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  • 1
    Electronic Resource
    Electronic Resource
    Peritoneal carcinomatosis from appendiceal cancer: Results in 69 patients treated by cytoreductive surgery and intraperitoneal chemotherapy (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 323-329 
    Details
    ISSN: 1530-0358
    Keywords: Appendix ; Pseudomyxoma ; Peritoneum ; 5-Fluorouracil ; Mitomycin C ; Intraperitoneal chemotherapy ; Cytoreductive surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sixty-nine patients presenting over a 10-year period with peritoneal carcinomatosis from appendiceal cancer were treated with cytoreductive surgery combined with intraperitoneal chemotherapy. The three-year survival is 89.5 percent in patients (38/69) with pseudomyxoma peritonei, 34.5 percent in patients (25/69) with cystadenocarcinoma, and 38.1 percent in patients (6/69) with adenocarcinoma ( P 〈0.01). In this study, a classification of residual disease following the cytoreductive surgery was used. The prognosis of the patients with minimal residual disease was better than that of those with moderate or gross disease, showing a 91.6 percent three-year survival compared with 47.8 percent and 20 percent, respectively ( P 〈0.01). The patients without lymphatic or hematogenous metastases had a better three-year survival than those with metastases (75.1 percent vs.28.6 percent; P 〈0.01). These findings suggest that peritoneal carcinomatosis from appendiceal cancer can be treated with long-term disease-free survival. The patients with low malignant potential cancer, complete cytoreduction, and no metastases showed the most effective disease control.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02053933
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  • 2
    Electronic Resource
    Electronic Resource
    Invited editorial (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1347-1348 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236628
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  • 3
    Electronic Resource
    Electronic Resource
    Ultrasonic dissection for pseudomyxoma peritonei: Debulking, not cytoreduction (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1454-1456 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236649
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  • 4
    Electronic Resource
    Electronic Resource
    Hemodynamic and Cardiac Function Parameters During Heated Intraoperative Intraperitoneal Chemotherapy Using the Open “Coliseum Technique” (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 296-300 
    Details
    ISSN: 1534-4681
    Keywords: Heated intraoperative intraperitoneal chemotherapy—Operative monitoring.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Heated intraoperative intraperitoneal chemotherapy achieves high peritoneal concentrations with limited systemic absorption and has become an important tool in the management of patients with peritoneal carcinomatosis from low-grade malignancies such as pseudomyxoma peritonei and in selected cases of high-grade tumors such as colon adenocarcinoma. When the closed abdomen technique is used, its perioperative toxicity seems to be related to the hemodynamic and cardiac function changes associated with increased body temperature and increased intra-abdominal pressure. Methods: Hemodynamic and cardiac function variables during heated intraoperative intraperitoneal chemotherapy, using an open abdomen “coliseum technique,” were measured in 15 patients with the use of a noninvasive esophageal Doppler monitor. Results: The hemodynamic and cardiac function changes were characterized by an increased heart rate, increased cardiac output and decreased systemic vascular resistance associated with an increased body temperature, and decreased effective circulating volume with the urinary output tending to decrease as the therapy progressed. Conclusion: Heated intraoperative intraperitoneal chemotherapy with the open abdomen coliseum technique induces a hyperdynamic circulatory state with an increased intravenous fluid requirement and avoids changes because of increased intra-abdominal pressure. Hemodynamic and cardiac stability, as documented by normal blood pressure and adequate urinary output, can be achieved by liberal intravenous fluids, titrated to frequent urinary output determination.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0296-2
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  • 5
    Electronic Resource
    Electronic Resource
    Results of Treatment of 385 Patients With Peritoneal Surface Spread of Appendiceal Malignancy (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 727-731 
    Details
    ISSN: 1534-4681
    Keywords: Appendix cancer ; Intraperitoneal chemotherapy ; Pseudomyxoma peritonei ; Cytoreduction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Introduction: In the past, peritoneal carcinomatosis, regardless of primary tumor type, has always been a lethal condition. Recently, special treatments using cytoreductive surgery with peritonectomy procedures combined with perioperative intraperitoneal chemotherapy have resulted in long-term survival. Appendiceal malignancy with a low incidence of liver and lymph node metastases may be especially appropriate for these aggressive local regional treatments. Methods: All patients treated with surgery before January 1999 are included. Patients left with gross residual disease after surgery were not given intraperitoneal chemotherapy, but were later treated with intravenous chemotherapy. The intraperitoneal chemotherapy was given in the perioperative period, starting with mitomycin C at 12.5 mg/m2 for males and 10 mg/m2 for females. For patients whose pathology showed adenomucinosis, intraperitoneal chemotherapy was limited to treatment in the operating theater with heated mitomycin C. Patients with mucinous adenocarcinoma or pseudomyxoma/adenocarcinoma hybrid had, in addition to mitomycin C, five consecutive days of intraperitoneal 5-fluorouracil at 650 mg/m2 instilled in 1–1.5 liters of 1.5% dextrose peritoneal dialysis solution. A complete cytoreduction was defined as tumor nodules 〈2.5 mm in diameter remaining after surgery. The histopathology categorized the patients as having adenomucinosis, adenomucinosis/carcinomatosis hybrid, or mucinous carcinomatosis. A previous surgical score was used to estimate the extent of previous surgical procedures. Results: The morbidity of treated patients was 27% and the mortality was 2.7%. In a multivariate analysis, prognostic factors for survival included the completeness of cytoreduction (P 〈 .0001), the histopathological character of the appendix malignancy (P 〈 .0001), and the extent of previous surgical interventions (P = .001). Patients with a complete cytoreduction and adenomucinosis by pathology had a 5-year survival of 86%; with hybrid pathology, survival at 5 years was 50%. Incomplete cytoreduction had a 5-year survival of 20% and 0% at 10 years. Conclusions: Cytoreductive surgery and perioperative intraperitoneal chemotherapy can be used to salvage selected patients with peritoneal surface spread of appendiceal primary tumors. Similar strategies for other patients with peritoneal surface malignancy such as peritoneal carcinomatosis from colon or gastric cancer, peritoneal sarcomatosis, or peritoneal mesothelioma should be pursued.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0727-7
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  • 6
    Electronic Resource
    Electronic Resource
    Morbidity and mortality of hepatic resection for metastatic colorectal carcinoma (1990)
    Springer
    Diseases of the colon & rectum 33 (1990), S. 408-413 
    Details
    ISSN: 1530-0358
    Keywords: Liver neoplasms ; Liver resection ; Hepatic metastases ; Morbidity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hepatic resection is the only curative therapy currently available for colorectal cancer metastases to the liver. However, concern over high morbidity and mortality of the procedure has limited referral of patients for resection. The authors report on 58 patients undergoing hepatic resection for colorectal metastases at the National Cancer Institute between the years 1976 and 1985. Thirty-two patients underwent a major hepatic resection, and 26 patients underwent one or more wedge resections. Mean anesthesia time was 448 minutes, mean estimated blood loss was 3663 ml, and mean hospital stay was 17.5 days. Operative mortality was 3 percent, and morbidity was 62 percent. Using a grading scale for complications, 24 percent of patients had inconsequential complications, 16 percent had moderate complications, and 19 percent had severe complications. Complications were clearly related to extent of procedure. Factors that correlated best with morbidity were high blood loss and trisegmentectomy. The authors conclude that while hepatic resection can carry a high morbidity, much of this morbidity is minor and operative mortality is low. Recent improvements in anesthesia, improved resection technique, and a better understanding of hepatic anatomy have made possible correspondingly lower morbidity and mortality rates. Careful selection of patients can make hepatic resection a safe procedure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02156268
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  • 7
    Electronic Resource
    Electronic Resource
    Intraperitoneal chemotherapy for treatment and prevention of peritoneal carcinomatosis and sarcomatosis (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. S115 
    Details
    ISSN: 1530-0358
    Keywords: Colorectal cancer ; Appendix cancer ; Ovarian cancer ; Peritoneal sarcomatosis ; Intraperitoneal chemotherapy ; 5-Fluorouracil ; Mitomycin C ; Cisplatin ; Doxirubicin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The treatment of peritoneal carcinomatosis and sarcomatosis has been associated with long-term disease-free survival. Recently, new intraperitoneal chemotherapy regimens used in patients with small volume peritoneal implants have shown benefits. METHODS: After removal of all but minimal residual disease, the abdominal cavity is flooded with a large volume of fluid containing full systemic doses of chemotherapy. Adenocarcinoma patients receive mitomycin C and 5-fluorouracil; sarcoma patients receive cisplatin and doxirubicin. RESULTS: Long-term disease-free survival is seen in patients with low-grade malignancy, no lymph node or liver metastases, and a complete cytoreduction. CONCLUSIONS: If patients can be treated early when the volume of peritoneal surface cancer is low or if the patient can be made disease free by surgery, then intraperitoneal chemotherapy may be expected to achieve long-term disease-free survival in a majority of selected patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02048443
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  • 8
    Electronic Resource
    Electronic Resource
    Invited editorial (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 115-116 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02235195
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  • 9
    Electronic Resource
    Electronic Resource
    Morbidity and Mortality Analysis of 200 Treatments With Cytoreductive Surgery and Hyperthermic Intraoperative Intraperitoneal Chemotherapy Using the Coliseum Technique (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 790-796 
    Details
    ISSN: 1534-4681
    Keywords: Morbidity ; Mortality ; Cytoreductive surgery ; Hyperthermia ; Intraperitoneal chemotherapy ; Mitomycin C ; 5-Fluorouracil ; Pseudomyxoma peritonei ; Colon cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Peritoneal carcinomatosis from gastrointestinal cancers is a fatal diagnosis without special combined surgical and chemotherapy interventions. Guidelines for cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) by using the Coliseum technique have been developed to treat patients with peritoneal carcinomatosis and other peritoneal surface malignancies. The purpose of this study was to analyze the morbidity and mortality of patients undergoing cytoreductive surgery and HIIC by using mitomycin C. Methods: Data were prospectively recorded on 183 patients who underwent 200 cytoreductive surgeries with HIIC between November 1994 and June 1998. Seventeen of the 183 patients returned for a second-look surgery plus HIIC. All HIIC administrations occurred after cytoreduction and used continuous manual separation of intra-abdominal structures to optimize drug and heat distribution. Origins of the tumors were as follows: appendix (150 patients), colon (20 patients), stomach (7 patients), pancreas (2 patients), small bowel (1 patient), rectum (1 patient), gallbladder (1 patient), and peritoneal papillary serous carcinoma (1 patient). Morbidity was organized into 20 categories that were graded 0 to IV by the National Cancer Institute’s Common Toxicity Criteria. In an attempt to identify patient characteristics that may predispose to complications, each morbidity variable was analyzed for an association with the 25 clinical variables recorded. Results: Combined grade III/IV morbidity was 27.0%. Complications observed included the following: peripancreatitis (6.0%), fistula (4.5%), postoperative bleeding (4.5%), and hematological toxicity (4.0%). Morbidity was statistically linked with the following clinical variables: duration of surgery (P 〈 .0001), the number of peritonectomy procedures and resections (P 〈 .0001), and the number of suture lines (P = .0078). No HIIC variables were statistically associated with the presence of grade III or grade IV morbidity. Treatment-related mortality was 1.5%. Conclusions: HIIC may be applied to select patients with peritoneal carcinomatosis from gastrointestinal malignancies with 27.0% major morbidity and 1.5% treatment-related mortality. The frequency of complications was associated with the extent of the surgical procedure and not with variables associated with the delivery of heated intraoperative intraperitoneal chemotherapy. The technique has shown an acceptable frequency of adverse events to be tested in phase III adjuvant trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0790-0
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  • 10
    Electronic Resource
    Electronic Resource
    Cancer recurrence following laparoscopic colectomy (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 1110-1114 
    Details
    ISSN: 1530-0358
    Keywords: Colon cancer ; Laparoscopy ; Peritoneal carcinomatosis ; Intraperitoneal chemotherapy ; Hypothermia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Use of laparoscopic techniques for resection of colon and rectal cancer has raised considerable controversy. There is increasing concern that wound recurrence and peritoneal dissemination may represent a potentially fatal complication of this technique. METHODS: The surgical literature was reviewed, and clinical course of two patients is presented. RESULTS: Our two patients had tumor recurrence in the laparoscopy port sites within one year after laparoscopic-assisted colectomy for Dukes B adenocarcinoma of the colon. At laparotomy, diffuse peritoneal carcinomatosis without lymph node or liver metastases were found in both patients. They were treated by surgical resection of recurrent disease combined with heated intraoperative intraperitoneal mitomycin C chemotherapy and five days of early postoperative intraperitoneal 5-fluorouracil. These patients are clinically free of disease at 1.5 years after treatment of peritoneal implants. CONCLUSIONS: Cancer recurrence in abdominal wall incisions after laparoscopic colectomy has been reported in an increasing number of patients. It is possible that this technique should be abandoned. Cytoreductive surgery combined with intraperitoneal chemotherapy may represent the most adequate treatment of recurrent cancer that occurs following laparoscopic colectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02133989
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