HIPEC Controversies in the Indications and Application of Regional Chemotherapy for Peritoneal Surface Malignancies
|
|
- Godfrey Lawrence Miller
- 5 years ago
- Views:
Transcription
1 HIPEC Controversies in the Indications and Application of Regional Chemotherapy for Peritoneal Surface Malignancies Crescent City Cancer Update: GI and HPB Saturday September 24, 2016 George M. Fuhrman, MD FACS Ochsner Clinic Foundation New Orleans, LA OVERVIEW Rationale for Combined (Surgery and Chemotherapy) to Treat Peritoneal Malignancy Indications Staging Operative Technique Morbidity 1
2 Rationale Surgical Oncology is focused on resection of primary tumor plus regional site for staging and control Distant disease unresectable/nonsurgical Exceptions for unique circumstances Hepatic Resection Colorectal metastasis Rationale Peritoneal Surface can be considered localized disease unique circumstance Combined modality treatment to eradicate disease that is limited to the abdominal cavity Balance oncologic benefit with risk of treatment 2
3 Rationale Cytoreduction resect all gross disease what you can see Chemotherapy treat what you can t see achieves lower systemic drug exposure with penetration to 5 mm below the surface Hyperthermia enhance drug cytotoxicity Appendiceal Mesothelioma Colorectal Indications 3
4 Staging Prior Surgical Score (Sugarbaker) PSS 0 biopsy only PSS 1 one region dissected during prior ex lap PSS regions previously dissected PSS 3 - > 5 regions dissected After completeness of resection and histology PSS most significant predictor of survival Sugarbacker et al Ann Surg Oncol 1999;6: Completeness of Resection RO no gross disease with negative margins RI no gross disease with positive microscopic margins R2 gross residual disease R2a - < 5 mm residual disease R2b 5-20 mm residual disease R2c - > 20 mm residual disease R0/1 survival advantage compared to R2 patients The most powerful predictor of outcome 2-4 fold improvement in survival 4
5 PSDSS Peritoneal Carcinomatosis Disease Severity Score 3 factors Clinical Symptoms 0 pts asymptomatic 1 pt mild symptoms 6 severe symptoms (weight loss, pain, obstruction, ascites) PCI Histology PSDSS Peritoneal Carcinomatosis Disease Severity Score 3 factors Clinical Symptoms PCI Divide abdomen into ninths and score disease in each area 0,1,2,3 based on amount of tumor 4 small bowel segments with same scores Maximum PCI 13X3 = 39 PCI<10= 1 pt, 10-20= 3 pts, > 20 7 pts Histology 5
6 PSDSS Peritoneal Carcinomatosis Disease Severity Score 3 factors Clinical Symptoms PCI Histology Well differentiated node negative 1 pt Moderately differentiated with nodal disease 3 pts Poorly differentiated or signet ring formation 9 pts PSDSS Peritoneal Carcinomatosis Disease Severity Score PSDSS 4 groups (< 4, 4-7, 8-10, > 10) PSDSS strongly correlates with completeness of resection and the administration of HIPEC and therefore survival Helpful in comparing experience across centers and for multi-institutional studies 6
7 CRS/HIPEC Appendiceal Cancer 481 patients 317 Low grade 93 high grade 28 % morbidity/2.7% Mortality Complete resection(44.4%) and node negative(75%) predicts best outcome Median Survival 30 months for node +/High grade 85 months for node +/Low Grade 153 months for node -/ High Grade NR (82% alive at 90 months) node -/Low Grade Votanopoulos et al Ann Surg Onc : CRS/HIPEC for Peritoneal Mesothelioma 405 patients 53 month overall median survival Predictors of survival Histology 79% epithelial tumors 63 mo mean survival 12% sarcomatoid/biphasic 16 mo mean survival 6% involved nodes (56 vs. 20 mo mean survival) 46% complete CRS (8 vs. 1 yr mean survival) 2 % mortality/22 day mean hospital stay Yan et al J Clin Oncol 27:
8 CRS/HIPEC for Colorectal Cancer Using the Peritoneal Disease Severity Score (PSDSS) 884 patient evaluated in a multicenter study 275 not treated patients median survival (months) 45 for I, 19 for II, 8 for III, and 6 for IV 609 treated patients median survival (months) 86 for I, 43 for II, 29 for III, and 28 for IV Cytoreduction/HIPEC vs. Systemic Chemotherapy in Colorectal Carcinomatosis Randomized trial Netherlands 51 patients 5-FU/leucovorin 54 cytoreduction plus heated MMC 8-year follow up 7.7 month vs month progression free survival 12.6 month vs 22.2 month disease specific survival Ann Surg Oncol 15(9):
9 Wake Forest Experience , 53 years old, 53% female 1000 patients 1097 treatments Tumor types 472 Appendix 248 CRS 72 Mesothelioma 69 Ovary 46 Gastric 97 Other 4% mortality 8 day median hospital stay 32% overall five year survival Levine et al J Am Coll Surg 2014;218: Wake Forest Experience 50% transfusion requirement 19% stoma creation Mean PCI 12 Time in OR mean 10 hrs (183-1,531 minutes) 50% R0/R1 Organs Resected: Omentum(72%), Colon (50%), Spleen(41%), Small Bowel(32%), Ovaries(32%), Gallbladder (29%), Uterus(17%), Stomach(11%) 9
10 Wake Forest Experience Most powerful predictors of survival Performance status Tumor Type Resection status Experience Patient without symptoms, Low grade appendiceal tumors, completely resected, and treated in high volume centers do best Estimate that only 10 US centers have treated more than 100 patients Levine et al J Am Coll Surg 2014;218: Wake Forest Experience Lesson learned Heavily pre-treated systemic chemotherapy patients are often referred once they become ECOG 2 or 3 patients Cr < 3 Liver enzymes < 3X normal WBC > 4 Platelets > 100K Ureteral Stents Parenchymal liver disease must be resectable Don t currently treat hepatic, biliary, pancreatic, gastric, or sarcoma patients Levine et al J Am Coll Surg 2014;218:
11 Operative Technique Omentectomy Anastomosis Ostomies Visceral Resections Hyperthermia Open vs Closed Selection of Drug Technical aspects As resection is nearing completion cool patient to degrees C Use closed technique two 24 Fr inflow and two 32 Fr outflow tubes placed in the midline wound (not through fascia) with temp probes attached Maximum inflow temp 43 degrees Outflow temp 40 degrees 120 minute perfusion MMC > 5 micrograms/ml appendiceal Cisplatin 250 mg/sq meter - mesothelioma MMC or oxaliplatin (200 mg/sq meter) Colorectal Dose reduction in elderly or poorer performance status patients 11
12 12
13 Morbidity/Mortality 27-56%/2.7-11% Abscess Fistula Prolonged ileus Pneumonia DVT/PE Hematologic toxicity Morbidity associated with PCI score, duration of surgery, # anatomoses 13
14 14
15 15
16 PSDSS Peritoneal Carcinomatosis Disease Severity Score No symptoms 0 pt PCI 6 = 1 pt Favorable path = 1 pt PSDSS = 2 so in the most favorable group 16
17 17
18 18
19 19
20 A 52 year old with free air has a perforated sigmoid cancer Resection in the middle of the night with colostomy Transmural tumor 1/18 nodes involved Posterior bladder biopsied demonstrating involvement No other visible disease at exploration Post op CEA 1.0 (unchanged) Adjuvant systemic therapy (FOLFOX) nearly completed HIPEC at the time of stoma takedown? 20
21 Conclusions Preferred treatment for patients with low grade node negative appendiceal carcinoma and mesothelioma Selective with treatment of high grade and node positive appendiceal and colorectal Rarely appropriate for other tumor types Complete cytoreduction is key 21
Patient Presentation. 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201
Patient Presentation 32 y.o. female complains of lower abdominal mass CEA = 433, CA125 = 201 CT shows: Thickening of the right hemidiaphragm CT shows: Fluid in the right paracolic sulcus CT shows: Large
More informationPre-operative assessment of patients for cytoreduction and HIPEC
Pre-operative assessment of patients for cytoreduction and HIPEC Washington Hospital Center Washington, DC, USA Ovarian Cancer Surgery New Strategies Bergamo, Italy May 5, 2011 Background Cytoreductive
More informationRegional Therapy for Management of Peritoneal Carcinomatosis from Gastrointestinal Malignancies
Regional Therapy for Management of Peritoneal Carcinomatosis from Gastrointestinal Malignancies Byrne Lee, MD FACS Chief, Mixed Tumor Surgery Service City of Hope Division of Surgical Oncology September
More informationRegional Therapy for Management of Peritoneal Carcinomatosis from Gastrointestinal Malignancies
Regional Therapy for Management of Peritoneal Carcinomatosis from Gastrointestinal Malignancies Byrne Lee, MD FACS Chief, Mixed Tumor Surgery Service City of Hope Division of Surgical Oncology September
More informationPlanned relaparotomy following curative resection of a locally advanced gastrointestinal cancer
Planned relaparotomy following curative resection of a locally advanced gastrointestinal cancer PD Dr. med. Michel Adamina, MSc Department of Surgery Agenda Prerequisite for successful CRS HIPEC Planned
More informationKathleen A. Cummins 1, Gregory B. Russell 2, Konstantinos I. Votanopoulos 1, Perry Shen 1, John H. Stewart 1, Edward A. Levine 1.
Original Article Peritoneal dissemination from high-grade appendiceal cancer treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) Kathleen A. Cummins 1, Gregory
More informationSurgical Management of Advanced Stage Colon Cancer. Nathan Huber, MD 6/11/14
Surgical Management of Advanced Stage Colon Cancer Nathan Huber, MD 6/11/14 Colon Cancer Overview Approximately 50,000 attributable deaths per year Colorectal cancer is the 3 rd most common cause of cancer-related
More informationis time consuming and expensive. An intra-operative assessment is not going to be helpful if there is no more tissue that can be taken to improve the
My name is Barry Feig. I am a Professor of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, Texas. I am going to talk to you today about the role for surgery in the treatment
More informationCRS e HIPEC: Efficacia e Limiti
CRS e HIPEC: Efficacia e Limiti Marcello Deraco M.D. Responsabile Tumori Peritoneali The Concept of Cytoreductive Surgery Means a complete removal of all macroscopic tumor in the peritoneal cavity; It
More informationManagement of Pseudomyxoma Peritonei (PMP) and Colon Cancer Carcinomatosis by Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
Surgical Oncology Department Management of Pseudomyxoma Peritonei (PMP) and Colon Cancer Carcinomatosis by Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). 21/04/2010 THERMOMETRY 1000-1500
More informationCOLON CANCER PERITONEAL CARCINOMATOSIS TREATMENT Prof. Annibale Donini
UNIVERSITY OF PERUGIA Department of General and Emergency Surgery Chief: Prof. Annibale Donini COLON CANCER PERITONEAL CARCINOMATOSIS TREATMENT Prof. Annibale Donini COLON CANCER IS A HIGHLY FREQUENT NEOPLASIA
More informationDepartment of Surgery, Kusatsu General Hospital, Yabase Kusatsu 1660, Japan 2
Gastroenterology Research and Practice Volume 2012, Article ID 836425, 5 pages doi:10.1155/2012/836425 Clinical Study Morbidity and Mortality Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal
More informationCytoreductive surgery and perioperative intraperitoneal chemotherapy for Rare Peritoneal Disease. Results of the French multicentric database
Cytoreductive surgery and perioperative intraperitoneal chemotherapy for Rare Peritoneal Disease Results of the French multicentric database Université Lyon 1 Centre Hospitalo-Universitaire Lyon-Sud EA
More informationWinship Cancer Institute of Emory University Optimizing First Line Treatment of Advanced Ovarian Cancer
Winship Cancer Institute of Emory University Optimizing First Line Treatment of Advanced Ovarian Cancer Ira R. Horowitz, MD, SM, FACOG, FACS John D. Thompson Professor and Chairman Department of Gynecology
More informationPseudomyxoma peritoni et al HOW TO TREAT PERITONEAL MALIGNANCIES
Pseudomyxoma peritoni et al HOW TO TREAT PERITONEAL MALIGNANCIES Case Presentation 72M 3 weeks abdominal distension and lower abdominal pain. 3 weeks constipation w/ 2-3 BM per week. Post-prandial epigastric/substernal
More informationSurgical Management of Pancreatic Cancer
I Congresso de Oncologia D Or July 5-6, 2013 Surgical Management of Pancreatic Cancer Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University School of Medicine, Baltimore, MD Estimated
More informationTREATMENT OF PERITONEAL COLORECTAL CARCINOMATOSIS
TREATMENT OF PERITONEAL COLORECTAL CARCINOMATOSIS Anna Lepistö, MD, PhD Department of Colorectal Surgery, Abdominal Center, Helsinki University Hospital Incidence, prevalence and risk factors for peritoneal
More informationCOLON CANCER CARE GUIDELINES NON-METASTATIC DISEASE
COLON CANCER CARE GUIDELINES NON-METASTATIC DISEASE Guideline Authors: Todd S. Crocenzi, M.D.; Mark Whiteford, M.D.; Matthew Solhjem, M.D.; Carlo Bifulco, M.D.; Melissa Li, M.D.; Christopher Cai, M.D.;
More informationMedical Policy An Independent Licensee of the Blue Cross and Blue Shield Association
Cytoreduction and Hyperthermic Page 1 of 10 Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association Title: Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for the
More informationInformation for health professionals - pseudomyxoma peritonei
Colorectal and peritoneal oncology centre Information for health professionals - pseudomyxoma peritonei What is it? Pseudomyxoma Peritonei (PMP) is often a slowly progressive disease that produces extensive
More informationClinical Study Laparoscopic Cytoreductive Surgery and HIPEC in Patients with Limited Pseudomyxoma Peritonei of Appendiceal Origin
Gastroenterology Research and Practice Volume 2012, Article ID 981245, 5 pages doi:10.1155/2012/981245 Clinical Study Laparoscopic Cytoreductive Surgery and HIPEC in Patients with Limited Pseudomyxoma
More informationClinical Policy: Intraperitoneal Hyperthermic Chemotherapy for Abdominopelvic Cancers Reference Number: CP.MP. 346
Clinical Policy: Intraperitoneal Hyperthermic Chemotherapy for Abdominopelvic Reference Number: CP.MP. 346 Effective Date: 11/15 Last Review Date: 11/17 See Important Reminder at the end of this policy
More informationOFCCR CLINICAL DIAGNOSIS AND TREATMENT FORM
OFCCR CLINICAL DIAGNOSIS AND TREATMENT FORM Name: _, OFCCR # _ OCGN # _ OCR Group # _ HIN# Sex: MALE FEMALE UNKNOWN Date of Birth: DD MMM YYYY BASELINE DIAGNOSIS & TREATMENT 1. Place of Diagnosis: Name
More informationHeated Intraperitoneal Chemotherapy (HIPEC) for Advanced Abdominal Cancers
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-breakthroughs-from-penn-medicine/heated-intraperitonealchemotherapy-hipec-for-advanced-abdominal-cancers/7091/
More informationCurrent standard in treatment of peritoneal carcinomotisis. Data behind the HIPEC trials
Current standard in treatment of peritoneal carcinomotisis Data behind the HIPEC trials Overview Peritoneal carcinomatosis STANDARD treatment HIPEC Results of treatment Counter side of treatment Peritoneal
More informationCase Scenario 1. Pathology report Specimen from mediastinoscopy Final Diagnosis : Metastatic small cell carcinoma with residual lymphatic tissue
Case Scenario 1 Oncology Consult: Patient is a 51-year-old male with history of T4N3 squamous cell carcinoma of tonsil status post concurrent chemoradiation finished in October two years ago. He was hospitalized
More informationLocally Advanced Colon Cancer. Feiran Lou MD. MS. Richmond University Medical Center Department of Surgery
Locally Advanced Colon Cancer Feiran Lou MD. MS. Richmond University Medical Center Department of Surgery Case 34 yo man presented with severe RLQ abdominal pain X 24 hrs. No nausea/vomiting/fever. + flatus.
More informationINTRAPERITONEAL CHEMOTHERAPY, CYTOREDUCTION
INTRAPERITONEAL CHEMOTHERAPY, CYTOREDUCTION Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures,
More informationCytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Last Review Status/Date: December 2016 Page: 1 of 29 Intraperitoneal Chemotherapy for Select Intra- Description Cytoreductive surgery (CRS) comprises peritonectomy (ie, peritoneal stripping) procedures
More informationCorporate Medical Policy
Corporate Medical Policy Hyperthermic Intraperitoneal Chemotherapy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hyperthermic_intraperitoneal_chemotherapy 5/19/2005 3/2018 3/2019
More informationCytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Last Review Status/Date: March 2015 Page: 1 of 32 Intraperitoneal Chemotherapy for Select Intra- Description Pseudomyxoma peritonei describes extensive mucus accumulation within the peritoneum resulting
More informationSurgical Oncology, Mercy Medical Center, Baltimore, MD
Ann Surg Oncol (2012) 19:110 114 DOI 10.1245/s10434-011-1840-y ORIGINAL ARTICLE GASTROINTESTINAL ONCOLOGY The Role of Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy (CRS/HIPEC) in Patients
More information11/21/13 CEA: 1.7 WNL
Case Scenario 1 A 70 year-old white male presented to his primary care physician with a recent history of rectal bleeding. He was referred for imaging and a colonoscopy and was found to have adenocarcinoma.
More informationHyperthermic Intraperitoneal Chemotherapy (HIPEC)
Medical Coverage Policy Effective Date...10/15/2017 Next Review Date...10/15/2018 Coverage Policy Number... 0396 Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Table of Contents Related Coverage Resources
More informationINTRAOPERATIVE HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC)
UnitedHealthcare Commercial Medical Policy INTRAOPERATIVE HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC) Policy Number: SUR052 Effective Date: January 1, 2019 Table of Contents Page INSTRUCTIONS FOR
More informationSpecialised Services Policy: CP02 Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery for treatment of Pseudomyxoma Peritonei
Specialised Services Policy: CP02 Hyperthermic Intraperitoneal Chemotherapy (HIPEC) of Pseudomyxoma Peritonei Document Author: Assistant Medical Director Executive Lead: Medical Director Approved by: Management
More informationCRS and HIPEC for Colorectal Cancer. Rajesh Nair, MD UF Health Cancer Center-Orlando Health March 11, 2017
CRS and HIPEC for Colorectal Cancer Rajesh Nair, MD UF Health Cancer Center-Orlando Health March 11, 2017 Peritoneal Carcinomatosis from CRC Historically, a devastating problem Extreme morbidity from disease
More informationImaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationPeritonectomy plus hyperthermic peritoneal perfusion for the treatment of peritoneal carcinosis H. Müller, MD, FACS
Peritonectomy plus hyperthermic peritoneal perfusion for the treatment of peritoneal carcinosis H. Müller, MD, FACS Department of surgical oncology, Carl von Hess hospital, Hammelburg, Germany www.klinik-hammelburg.de
More informationOvarian cancer: clinical practice the Arabic perspective
Lead Group Log Ovarian cancer: clinical practice the Arabic perspective Experience of Hôtel-Dieu de France University Hospital (Beirut, LEBANON) in supraradical surgery for ovarian cancer David ATALLAH
More informationBasic Data. Birthday: Gender:Female Admission date:
Basic Data Birthday:1951-07-02 Gender:Female Admission date:2004-06-28 Chief Complaint A protruding mass over RLQ abdomen for many years. Present Illness & Past History Pseudomyxoma peritonei s/p laparotomy
More informationOncology General Principles L A U R I E S I M A R D B R E A S T S U R G I C A L O N C O L O G Y F E L L O W D E C E M B E R
Oncology General Principles L A U R I E S I M A R D B R E A S T S U R G I C A L O N C O L O G Y F E L L O W D E C E M B E R 2 0 1 2 Objectives Discuss Diagnostic and staging strategies in oncology Know
More informationManagement of Colorectal Liver Metastases
Management of Colorectal Liver Metastases MM Bernon, JEJ Krige HPB Surgical Unit, Groote Schuur Hospital Department of Surgery, University of Cape Town 50% of patients with colorectal cancer develop liver
More informationMP Hyperthermic Intraperitoneal Chemotherapy for Select IntraAbdominal and Pelvic Malignancies. Related Policies None
Medical Policy MP 2.03.07 BCBSA Ref. Policy: 2.03.07 Last Review: 10/18/2018 Effective Date: 01/25/2019 Section: Medicine Related Policies None DISCLAIMER Our medical policies are designed for informational
More informationCytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei
Int J Colorectal Dis (2005) 20:155 160 DOI 10.1007/s00384-004-0648-7 O R I G I N A L A R T I C L E Z. Güner U. Schmidt M. H. Dahlke H. J. Schlitt J. Klempnauer P. Piso Cytoreductive surgery and intraperitoneal
More informationU T C H. No disclosure
D U GOG T C H Randomized phase 3 trial comparing primary cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for stage III epithelial ovarian cancer: OVHIPEC-2 Willemien van
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy
More informationHow to deal with patients with isolated peritoneal metastases
ESMO Preceptorship Programme Colorectal Valencia 18-19 May 2018 Michel DUCREUX, MD, PhD Gustave Roussy Cancer Centre, Grand Paris, FRANCE How to deal with patients with isolated peritoneal metastases DISCLOSURE
More informationContents. Part 1. Peritoneal Carcinomatosis: Basic Concepts
Contents Part 1. Peritoneal Carcinomatosis: Basic Concepts 1. Structure and Function of Mesothelial Cells... 1 Introduction... 1 Structure of Mesothelial Cells... 1 Mesothelial Cell Functions... 3 Slippery
More informationCorrespondence should be addressed to David Morris; Received 17 February 2013; Revised 14 April 2013; Accepted 24 June 2013
International Surgical Oncology Volume 2013, Article ID 461041, 5 pages http://dx.doi.org/10.1155/2013/461041 Research Article Quality of Life Study following Cytoreductive Surgery and Intraperitoneal
More informationClinical Study Adjuvant Perioperative Intraperitoneal Chemotherapy in Locally Advanced Colorectal Carcinoma: Preliminary Results
International Scholarly Research Network ISRN Surgery Volume 2011, Article ID 529876, 6 pages doi:10.5402/2011/529876 Clinical Study Adjuvant Perioperative Intraperitoneal Chemotherapy in Locally Advanced
More informationVic J. Verwaal, MD, PhD, 1 Sjoerd Bruin, MD, 1 Henk Boot, MD, PhD, 2 Gooike van Slooten, MD, 1 and Harm van Tinteren, ScM 3
Annals of Surgical Oncology 15(9):2426 2432 DOI: 10.1245/s10434-008-9966-2 8-Year Follow-up of Randomized Trial: Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy Versus Systemic Chemotherapy
More informationAlejandro Cracco, Mayank Roy, Conrad H. Simpfendorfer. Introduction
Case Report Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy combined with two-stage hepatectomy for multiple and bilobar desmoplastic small round cell tumor liver metastases Alejandro
More informationResults of a French Multicentric Analysis
Peritonectomy, Perioperative and Intraoperative Intraperitoneal Chemotherapy for Carcinosis Arising from Gastric Cancer Results of a French Multicentric Analysis 17 th -19 th 2008 Report Digestive and
More informationProf. Dr. Aydın ÖZSARAN
Prof. Dr. Aydın ÖZSARAN Adenocarcinomas of the endometrium Most common gynecologic malignancy in developed countries Second most common in developing countries. Adenocarcinomas, grade 1 and 2 endometrioid
More informationAcute Diverticulitis. Andrew B. Peitzman, MD Mark M. Ravitch Professor of Surgery University of Pittsburgh
Acute Diverticulitis Andrew B. Peitzman, MD Mark M. Ravitch Professor of Surgery University of Pittsburgh Focus today: when to operate n Recurrent, uncomplicated diverticulitis; after how many episodes?
More informationJoseph Misdraji, M.D. GI pathology Unit Massachusetts General Hospital
Joseph Misdraji, M.D. GI pathology Unit Massachusetts General Hospital jmisdraji@partners.org Low-grade appendiceal mucinous neoplasm (LAMN) High-grade appendiceal mucinous neoplasm (HAMN) Adenocarcinoma
More informationColorectal peritoneal metastases and IMPACT
Colorectal peritoneal metastases and IMPACT Vicki Pleavin-Evans Peritoneal Malignancy Clinical Nurse Specialist PMI Basingstoke Basingstoke and North Hampshire Hospital Aldermaston Road, Basingstoke, Hampshire
More informationResults of CRS and HIPEC in. Colorectal PSM. and. Pseudomyxoma Peritonei
Results of CRS and HIPEC in Colorectal PSM and Pseudomyxoma Peritonei K. Van der Speeten 05/10/12 Introduction Results Morbidity & Mortality Adjuvant HIPEC Conclusions K. Van der Speeten Introduction PSM
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Cytoreductive Surgery and Perioperative Intraperitoneal Page 1 of 26 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Cytoreductive Surgery and Perioperative Intraperitoneal
More informationSurgical management and neoadjuvant chemotherapy for stage III-IV ovarian cancer
Ovarian cancer Surgical management and neoadjuvant chemotherapy for stage III-IV ovarian cancer JM. Classe, R. Rouzier, O.Glehen, P.Meeus, L.Gladieff, JM. Bereder, F Lécuru Suitable candidates for neo-adjuvant
More informationMP Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Medical Policy MP 2.03.07 Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic BCBSA Ref. Policy: 2.03.07 Last Review: 07/25/2018 Effective Date: 07/25/2018
More informationAppendix 5. EFSUMB Newsletter. Gastroenterological Ultrasound
EFSUMB Newsletter 87 Examinations should encompass the full range of pathological conditions listed below A log book listing the types of examinations undertaken should be kept Training should usually
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of complete cytoreduction Introduction (Sugarbaker technique) for pseudomyxoma peritonei
More informationAppendix adenocarcinomas are rare and heterogeneous
ORIGINAL CONTRIBUTION Predicting Survival After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Appendix Adenocarcinoma Omer Aziz, Ph.D., F.R.C.S. 1,2 Ihab Jaradat, F.R.C.S. 1 Bipasha
More informationGallbladder Cancer. GI Practice Guideline. Michael Sanatani, MD, FRCPC (Medical Oncologist) Barbara Fisher, MD, FRCPC (Radiation Oncologist)
Gallbladder Cancer GI Practice Guideline Michael Sanatani, MD, FRCPC (Medical Oncologist) Barbara Fisher, MD, FRCPC (Radiation Oncologist) Approval Date: September 2006 This guideline is a statement of
More informationBirthday: 1952/07/31 Date of admission:1999/12/30 Age:48 y/o Past medication:esrd under regular HD for 5+ years; denied DM and HTN
Birthday: 1952/07/31 Date of admission:1999/12/30 Age:48 y/o Past medication:esrd under regular HD for 5+ years; denied DM and HTN Chief Complaint : 1)intermittent LLQ cramping pain for 2 months 2) LGI
More informationCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal and appendiceal carcinomas with peritoneal carcinomatosis
JBUON 2017; 22(6): 1547-1553 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com ORIGINAL ARTICLE Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
More information1. Introduction. Correspondence should be addressed to Horacio N. López-Basave, Received 23 May 2011; Accepted 20 June 2011
International Scholarly Research Network ISRN Oncology Volume 2011, Article ID 526384, 6 pages doi:10.5402/2011/526384 Research Article Morbidity and Mortality of Cytoreductive Surgery with Hyperthermic
More informationMarcello Deraco M.D. Responsible Peritoneal Malignancies
Perspectives in clinical research for the treatment of peritoneal carcinomatosisin from ovarian cancer Marcello Deraco M.D. Responsible Peritoneal Malignancies Advisable limits of cytoreduction Survey
More informationHepatobiliary Procedures in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Ann Surg Oncol (2011) 18:1052 1059 DOI 10.1245/s10434-010-1415-3 ORIGINAL ARTICLE GASTROINTESTINAL ONCOLOGY Hepatobiliary Procedures in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal
More informationBRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT
BRANDON REGIONAL HEALTH CENTER; WHIPPLE S PROCEDURE AND ESOPHAGECTOMY AUDIT By: Amy Cisyk Home for the Summer Program July, 2016 Brandon, Manitoba Supervisor: Dr. Marvin Goossen Whipple s Procedure Audit
More informationHEPATECTOMY. Surgical Potpourri Session. ACS NSQIP National Conference Salt Lake City 2012
HEPATECTOMY Surgical Potpourri Session ACS NSQIP National Conference Salt Lake City 2012 Pascal Fuchshuber, MD, PhD, FACS Kaiser Permanente Medical Center Walnut Creek - California Hepatic Resection Is
More informationGENERAL SURGERY Jill Attia, NP
GENERAL SURGERY Jill Attia, NP Lisa Morgan, NP GOALS OF THIS PRESENTATION Review the role of Inpatient Nurse Practitioner Identify the 3 main General Surgery services Describe Surgical Oncology services
More informationTreatment outcomes and prognostic factors of gallbladder cancer patients after postoperative radiation therapy
Korean J Hepatobiliary Pancreat Surg 2011;15:152-156 Original Article Treatment outcomes and prognostic factors of gallbladder cancer patients after postoperative radiation therapy Suzy Kim 1,#, Kyubo
More informationManagement of an Appendiceal Mass - Approach to acute presentation of appendiceal neoplasms
Management of an Appendiceal Mass - Approach to acute presentation of appendiceal neoplasms Dr. Claudia LY WONG, Department of Surgery, Kwong Wah Hospital Joint Hospital Surgical Grand Round Presentation,
More informationColon Cancer Surgery
Colon Cancer Surgery Introduction Colon cancer is a life-threatening condition that affects thousands of people. Doctors usually recommend surgery for the removal of colon cancer. If your doctor recommends
More informationColonic stenting anno 2014
Jeanin E. van Hooft, MD, PhD Gastroenterologist Academic Medical Centre Dept. of Gastroenterology and Hepatology Amsterdam, Netherlands Annual meeting of Colonic Stent Safe Procedure Research Group May
More informationSurgical Department, Didimotichon General Hospital, Didimotichon, Greece 2
Hindawi Publishing Corporation Journal of Oncology Volume 22, Article ID 35834, 6 pages doi:.55/22/35834 Clinical Study Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Intraoperative Chemotherapy
More informationONLINE CONTINUING EDUCATION ACTIVITY
ONLINE CONTINUING EDUCATION ACTIVITY Take free quizzes online at acsjournals.com/ce ARTICLE TITLE: Looking Up: Recent Advances in Understanding and Treating Peritoneal Carcinomatosis CONTINUING MEDICAL
More informationSurgical Management of Neuroendocrine Tumors of the Gut. Richard Hodin MD Professor of Surgery Massachusetts General Hospital Harvard Medical School
Surgical Management of Neuroendocrine Tumors of the Gut Richard Hodin MD Professor of Surgery Massachusetts General Hospital Harvard Medical School Sites of GI Carcinoid Tumors Small intestine 44% Rectum
More informationM of initial surgical treatment of cancer of
ATTEMPTED PALLIATION BY RADICAL SURGERY FOR PELVIC AND ABDOMINAL CARCINOMATOSIS PRIMARY IN THE OVARIES ALEXAXDER BRUNSCHWIG, M.D. UCH HAS been written about the results M of initial surgical treatment
More informationColon Cancer Liver Metastases: Liver-Directed Therapy
Colon Cancer Liver Metastases: Liver-Directed Therapy Shishir K. Maithel, MD FACS Assistant Professor of Surgery Division of Surgical Oncology Winship Cancer Institute Emory University August 10, 2014
More informationQué operar y que no operar en carcinomatosis peritoneal. Indicaciones y límites.
Qué operar y que no operar en carcinomatosis peritoneal. Indicaciones y límites. Dr. Pere Bretcha Boix Plataforma de Oncología Hospital quironsalud Torrevieja 1 20-year survival of 70% 2 Appendiceal Neoplasms
More informationRobotic Surgery for Esophageal Cancer
Robotic Surgery for Esophageal Cancer Kemp H. Kernstine, MD PhD Division of Thoracic Surgery City of Hope Medical Center and Beckman Research Institute May 1, 2010 Esophageal Cancer on the Rise JNCI 2005,
More informationManagement of Perforated Colon Cancers
Management of Perforated Colon Cancers Introduction Colon and rectal cancers are the most common gastrointestinal cancers. They are 3 rd most common and 2 nd most common causes of cancer deaths among men
More informationCase Scenario 1. Discharge Summary
Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal
More informationRandomized Phase III Trials of Intravenous vs. Intraperitoneal Therapy in Optimal Ovarian Cancer
Randomized Phase III Trials of Intravenous vs. Intraperitoneal Therapy in Optimal Ovarian Cancer Deborah K. Armstrong, M.D. Associate Professor of Oncology, Gynecology and Obstetrics Development of Intraperitoneal
More informationOvarian Tumors. Andrea Hayes-Jordan MD FACS, FAAP Section Chief, Pediatric Surgery/Surgical Onc. UT MD Anderson Cancer Center
Ovarian Tumors Andrea Hayes-Jordan MD FACS, FAAP Section Chief, Pediatric Surgery/Surgical Onc. UT MD Anderson Cancer Center Case 13yo female with abdominal pain Ultrasound shows huge ovarian mass Surgeon
More informationShort bowel syndrome after cytoreductive surgery and HIPEC: nutritional considerations
JBUON 2014; 19(2): 549-553 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com ORIGINAL ARTICLE Short bowel syndrome after cytoreductive surgery and HIPEC: nutritional
More informationRadiation Therapy for Liver Malignancies
Outline Radiation Therapy for Liver Malignancies Albert J. Chang, M.D., Ph.D. Department of Radiation Oncology, UCSF March 23, 2014 Rationale for developing liver directed therapies Liver directed therapies
More informationSurgical Therapy: Sentinel Node Biopsy and Breast Conservation
Surgical Therapy: Sentinel Node Biopsy and Breast Conservation Stephen B. Edge, MD Professor of Surgery and Oncology Roswell Park Cancer Institute University at Buffalo Dr. Roswell Park: Tradition in Cancer
More informationCollection of Recorded Radiotherapy Seminars
IAEA Human Health Campus Collection of Recorded Radiotherapy Seminars http://humanhealth.iaea.org Conservative Treatment of Invasive Bladder Cancer Luis Souhami, MD Professor Department of Radiation Oncology
More informationPancreas Quizzes c. Both A and B a. Directly into the blood stream (not using ducts)
Pancreas Quizzes Quiz 1 1. The pancreas produces hormones. Which type of hormone producing organ is the pancreas? a. Endocrine b. Exocrine c. Both A and B d. Neither A or B 2. Endocrine indicates hormones
More informationLaparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Laparoscopic Resection Of Colon & Rectal Cancers R Sim Centre for Advanced Laparoscopic Surgery, TTSH Feasibility and safety Adequacy - same radical surgery as open op. Efficacy short term benefits and
More informationMPH Quiz. 1. How many primaries are present based on this pathology report? 2. What rule is this based on?
MPH Quiz Case 1 Surgical Pathology from hysterectomy performed July 11, 2007 Final Diagnosis: Uterus, resection: Endometrioid adenocarcinoma, Grade 1 involving most of endometrium, myometrial invasion
More informationCase Conference. Craig Morgenthal Department of Surgery Long Island College Hospital
Case Conference Craig Morgenthal Department of Surgery Long Island College Hospital Neoadjuvant versus Adjuvant Radiation Therapy in Rectal Carcinoma Epidemiology American Cancer Society statistics for
More informationThe Surgical Management of Colorectal Metastases
11th July 2017 Bowel Cancer UK The Surgical Management of Colorectal Metastases Ben Cresswell MD(Res) FRCS Consultant HPB Surgeon The Basingstoke Hepatobiliary Unit United Kingdom Surgical Management of
More informationQ: In order to use the code 8461/3 (serous surface papillary) for ovary, does it have to say the term "surface" on the path report?
Q&A Session for Collecting Cancer Data: Ovary Q: In order to use the code 8461/3 (serous surface papillary) for ovary, does it have to say the term "surface" on the path report? A: We reviewed both the
More information