RESUMEN
Volvulus of the transverse colon is very rare in children. Three cases that occurred in a short time span are described and the scarce literature is reviewed. All patients presented with colonic obstruction and in all three the condition was diagnosed at laparotomy, as CT-scanning is not an available option in either of the two institutions. The transverse colon had not become gangrenous but was resected after detorsion for redundancy. The postoperative course was complicated and relaparotomy had to be performed for reobstruction in all cases. Only if the 'reverse' bean sign is recognized on the preoperative plain abdominal radiograph this rare diagnosis can be suspected.
Asunto(s)
Colon Transverso/cirugía , Enfermedades del Colon/cirugía , Vólvulo Intestinal/cirugía , Adolescente , Niño , Enfermedades del Colon/diagnóstico , Femenino , Humanos , Vólvulo Intestinal/diagnóstico , Laparotomía , MasculinoRESUMEN
AIMS: Selecting patients for cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (HIPEC) remains challenging. We compared the predictive power of three intra-operative assessment tools of peritoneal involvement of colorectal cancer. METHODS: Ninety-two procedures (1999-2005) were prospectively scored using the Simplified Peritoneal Cancer Index (SPCI) and 7 Region Count. The Peritoneal Cancer Index (PCI) was retrospectively scored using the SPCI tool, operative notes and pathological reports. Endpoints were completeness of cytoreduction and overall survival. Logistic regression and Receiver Operating Characteristic (ROC) curves were applied to compare the predictive value of the three scoring systems on completeness of cytoreduction. RESULTS: After a median follow-up of 31 months, the median overall survival was 25.6 months. It decreased to 7.3 months, when cytoreduction was incomplete (p=0.001). An increased PCI, SPCI or number of regions were all associated with a decrease in probability of complete cytoreduction (p<0.05). With complete cytoreduction as outcome, the ROC areas for the PCI, SPCI and 7 Region Count were 0.92, 0.94 and 0.90, respectively (p=0.14). Using a cut-off value of 16 in the PCI system (p=0.03), 13 in the SPCI system (p=0.04) and 6 regions in the 7 Region Count (p=0.0002) the probability of complete cytoreduction decreased significantly. CONCLUSION: The PCI, SPCI and 7 Region Count are useful and equally effective prognostic tools predicting completeness of cytoreduction and associated improved survival. The 7 Region Count may be preferred due to its practical simplicity.
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Carcinoma/tratamiento farmacológico , Carcinoma/patología , Quimioterapia del Cáncer por Perfusión Regional , Hipertermia Inducida , Selección de Paciente , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/patología , Carcinoma/secundario , Carcinoma/cirugía , Neoplasias Colorrectales/patología , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Periodo Intraoperatorio , Modelos Logísticos , Masculino , Países Bajos , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/cirugía , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Análisis de SupervivenciaRESUMEN
BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare disease with an estimated incidence of 1 per million per year, and is thought to originate usually from an appendiceal mucinous epithelial neoplasm. However it is not known exactly how often these neoplasms lead to PMP. The aim of this study is to investigate the incidence of both lesions and their relation. METHODS: The nationwide pathology database of the Netherlands (PALGA) was searched for the incidence of all appendectomies, the incidence of primary epithelial appendiceal lesions and the incidence and pathology history of patients with PMP. All regarded the 10-year period of 1995-2005. RESULTS: In the 10-year period 167,744 appendectomies were performed in the Netherlands. An appendiceal lesion was found in 1482 appendiceal specimens (0.9%). Nine percent of these patients developed PMP. Coincidentally, an additional epithelial colonic neoplasm was found in 13% of patients with an appendiceal epithelial lesion. A mucinous epithelial neoplasm was identified in 0.3% (73% benign, 27% malignant) of appendiceal specimens and 20% of these patients developed PMP. For mucocele and non-mucinous neoplasm the association with PMP was only 2% and 3%, respectively. From the nationwide database 267 patients (62 men and 205 women) with PMP were identified, which demonstrates an incidence of PMP in the Netherlands approaching 2 per million per year. The primary site was identified in 68% and dominated by the appendix (82%). CONCLUSIONS: Primary epithelial lesions of the appendix are rare. One third of these lesions are mucinous epithelial neoplasms and especially these tumours may progress into PMP. The incidence of PMP seems to be higher than thought before. Furthermore there is a considerable risk of an additional colonic epithelial neoplasm in patients with an epithelial neoplasm at appendectomy.
Asunto(s)
Adenocarcinoma Mucinoso/epidemiología , Neoplasias del Apéndice/epidemiología , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Peritoneales/epidemiología , Seudomixoma Peritoneal/epidemiología , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Apendicectomía/métodos , Neoplasias del Apéndice/patología , Neoplasias del Apéndice/cirugía , Distribución de Chi-Cuadrado , Niño , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/cirugía , Países Bajos/epidemiología , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/cirugía , Probabilidad , Seudomixoma Peritoneal/patología , Seudomixoma Peritoneal/cirugía , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Distribución por Sexo , Análisis de SupervivenciaRESUMEN
BACKGROUND: Cytoreductive surgery with intraperitoneal chemotherapy has emerged as a new standard approach for peritoneal surface disease. This study investigated the learning curve of this combined modality treatment at a single institute. METHODS: Variables analysed over three consecutive treatment periods (1996-1998, 1999-2002 and 2003-2006) included number of abdominal regions affected, Simplified Peritoneal Cancer Index (SPCI) score, result of cytoreduction, morbidity, duration of hospital stay and survival. RESULTS: A total of 323 procedures were performed between January 1996 and June 2006, 184 for peritoneal carcinomatosis of colorectal cancer origin and 139 for pseudomyxoma peritonei (PMP), including second procedures in 11 patients with PMP. The mean SPCI score decreased significantly over the study period (P < 0.001), but the number of regions affected did not. The rate of complete cytoreductions increased from 35.6 to 65.1 per cent (P = 0.012). The postoperative morbidity rate decreased from 71.2 to 34.1 per cent (P < 0.001). The median duration of hospital stay decreased from 24 to 17 days. The peak of the learning curve, graded by the percentage of complete cytoreductions, was reached after approximately 130 procedures. CONCLUSION: The learning curve of combined modality treatment for peritoneal surface disease is long, and reflects patient selection and treatment expertise.
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Competencia Clínica/normas , Neoplasias Colorrectales/cirugía , Cirugía General/educación , Neoplasias Peritoneales/cirugía , Seudomixoma Peritoneal/cirugía , Adulto , Anciano , Neoplasias Colorrectales/tratamiento farmacológico , Terapia Combinada , Femenino , Cirugía General/normas , Humanos , Aprendizaje , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/tratamiento farmacológico , Seudomixoma Peritoneal/tratamiento farmacológico , Análisis de SupervivenciaRESUMEN
Three patients, men aged 47 and 30 and a woman aged 48 years, presented with appendicitis-like symptoms, progressive abdominal distension, and an ovarian pelvic mass, respectively. All three were diagnosed with pseudomyxoma peritonei. Treatment consisted of cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). After a mean follow-up of 64 months (range: 19-89) after initial treatment, the second patient had died of disease progression but the other two were alive and free of disease. Pseudomyxoma peritonei is a rare disease, characterised by progressive intraperitoneal accumulation of mucinous ascites, produced by a mucinous tumour mass on the peritoneal surfaces. The primary tumour is usually a mucinous adenoma of the appendix. Treatment by cytoreductive surgery and HIPEC can result in a 5-year survival rate of more than 80%, depending on the histopathology and the completeness of the cytoreduction. Recognising pseudomyxoma peritonei in an early stage, when complete cytoreduction is still achievable, may result in a considerable improvement in survival.
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Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Seudomixoma Peritoneal/tratamiento farmacológico , Seudomixoma Peritoneal/cirugía , Adulto , Antineoplásicos/uso terapéutico , Terapia Combinada , Resultado Fatal , Femenino , Humanos , Hipertermia Inducida/métodos , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/diagnóstico , Seudomixoma Peritoneal/diagnóstico , Resultado del TratamientoRESUMEN
Pseudomyxoma peritonei (PMP) is a rare condition, which is known for its high mortality when not treated properly. The first step to improve prognosis of these patients is to recognize this clinical syndrome preferably in an early stage. Knowledge of pathogenesis and common diagnostic tools is essential in this regard. Treatment strategy for PMP should pursue complete cytoreduction and prevention of recurrence or progression. Combined modality treatment, consisting of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, seems very efficient in this regard. This approach is currently carried out in many centers throughout the world with promising results and seems to win ground as the standard treatment approach.
Asunto(s)
Neoplasias Peritoneales , Seudomixoma Peritoneal , Terapia Combinada , Humanos , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/terapia , Seudomixoma Peritoneal/diagnóstico , Seudomixoma Peritoneal/terapiaRESUMEN
BACKGROUND AND OBJECTIVES: To determine retrospectively in a population-based setting, the influence of the introduction of total mesorectal excision (TME) on local recurrence and survival in patients with rectal carcinoma. METHODS: All rectal carcinomas diagnosed during 1988-1991 (979 patients, conventional surgery with blunt dissection of the rectum) and 1998-2000 (890 patients, TME resection) were selected from the Amsterdam Cancer Registry. For all patients who underwent a macroscopically radical resection in the absence of distant dissemination, information on the occurrence of local recurrent disease and distant metastasis was collected. RESULTS: The cumulative 5-year recurrence rate decreased significantly from 20% for patients diagnosed in 1988-1991 to 11% in 1998-2000. Stage (T-category, nodal status), period of diagnosis (conventional surgery vs. TME resection), radiotherapy, and chemotherapy were independent variables of local recurrence in multivariate analysis. There was a non-significant trend for improved 5-year relative survival for all rectal carcinoma cases from 52% (95% CI 48-55) for patients diagnosed in 1988-1991 to 59% (95% CI 55-63) in 1998-2000. CONCLUSIONS: A significant decrease in local recurrence and a trend for improved relative survival were observed. The broad introduction of TME and the shift towards preoperative radiotherapy are the most plausible explanations for these observations.
Asunto(s)
Recurrencia Local de Neoplasia/epidemiología , Neoplasias del Recto/epidemiología , Neoplasias del Recto/cirugía , Recto/cirugía , Anciano , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Países Bajos/epidemiología , Pronóstico , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Neoplasias del Recto/terapia , Recto/efectos de la radiación , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Estadísticas VitalesRESUMEN
BACKGROUND: To properly balance the benefit (reduction of local recurrence) of short-term pre-operative radiotherapy for resectable rectal cancer against its harm (complications), a consensus concerning the severity of complications is required. The aim of this study was to reach consensus regarding major and minor complications after short-term radiotherapy followed by total mesorectal excision in the treatment of rectal carcinoma, using the Delphi technique. METHODS: A Delphi round was performed in cooperation with 21 colo-rectal surgeons from the Netherlands, United Kingdom and Sweden. The key-question was: 'Which of the predefined complications, caused or substantially aggravated by radiotherapy, are so important (major) that they might lead to the decision to abandon short-term pre-operative radiotherapy (5 x 5Gy) when treating patients with resectable rectal cancer (T1-3N0-2M0)?' RESULTS: After three rounds, consensus was reached for 37 (68%) of 54 complications of which 13 were considered major and 24 considered minor. The following complications were considered to be major: mortality, anastomotic leakage managed by relaparotomy, anastomotic leakage resulting in persisting fistula, postoperative haemorrhage managed by relaparotomy, intra-abdominal abscess without healing tendency, sepsis, pulmonary embolism, myocardial infarction, compartment syndrome of the lower legs, long-term incontinence for solid stool, long-term problems with voiding, pelvic fracture with persisting pain, and neuropathy with persisting pain (legs). Three of 17 complications without consensus showed a tendency to be considered as major: perineal wound dehiscence managed by surgical treatment, small bowel obstruction leading to relaparotomy and long-term incontinence for liquid stool. CONCLUSION: The 13 major and three 'accepted as major' complications can be used to properly balance the benefit and harm of short-term pre-operative radiotherapy in resectable rectal cancer. This may eventually lead to improved treatment strategies for these patients.
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Cirugía Colorrectal , Consenso , Testimonio de Experto , Terapia Neoadyuvante/efectos adversos , Radioterapia Adyuvante/efectos adversos , Neoplasias del Recto/radioterapia , Bélgica , Técnica Delphi , Humanos , Neoplasias del Recto/cirugía , Medición de Riesgo , Suecia , Reino UnidoRESUMEN
AIM: To weigh the harms and benefits of short-term pre-operative radiotherapy in the treatment of resectable rectal cancer. METHODS: The benefits (reduction of local recurrence) and harm (increase of short-term complications) of short-term pre-operative radiotherapy are balanced using a model which classifies patients in one of five outcome combinations; 1-benefit without additional harm, 2-benefit with additional harm, 3-no benefit, no additional harm, 4-no benefit but additional harm, 5-mortality due to combined treatment. The results of four randomised clinical trials (RCT) which study the addition of short-term pre-operative radiotherapy in rectal cancer were classified according to this model. RESULTS: Five to thirteen percent of the patients have benefit without additional harm of pre-operative radiotherapy, while 0-2% have benefit with additional harm; 74-87% has neither benefit nor additional harm and 6-11% have no benefit but additional harm. A small percentage of patients (1-6%) dies post-operatively as a result of the addition of radiotherapy. CONCLUSION: This model provides a transparent appreciation of the harmful and beneficial effects of any treatment modality investigated by means of a randomised clinical trial. As for short-term pre-operative radiotherapy in resectable rectal cancer is shown, a small percentage of patients benefits from such treatment. Most patients have neither benefit nor additional harm, while a small percentage suffers from additional harm while not receiving any benefit.
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Carcinoma/radioterapia , Neoplasias del Recto/radioterapia , Carcinoma/cirugía , Causas de Muerte , Humanos , Modelos Estadísticos , Recurrencia Local de Neoplasia/prevención & control , Cuidados Preoperatorios , Radioterapia/efectos adversos , Radioterapia Adyuvante , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias del Recto/cirugía , Medición de Riesgo , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterized by intraperitoneal accumulation of mucus produced by neoplastic cells of mostly appendiceal origin. The aim of this study was to analyze primary and secondary involvement and treatment-related complications of the urinary tract in PMP. METHODS: A retrospective study of 92 patients with PMP, treated by cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) at The Netherlands Cancer Institute between 1996 and 2004. RESULTS: Seven patients presented with involvement of the urinary tract. Major urologic complications occurred in five patients, of which two had secondary involvement of the urinary tract. Major urologic complications consisted predominantly of surgical complications related to the bladder. All patients with secondary involvement and/or urologic complications had undergone previous pelvic surgery. CONCLUSIONS: The urinary tract is rarely involved in patients with PMP. Secondary involvement is mostly observed and may be a result of seeding of PMP of pelvic origin after prior pelvic surgery. There is a low urologic complication risk of treatment with cytoreduction and HIPEC. The combination of secondary involvement and previous pelvic surgery is an omen of treatment-related urologic complications, necessitating (surgical) re-interventions and further management in close collaboration with urologists.
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Hipertermia Inducida , Pelvis/cirugía , Neoplasias Peritoneales/cirugía , Complicaciones Posoperatorias , Seudomixoma Peritoneal/cirugía , Adulto , Anciano , Antineoplásicos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Siembra Neoplásica , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/patología , Complicaciones Posoperatorias/epidemiología , Seudomixoma Peritoneal/tratamiento farmacológico , Seudomixoma Peritoneal/patología , Estudios Retrospectivos , Fístula de la Vejiga Urinaria/epidemiología , Incontinencia Urinaria de Esfuerzo/epidemiología , Infecciones Urinarias/epidemiologíaRESUMEN
AIMS: To report on treatment related toxicity and mortality in patients with pseudomyxoma peritonei (PMP) treated by cytoreduction in combination with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and to identify prognostic factors. METHODS: A review was performed of 103 procedures of cytoreduction and intraoperative HIPEC for PMP between 1996 and 2004. Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria (NCI CTC) classification. A surgical complication was defined as any post-operative event that needed re-intervention. Pre and peroperative factors were studied on their relationship to toxicity and mortality. RESULTS: The median hospital stay was 21 days (4-149) with a treatment related toxicity of 54% and a 30 days mortality of 3%. In univariate analysis, toxicity was associated with abdominal tumour load (p<0.01), completeness of cytoreduction (p<0.01), and age (p=0.05). Surgical complications, mainly small bowel perforations/suture leaks, were the main cause of toxicity. A favourable pathology decreased mortality. CONCLUSIONS: Cytoreduction in combination with intraoperative HIPEC in PMP patients is a treatment with a relatively high toxicity, but a considerable long-term survival in selected patients. Toxicity is mainly surgery related. Concentration of cases to acquire sufficient experience and better selection on age, pathology, and extent of disease is essential to reduce treatment related toxicity and mortality.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Hipertermia Inducida/efectos adversos , Hipertermia Inducida/mortalidad , Cuidados Intraoperatorios , Neoplasias Peritoneales/terapia , Seudomixoma Peritoneal/terapia , Adenocarcinoma Mucinoso/terapia , Adulto , Anciano , Antibióticos Antineoplásicos/efectos adversos , Quimioterapia Adyuvante/efectos adversos , Quimioterapia Adyuvante/mortalidad , Terapia Combinada , Factores de Confusión Epidemiológicos , Femenino , Estudios de Seguimiento , Humanos , Infusiones Parenterales , Tiempo de Internación , Masculino , Persona de Mediana Edad , Mitomicina/efectos adversos , Países Bajos/epidemiología , Neoplasias Peritoneales/epidemiología , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/patología , Seudomixoma Peritoneal/epidemiología , Seudomixoma Peritoneal/mortalidad , Seudomixoma Peritoneal/patología , Tasa de Supervivencia , Insuficiencia del TratamientoRESUMEN
AIM: A survival benefit has been observed for colorectal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). However, this treatment modality is associated with a considerable morbidity and mortality and in a significant number of patients survival is not improved. We studied whether poor survivors could be identified on preoperative computed tomography (CT), in order to avoid unnecessary surgery. PATIENTS AND METHODS: Films of abdominopelvic CT scans from 25 such patients treated by cytoreductive surgery and HIPEC were retrospectively analysed by two radiologists separately. A simplified peritoneal cancer index (SPCI) was used to determine the extent of peritoneal involvement. Correlation between the on preoperative CT based SPCI-scores as well as number of involved abdominopelvic areas (N) and survival was examined with the log-rank test. The relation between each affected region and survival was evaluated with Cox regression analysis. RESULTS: The preoperative SPCI- and N-scores of one of the radiologists had no statistically significant prognostic value, while for the second radiologist SPCI > or = 7 and N > or = 4 were associated with particularly poor outcome. Additionally, the presence of ileocaecal region involvement and, depending on the radiologist, the occurrence of tumour deposits in the left subdiaphragmatic area on CT appeared to be unfavourable prognostic signs. CONCLUSIONS: The prognostic value of preoperative conventional CT appeared to be radiologist dependent and may, therefore, be of limited value in selecting colorectal cancer patients with peritoneal carcinomatosis who will not benefit from extensive cytoreductive surgery followed by HIPEC.
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Antineoplásicos/administración & dosificación , Carcinoma/diagnóstico por imagen , Neoplasias Colorrectales/diagnóstico por imagen , Hipertermia Inducida , Laparotomía , Selección de Paciente , Neoplasias Peritoneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Antineoplásicos/uso terapéutico , Carcinoma/secundario , Carcinoma/terapia , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/terapia , Estudios de Seguimiento , Humanos , Inyecciones Intraperitoneales , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/terapia , Cuidados Preoperatorios , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIMS: To report the results of standard therapy for peritoneal carcinomatosis of colorectal origin, which consists of conventional surgery and systemic chemotherapy. METHOD: In a prospective study 50 patients with proven peritoneal carcinomatosis of colorectal origin were treated with conventional surgery combined with 5-fluorouracil and leucovorin, or irinotecan in patients treated by 5-fluorouracil within 12 months prior to entry. Survival and progression-free survival were studied and prognostic factors were analysed. RESULTS: The median survival time was 12.6 months. The median time to progression was 7.6 months. Location of primary tumour and result of conventional surgery and systemic chemotherapy were prognostic factors related to survival. CONCLUSION: The survival time of patients with peritoneal carcinomatosis of colorectal origin seems to be increased in patients treated by conventional surgery and systemic chemotherapy when compared to minimal treatment.
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Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/cirugía , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Adulto , Anciano , Antineoplásicos/uso terapéutico , Neoplasias Colorrectales/patología , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/secundario , Pronóstico , Estudios Prospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: The aim of our study was to analyse data of patients treated by salvage surgery for locally recurrent rectal cancer, with emphasis on the question whether salvage surgery is still worthwhile when adjuvant radiotherapy is no longer a treatment option. METHODS: Forty patients (19 males/21 females) treated by surgery with curative intent for locally recurrent rectal carcinoma were analysed. Local recurrence was defined as cancer recurrence within the lower pelvis. Salvage surgery included abdominoperineal resection, abdominosacral resection, exenteration (posterior or total) and local resection. Clinical and pathological factors were analysed to identify prognostic factors for survival. RESULTS: The median overall survival was 25 months (95% CI: 13-37 months) and 5-year survival was 28% (95% CI: 12-45%). The absence of symptoms at the time of recurrence, central localisation and the absence of microscopic involvement of surgical margins, but not additional radiotherapy, were found to be significant independent prognostic factors for better survival after salvage surgery. CONCLUSION: Salvage surgery, alone or in combination with radiotherapy, can achieve radical resection of locally recurrent rectal cancer and can result in long-term survival.
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Adenocarcinoma/cirugía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Neoplasias del Recto/cirugía , Terapia Recuperativa , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Distribución por Edad , Biopsia con Aguja , Femenino , Humanos , Inmunohistoquímica , Masculino , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Países Bajos , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Pronóstico , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Sistema de Registros , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Distribución por Sexo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Peritoneal carcinomatosis in the absence of distant metastasis occurs in approximately 8 per cent of patients with colorectal cancer. Cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a new treatment option. Patient selection is crucial to outcome. METHODS: Cytoreduction followed by HIPEC was performed in 102 patients with peritoneal carcinomatosis. The following factors were studied for association with survival: perforation and obstruction of the primary lesion, location of the primary lesion, obstruction associated with carcinomatosis, presentation, tumour differentiation and histological type. Extent of disease and completeness of cytoreduction were also studied. Hazard ratios (HRs) were used to study these factors. RESULTS: Location of the primary tumour in rectum (HR 3.14 (95 per cent confidence interval (c.i.) 1.11 to 8.91); P = 0.069), poor differentiation (HR 1.73 (95 per cent c.i. 1.04 to 2.88); P = 0.031) and signet cell histological type (HR 2.24 (95 per cent c.i. 1.21 to 4.16); P = 0.008) were associated with shorter survival. Important factors predicting survival were the number of affected regions (HR 1.38 (95 per cent c.i. 1.20 to 1.59); P < 0.001), the simplified peritoneal cancer score (HR 1.19 (95 per cent c.i. 1.12 to 1.26); P < 0.001) and completeness of cytoreduction (HR 8.54 (95 per cent c.i. 4.01 to 18.18); P < 0.001). No other factor correlated with survival. CONCLUSION: The survival of patients with peritoneal carcinomatosis of colorectal origin is dominated by the extent of disease and the amount of residual tumour after cytoreduction.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/mortalidad , Neoplasias Colorrectales/mortalidad , Hipertermia Inducida/métodos , Laparotomía/métodos , Neoplasias Peritoneales/mortalidad , Adulto , Anciano , Carcinoma/terapia , Quimioterapia Adyuvante , Neoplasias Colorrectales/terapia , Terapia Combinada/métodos , Femenino , Fluorouracilo/administración & dosificación , Humanos , Leucovorina/administración & dosificación , Masculino , Persona de Mediana Edad , Neoplasia Residual , Neoplasias Peritoneales/terapia , Análisis de SupervivenciaRESUMEN
AIM: The aim of this study was to determine the value of medical history and physical examination, tumour marker testing, and CT-scanning in the follow-up of patients treated for peritoneal carcinomatosis of colorectal origin. METHODS: Between November 1995 and June 2003, 107 patients were treated by cytoreduction and hyperthermic intra-peritoneal chemotherapy. The treatment was considered effective if residual tumour after cytoreduction was no thicker than 2.5 mm. The follow-up consisted of history, physical examination, serum CEA and CA 19.9 testing three-monthly, and CT-scanning of the abdomen six-monthly. Location of the recurrence was categorized into intra-abdominal, hepatic, thoracic, and both intra-abdominal and systemic. The investigation that led to the detection of a recurrence was ranked according to its invasiveness and costs. The simplest investigation that could have led to the detection was marked. RESULTS: A recurrence developed in 63 patients of the 74 patients effective initial treatment during the study period. Physical examination revealed the recurrence in 38 patients, at least one of the markers was raised above normal value in 39 patients and in 37 patients the CT-scan showed the recurrence. History and physical examination could have triggered the finding of a recurrence in 38 patients, tumour markers in 21 patients and CT-scanning in only three of the 74 recurrences. CONCLUSION: Physical examination and tumour marker testing detect most recurrences. CT-scanning is not an effective tool in the follow-up, and should be reserved for on-demand use.
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Neoplasias del Apéndice/diagnóstico , Neoplasias Colorrectales/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Peritoneales/diagnóstico , Adulto , Anciano , Antineoplásicos/administración & dosificación , Neoplasias del Apéndice/sangre , Neoplasias del Apéndice/patología , Biomarcadores de Tumor/sangre , Antígeno CA-19-9/sangre , Antígeno Carcinoembrionario/sangre , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/patología , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Hipertermia Inducida/métodos , Infusiones Parenterales , Masculino , Anamnesis , Persona de Mediana Edad , Recurrencia Local de Neoplasia/sangre , Neoplasias Peritoneales/sangre , Neoplasias Peritoneales/secundario , Examen Físico , Procedimientos Quirúrgicos Operativos/métodos , Tomografía Computarizada por Rayos XRESUMEN
The current standard treatment of patients with gastric cancer is partial or total stomach resection and dissection of the draining lymph nodes. This approach, however, results in a rather low survival rate, partly because the diagnosis is often established in an advanced stage. Various strategies, including adjuvant radiotherapy, chemotherapy or more extensive surgical procedures, have resulted mainly in increased morbidity without improving survival. In a recent randomised trial, concurrent postoperative radiotherapy and chemotherapy prolonged survival and reduced the chance of a local recurrence at an acceptable toxicity. Although several aspects of combined radiochemotherapy require further study, this new treatment concept appears to be a promising addition to the therapeutic arsenal for gastric cancer.
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Antineoplásicos/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Terapia Combinada , Gastrectomía , Humanos , Recurrencia Local de Neoplasia/prevención & control , Radioterapia Adyuvante/métodos , Neoplasias Gástricas/cirugíaRESUMEN
AIM: Pseudomyxoma peritonei (PMP) is a rare disease characterized by the abundance of mucus in the abdomen without extra-peritoneal growth. METHODS: Our patients with PMP have been treated with cytoreduction and hyperthermic intraperitoneal chemotherapy since 1996. The clinical and histopathological features of PMP and the relation of these features with disease-free interval and survival were assessed. RESULTS: Sixty-two patients with PMP (24 M/38 F) were studied. Adenomatous mucosal changes were present in 31 patients. In females, the ovaries were normal in 5 patients and pseudomyxoma ovarii was present in 20 patients. Patients with minimal atypia and with 1% focal proliferation or less (n=38) had a better survival (p=0.0008) than those with more focal proliferation (n=14). CONCLUSION: In most patients with PMP the appendix is affected; in females the ovaries are usually also involved. Focal proliferation appears to be a prognostic factor.
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Neoplasias Peritoneales , Seudomixoma Peritoneal , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/cirugía , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/cirugía , Seudomixoma Peritoneal/diagnóstico , Seudomixoma Peritoneal/patología , Seudomixoma Peritoneal/cirugía , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) with mitomycin C has been applied following cytoreductive surgery for various peritoneal surface malignancies. The aim of this study was to evaluate heat penetration in the abdomen during 10 HIPEC procedures. MATERIALS AND METHODS: Temperature measurements were taken at 5 levels through the abdominal wall. Core temperature and room temperature were also measured. The relationships between the temperature gradient and room or core temperature were studied. RESULTS: At the start of perfusion, the temperature was estimated on average to be 40.6 degrees C at the first level, then it decreased by 1.7 degrees C (SD 1.0 degree C, p = 0.0001) in the first mm. In outward direction, it decreases by a further 1.5 degrees C per cm (SD 0.3 degree C/cm, p < 0.0001). The core temperature influenced the temperature gradient; the room temperature was not found to be a significant factor. At the end of perfusion, the temperature is estimated on average to be 40.1 degrees C at the first level, then it decreased by 0.8 degree C (SD 0.7 degree C, p = 0.011) in the first mm. In an outward direction, it decreased by a further 1.7 degrees C per cm (SD 0.4 degree C/cm, p = 0.0001). No evidence of an association between the temperature gradient and the room temperature or the core temperature was observed. CONCLUSION: Hyperthermia used during HIPEC procedures has a limited penetration depth. The slope in temperature seems to be related to the core temperature.
Asunto(s)
Pared Abdominal , Antineoplásicos/administración & dosificación , Temperatura Corporal , Carcinoma/terapia , Hipertermia Inducida , Mitomicina/administración & dosificación , Neoplasias Peritoneales/terapia , Seudomixoma Peritoneal/terapia , Antineoplásicos/uso terapéutico , Carcinoma/tratamiento farmacológico , Carcinoma/cirugía , Neoplasias Colorrectales/patología , Terapia Combinada , Femenino , Humanos , Infusiones Parenterales , Masculino , Mitomicina/uso terapéutico , Cavidad Peritoneal , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Seudomixoma Peritoneal/tratamiento farmacológico , Seudomixoma Peritoneal/cirugía , TemperaturaRESUMEN
BACKGROUND: Malignant pleural mesothelioma (MPM) is a disease mostly confined to the thoracic cavity. Untreated, the median survival is <1 year. Cytoreductive surgery combined with intraoperative hyperthermic intrathoracic chemotherapy is used to kill residual tumor cells on the surface of the thoracic cavity while having limited systemic side effects. METHODS: From August 1998 to August 2001, 22 patients with stage I MPM were included in this study. Two patients were irresectable at operation because of extrathoracic tumor growth. Twenty procedures were performed. After cytoreduction, a perfusion was performed with cisplatin and doxorubicin at 40 degrees C to 41 degrees C for 90 minutes. Adjuvant radiotherapy was given to surgical scars and drainage tracts. RESULTS: There was no perioperative mortality, but significant morbidity was seen in 13 patients (65%), including bronchopleural fistula, diaphragm rupture, wound dehiscence, persistent air leakage, and chylous effusion. No hair loss or leucopenia was noticed. The median follow-up was 14 months. The median survival (Kaplan-Meier) was 11 months, with a 1-year survival of 42%. A favorable pharmacokinetic ratio was observed for both cisplatin and doxorubicin. CONCLUSIONS: Cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy for stage I MPM is feasible. However, this treatment is accompanied by considerable morbidity. Survival data were less encouraging.