positive and negative cytological findings.Between April 2013 and March 2020,84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts:HIPEC(20 patients with peritoneal metastasis),cytology-positive(23 patients without peritoneal nodules but with positive wash cytology),and cytology-negative(41 patients with advanced gastric cancer,no peritoneal nodules,and negative wash cytology).The HIPEC cohort underwent gastrectomy with HIPEC,while the cytology-positive and cytology-negative groups received gastrectomy alone.The demographic,pat-hological,and survival data of the groups were compared.RESULTS The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss.Nevertheless,the complication rates were consistent across all three groups.Median survival in the HIPEC group was 20.00±4.89 months,with 1-year,2-year,and 3-year overall survival rates of 73.90%,28.70%,and 9.60%,respectively.These figures paralleled the survival rates of the cytology-positive group(52.20%at 1 year,28.50%at 2 years,and 19.00%at 3 years).Notably,47%of patients experienced peritoneal recurrence.CONCLUSION HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis,mirroring the outcomes in cytology-positive patients.However,peritoneal recurrence remained high.

Probiotic interventions in peritoneal dialysis:A review of underlying mechanisms and therapeutic potentials

Peritoneal dialysis(PD)is a commonly used modality for kidney replacement therapy for patients with end-stage kidney disease(ESKD).PD offers many benefits,including home-based care,greater flexibility,and preservation of residual kidney function compared to in-center hemodialysis.Nonetheless,patients undergoing PD often face significant challenges,including systemic inflammation,PD-related peritonitis,metabolic disorders,and cardiovascular issues that can negatively affect their quality of life and treatment outcomes.Recent studies have demonstrated the crucial role of the gut microbiome in overall health and treatment results,supporting the hypothesis that probiotics may bring potential benefits to the general population of ESKD patients.However,specific data on probiotic use in PD patients are limited.This opinion review aims to summarize the current knowledge on the relationship between PD and the gut microbiome and offers a novel perspective by specifically exploring how probiotic interventions could improve the outcomes of PD treatment.The review also outlines some clinical data supporting the effectiveness of probiotics in patients undergoing PD and considers the difficulties and restrictions in their application.Based on the current knowledge gaps,this study seeks to explore future research directions and their implications for clinical practice.

Comprehensive Review:Diagnosis,Classification,and Risk Factors of Peritoneal Dialysis-Associated Peritonitis

Peritoneal dialysis(PD)is a predominant modality of renal replacement therapy(RRT)for individuals suffering from end-stage renal disease(ESRD).Peritoneal dialysis-associated peritonitis(PDAP)represents a frequent complication among patients undergoing PD,significantly contributing to adverse clinical outcomes.This review comprehensively examines the diagnosis,classification,and risk factors associated with PDAP,aiming to offer clinical practitioners essential guidance and a foundational framework for effective clinical management.

Meta-analysis of Cohort Studies on Clinical Efficacy of Icodextrin Peritoneal Dialysate

Objective To evaluate the effect of real-world practices for icodextrin peritoneal dialysis solution on patients with end-stage renal disease(ESRD)by Meta-analysis.Methods The PubMed and Embase databases were systematically searched for real-world research literature on icodextrin peritoneal dialysate in the treatment of ESRD patients,and RevMan5.4 statistical software was used for Meta-analysis.Results and Conclusion 12 studies with 114656 patients were included.Meta-analysis results showed that icodextrin peritoneal dialysis had good effects on mortality[RR=0.72,95%CI(0.62,0.83),P<0.001],congestive heart failure[RR=0.67,95%CI(0.52,0.87),P=0.003],and risk of new-onset diabetes[RR=0.65,95%CI(0.49,0.86),P=0.003],which was consistent with the Meta-analysis based on clinical trials.Meanwhile,there was no significant difference in PD technical failure rate[RR=0.67,95%CI(0.44,1.00),P=0.05],peritonitis[RR=1.02,95%CI(0.99,1.05),P=0.14],cardiovascular and cerebrovascular diseases[RR=0.79,95%CI(0.59,1.05),P=0.10],coronary artery disease[RR=0.99,95%CI(0.92,1.07),P=0.80],stroke[RR=0.86,95%CI(0.66,1.10),P=0.23],and atrial fibrillation[RR=0.73,95%CI(0.37,1.44),P=0.36].However,it might increase the risk of hypertension[RR=1.05,95%CI(1.03,1.07),P<0.001].Therefore,icodextrin can effectively reduce the risk of mortality,congestive heart failure,and new-onset diabetes,which is beneficial to ESRD patients.

A Cross-Sectional Study on The Prevalence of Anemia in Maintenance Hemodialysis and Peritoneal Dialysis Patients and Its Related Factors

Objective:To study the prevalence of anemia,the proportion of hemoglobin(Hb)levels,the treatment methods,and the influencing factors of Hb levels in maintenance hemodialysis(MHD)and peritoneal dialysis patients.Methods:In this study,602 patients with maintenance hemodialysis and continuous ambulatory peritoneal dialysis were enrolled from December 2020 to December 2022 in our hospital,and their medical records were collected and summarized.The main contents included the patient’s gender,age,primary disease,dialysis duration,dialysis method,the use of erythropoietic stimulating agents(ESA),intravenous iron,and laboratory tests.A Hb index exceeding 110 g/L was set as the standard for the prevalence of anemia.Results:The rate of anemia in patients undergoing blood purification was 83%.The proportion of ESA use was 84.1%,and the proportion of iron use was 76.7%,of which the proportion of intravenous iron used was 17.0%,and the proportion of folic acid used was 28.3%.Conclusion:The incidence of anemia in MHD patients was relatively high,with a low proportion of patients reaching the standard Hb levels.Risk factors include albumin(ALB)levels,iron storage,white blood cells,C-reactive protein,cholesterol,etc.Nutritional support,iron supplementation,and prevention of micro-inflammatory reactions can effectively promote the improvement of Hb indicators in dialysis patients to prevent anemia.

Benign Multicystic Peritoneal Mesothelioma: A Case Report

Benign multicystic peritoneal mesothelioma(BMPM)is a rare tumor originating from peritoneal mesothelial cells.Here,we present a case of an 18-year-old male with right lower abdominal pain.Physical examination revealed a palpable mass with unclear boundaries.Laboratory tests showed elevated levels of monocytes and high-sensitivity C-reactive protein.CT scan revealed a cystic mass in the ileocecal region with multiple septations.Laparoscopic surgery confirmed a cystic solid mass resembling beads on the colon’s right side.Immunohistochemistry confirmed BMPM diagnosis.BMPM,especially in the ileocecal region,is uncommon and presents diagnostic challenges.Differential diagnosis includes lymphangioma,peritoneal metastasis,and malignant mesothelioma.CT findings,such as thin cyst walls and septations,aid in diagnosis.Recognition of BMPM’s imaging features improves diagnostic accuracy.Surgical resection remains the primary treatment.This case underscores the importance of considering BMPM in young male patients with abdominal pain and emphasizes the value of imaging modalities in accurate diagnosis and management.

Inhibiting Effect of Lobenzarit Disodium on the Inter-leukin-1 Activity in Normal and in Adjuvant ArthritisKats and on the H_2O_2 Release from Rat Peritoneal Macro-phages

The effects of Lobenzarit disodium (CCA) upon the activity of interleukin-1(IL-1) of peritoneal macrophages(PMΦ)in normal and in adjuvant arthritis AA) rats and on the release of hydrogen peroxide(H_2O_2)of rat peritoneal macrophages were studied. CCA 10～200 μg/ml could inhibit IL-1activity in normal rat in vitro;CCA 10 and 50 mg/kg could depress the level of increased IL-1 in AA rats in vivo;CCA 5～100μg/ml could inhibit the release of H_2O_2 from rat PMΦin vitro.The results suggest that these effects could be one of the mechanisms of anti-inflammatory action of CCA.

Chinese expert consensus on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancies

Locoregional spread of abdominopelvic malignant tumors frequently results in peritoneal carcinomatosis(PC). The prognosis of PC patients treated by conventional systemic chemotherapy is poor, with a median survival of < 6 mo. However, over the past three decades, an integrated treatment strategy of cytoreductive surgery(CRS) + hyperthermic intraperitoneal chemotherapy(HIPEC) has been developed by the pioneering oncologists, with proved efficacy and safety in selected patients. Supported by several lines of clinical evidence from phases Ⅰ, Ⅱ and Ⅲ clinical trials, CRS + HIPEC has been regarded as the standard treatment for selected patients with PC in many established cancer centers worldwide. In China, an expert consensus on CRS + HIPEC has been reached by the leading surgical and medical oncologists, under the framework of the China Anti-Cancer Association. This expert consensus has summarized the progress in PC clinical studies and systematically evaluated the CRS + HIPEC procedures in China as well as across the world, so as to lay the foundation for formulating PC treatment guidelines specific to the national conditions of China.

Encapsulating peritoneal sclerosis

Encapsulating peritoneal sclerosis(EPS) is a debilitating condition characterized by a fibrocollagenous membrane encasing the small intestine, resulting in recurrent small bowel obstructions. EPS is most commonly associated with long-term peritoneal dialysis, though medications, peritoneal infection, and systemic inflammatory disorders have been implicated. Many cases remain idiopathic. Diagnosis is often delayed given the rarity of the disorder combined with non-specific symptoms and laboratory findings. Although cross-sectional imaging with computed tomography of the abdomen can be suggestive of the disorder, many patients undergo exploratory laparotomy for diagnosis. Mortality approaches 50% one year after diagnosis. Treatment for EPS involves treating the underlying condition or eliminating possible inciting agents(i.e. peritoneal dialysis, medications, infections) and nutritional support, frequently with total parenteral nutrition. EPSspecific treatment depends on the disease stage. In the inflammatory stage, corticosteroids are the treatment of choice, while in the fibrotic stage, tamoxifen may be beneficial. In practice, distinguishing between stages may be difficult and both may be used. Surgical intervention, consisting of peritonectomy and enterolysis, is timeconsuming and high-risk and is reserved for situations in which conservative medical therapy fails in institutions with surgical expertise in this area. Herein we review the available literature of the etiology, pathogenesis, diagnosis, and treatment of this rare, but potentially devastating disease.

Hyperthermic intraperitoneal chemotherapy:Rationale and technique

The combination of complete cytoreductive surgery and perioperative intraperitoneal chemotherapy provides the only chance for long-term survival for selected patients diagnosed with a variety of peritoneal neoplasms,either primary or secondary to digestive or gynecologic malignancy.Hyperthermic intraperitoneal chemotherapy (HIPEC) delivered in the operating room once the cytoreductive surgical procedure is fi nalized,constitutes the most common form of administration of perioperative intraperitoneal chemotherapy.This may be complemented in some instances with early postoperative intraperitoneal chemotherapy (EPIC).HIPEC combines the pharmacokinetic advantage inherent to the intracavitary delivery of certain cytotoxic drugs,which results in regional dose intensification,with the direct cytotoxic effect of hyperthermia.Hyperthermia exhibits a selective cell-killing effect in malignant cells by itself,potentiates the cytotoxic effect of certain chemotherapy agents and enhances the tissue penetration of the administered drug.The chemotherapeutic agents employed in HIPEC need to have a cell cycle nonspecific mechanism of action and should ideally show a heat-synergistic cytotoxic effect.Delivery of HIPEC requires an apparatus that heats and circulates the chemotherapeutic solution so that a stable temperature is maintained in the peritoneal cavity during the procedure.An open abdomen (Coliseum) or closed abdomen technique may be used,with no signif icant differences in eff icacy proven to date.Specif ic technical training and a solid knowledge of regional chemotherapy management are required.Concerns about safety of the procedure for operating room personnel are expected but are manageable if universal precautions and standard chemotherapy handling procedures are used.Different HIPEC drug regimens and dosages are currently in use.A tendency for concurrent intravenous chemotherapy administration (bidirectional chemotherapy,so-called "HIPEC plus") has been observed in recent years,with the aim to further enhance the cytotoxic potential of HIPEC.Future trials to ascertain the ideal HIPEC regimen in different diseases and to evaluate the efficacy of new drugs or drug combinations in this context are warranted.