BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice be...BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.展开更多
BACKGROUND Prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)is one of the methods to prevent peritoneal metastasis of advanced gastric cancer(AGC).However,the prognosis of gastric cancer patients who recei...BACKGROUND Prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)is one of the methods to prevent peritoneal metastasis of advanced gastric cancer(AGC).However,the prognosis of gastric cancer patients who receive this treatment are different.AIM To investigate whether inflammation and nutritional indicators affect the pro-gnosis of AGC patients undergoing gastrectomy and prophylactic HIPEC,and to develop a novel inflammatory nutritional prognostic index(INPI).Additionally,we aimed to construct a nomogram model to visually predict the prognosis of these patients and provide more accurate guidance for clinical decision-making.METHODS Clinical data from 181 Locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected.Multicollinearity analysis and least absolute shrinkage and selection operator(LASSO)Cox regression were utilized to construct the INPI.Survival analyses were performed using the Kaplan-Meier method and log-rank test.Both univariate and multivariate Cox proportional hazards regression models were used to analyze independent prognostic factors,and a prognostic nomogram was generated.And the model was validated using the bootstrap method.RESULTS Clinical data from 181 locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected.Multicollinearity analysis and LASSO Cox regression were utilized to construct the INPI.Survival analyses were performed using the Kaplan-Meier method and log-rank test.Both univariate and multivariate Cox proportional hazards regression models were applied to analyze independent prognostic factors,and a prognostic nomogram was generated.And the model was validated using the bootstrap method.CONCLUSION Inflammation and nutrition indicators are associated with the prognosis of AGC patients undergoing gastrectomy and prophylactic HIPEC.The nomogram based on the INPI and clinical features supports personalized treatment strategies improving prognosis for AGC patients undergoing gastrectomy and prophylactic HIPEC.展开更多
Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to corre...Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to correct an error in Figure 3 in which the flow cytometric scattergram of CD4/CD44 for the control group was erroneously used for the scattergram of CD8/CD44 for the PVIDSC group.The correct scattergram of CD8/CD44 for the PVIDSC group is provided below.The error does not affect the conclusion of the study.The authors apologize for the error and the inconvenience it might have caused to readers.展开更多
Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although t...Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although these treatments can be lifesaving,patients often experience a significant decrease in their overall quality of life(QoL),especially in the early stages of recovery,owing to the physical burden of surgery and the effects of chemotherapy.Many traditional QoL questionnaires have been used to measure CRS and HIPEC.However,these classical current QoL assessment tools often fail to capture the unique challenges faced by this population,including bowel dysfunction,stoma-related distress,and long-term survivorship issues.Therefore,additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.展开更多
Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic t...Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.展开更多
Objective:The trial was designed to evaluate the efficacy of prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)with cisplatin for patients with locally advanced gastric cancer(LAGC).Methods:Between March 20...Objective:The trial was designed to evaluate the efficacy of prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)with cisplatin for patients with locally advanced gastric cancer(LAGC).Methods:Between March 2015 and November 2016,a phase Ⅱ clinical trial was performed.Fifty consecutive patients with LAGC were randomly assigned to two groups:the experimental group(radical gastrectomy+HIPEC with cisplatin+adjuvant chemotherapy)and the control group(radical gastrectomy+adjuvant chemotherapy).Survival rates were closely monitored.Results:The 5-year overall survival(OS)rate of all patients was 80.0%.The 5-year OS rate in the experimental group was lower than that in the control group,at 75.8%and 88.2%,respectively,with no statistical significance.In addition,5-year recurrence-free survival(RFS)rates of patients who underwent HIPEC or not were also 75.8%and 88.2%,respectively.In the multivariate analysis,only pT stage[risk ratio(RR)=7.079,P=0.018]was significantly associated with prognosis.The most common recurrence pattern was peritoneal recurrence in both groups.The experimental group had a lower incidence of peritoneal recurrence than the control group with no statistical significance.Conclusions:This trial clearly revealed that prophylactic HIPEC with cisplatin neither decrease the risk of peritoneal recurrence nor improve the prognosis of patients with LAGC.Thus,HIPEC with cisplatin is not recommended as a prophylactic treatment for peritoneal recurrence of LAGC after radical gastrectomy.展开更多
Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectom...Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectomy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has emerged as a promising approach.This minireview explores the influence of ERAS on surgical and oncological outcomes in this multifaceted procedure.Recent evidence suggests that ERAS,comprising multimodal strategies,improves postoperative recovery,reduces complications,and enhances quality of life.It may also contribute to better survival outcomes by minimizing perioperative morbidity and thereby facilitating the timely initiation of adjuvant therapy.Mechanistically,ERAS promotes early mobilization,attenuates postoperative immunosuppression,and supports timely adjuvant therapies,which are crucial in managing carcinomatosis.This minireview underscores the importance of multidisciplinary collaboration and individualized patient care to maximize ERAS benefits.Large-scale,prospective investigations are warranted to validate these findings and refine ERAS protocols for this specialized patient cohort.Further research will facilitate ongoing advancements in oncological surgery and perioperative care,ultimately improving outcomes for patients with gastric cancer and PC.展开更多
BACKGROUND Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects.The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy(H...BACKGROUND Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects.The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy(HIPEC)has been shown to increase survival rates in these patients.Despite these advancements,debates persist regarding the magnitude of survival improvement attributed to this treatment modality.The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis,and it took a comparative analysis of patients exhibiting positive and negative cytological findings.Between April 2013 and March 2020,84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts:HIPEC(20 patients with peritoneal metastasis),cytology-positive(23 patients without peritoneal nodules but with positive wash cytology),and cytology-negative(41 patients with advanced gastric cancer,no peritoneal nodules,and negative wash cytology).The HIPEC cohort underwent gastrectomy with HIPEC,while the cytology-positive and cytology-negative groups received gastrectomy alone.The demographic,pat-hological,and survival data of the groups were compared.RESULTS The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss.Nevertheless,the complication rates were consistent across all three groups.Median survival in the HIPEC group was 20.00±4.89 months,with 1-year,2-year,and 3-year overall survival rates of 73.90%,28.70%,and 9.60%,respectively.These figures paralleled the survival rates of the cytology-positive group(52.20%at 1 year,28.50%at 2 years,and 19.00%at 3 years).Notably,47%of patients experienced peritoneal recurrence.CONCLUSION HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis,mirroring the outcomes in cytology-positive patients.However,peritoneal recurrence remained high.展开更多
Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1...Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1,2020 to July 31,2021,80 patients were enrolled,including 40 undergoing intraperitoneal Pringle maneuver(IPM)and 40 extraperitoneal Pringle maneuver(EPM).The observation indices included basic preoperative clinical characteristics and intraoperative and postoperative liver function indices.Results:There were no significant differences in the basic characteristics or types of hepatectomy,intraoperative blood loss,intraoperative blood transfusion,or hepatectomy time between the IPM and EPM groups.However,the blocking and operation time in the IPM group was shorter than that in the EPM group.There were no significant differences in alanine aminotransferase(ALT)or aspartate aminotransferase(AST)levels on the first day after surgery or in total bilirubin(TBIL)or albumin(ALB)levels on the first,third,or fifth days after surgery.However,C-reactive protein(CRP)levels on the first and third days,ALT and AST levels on the third and fifth days were lower,and hospital stay after surgery was shorter in the IPM group than in the EPM group.Conclusion:IPM using bulldog clamps is simple,safe,and effective.The inflammatory reaction is less severe,the degree of liver function injury is lower,and recovery is faster.展开更多
BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary significantly...BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary significantly.AIM To identify the clinical factors associated with progression-free survival(PFS)after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal,ovarian,and gastric cancers.METHODS We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival(OS)in patients recruited between 2015 and 2020.Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year.Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS.RESULTS Of the 80 enrolled patients,39 had an unfavorable PFS(<1 year)and 41 had a favorable PFS(≥1 year).Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0(CC-0)or length of CRS≤6 h had a favorable PFS[odds ratio(OR)=0.141,P=0.004;and OR=0.361,P=0.027,respectively].In multiple logistic regression,achieving CC-0 was the strongest prognostic factor for a favorable PFS(OR=0.131,P=0.005).A peritoneal cancer index score>12 was associated with a lower rate of achieving CC-0(P=0.027).The favorable PFS group had a significantly longer OS(median 81.7 mo vs 17.0 mo,P<0.001).CONCLUSION Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival.This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.展开更多
BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by h...BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by hematogenous dissemination.The former is more common,such as intestinal TB,mesenteric lymphatic TB,fa-llopian tube TB,etc.,and can be the direct primary lesion of the disease.CASE SUMMARY We present an older male patient with TBP complicated by an abdominal mass.The patient's preoperative symptoms,signs and imaging data suggested a poss-ible abdominal tumor.After surgical treatment,the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by com-bining past medical history,postoperative pathology,and positive results of TB-related laboratory tests.The patient's symptoms were significantly reduced after surgical treatment,and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.CONCLUSION This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.展开更多
BACKGROUND Pseudomyxoma peritonei is a rare tumor that can produce a biological behavior similar to that of a malignant tumor.Surgical resection combined with chemo-therapy is the traditional treatment method,but the ...BACKGROUND Pseudomyxoma peritonei is a rare tumor that can produce a biological behavior similar to that of a malignant tumor.Surgical resection combined with chemo-therapy is the traditional treatment method,but the effect is not good.Cell reduction(CRS)combined with intraperitoneal thermoperfusion chemotherapy(HIPEC)has become a new method for the treatment of peritoneal pseudomy-xoma(PMP).AIM To find out if CRS and HIPEC can be used safely and effectively to treat PMP.METHODS This is an observational study.Clinical data of PMP patients treated with CRS+HIPEC at our hospital from January 2013 to June 2023 was collated and analyzed.The main outcome measures were overall survival(OS),and the secondary outcome measures were the incidence of surgical complications and serious adverse events.Complications were graded according to common adverse event evaluation criteria.Peritoneal tumor staging was performed using the peritoneal tumor index(PCI)scoring system,and a cell reduction degree(CCR)score was performed after CRS.CCR-0 and CCR-1 were considered satisfactory CRS.RESULTS A total of 186 patients with PMP were included,with a median age of 56(48-64)years,65(34.9%)years in males,and 121(65.1%)years in females.The median PCI score was 28(20-34)points.The median operative time was 300(211-430)minutes,and no significant complications occurred.91.4%(170/186)were from the appendix,53.2%(99/186)were from the low grade,and 30.6%(57/186)were from the high grade.CCR scores showed that 55 patients(29.6%)achieved satisfactory CRS,and 113 patients(60.8%)did not achieve satisfactory CRS.The fatality rate at 30 days after surgery was 2.7%(5/186),1.6%(3/186)needed a second operation,and the fatality rate at 90 days was 4.3%(8/186).The total incidence of III-IV complications was 43.0%(80/186),among which the higher incidence was mainly anemia(27.4%,51/186),electrolyte disturbance(11.6%,21/181),and albumin decrease(7.5%,14/186).The main compli-cations associated with abdominal surgery were gastrointestinal anastomotic leakage(2.2%,4/186),abdominal hemorrhage(2.2%,4/186),and abdominal infection(4.3%,8/186).The median follow-up was 38.1(95%CI:31.2-45.1)months.The 5-year OS of PMP patients treated with CRS+HIPEC was 50.3%(95%CI:40.7%-59.9%),and the median survival time was 66.1(95%CI:43.1-89.1)months.The results of the survival analysis showed that patients with a low pathological grade,a low PCI,and a satisfactory CCR score had a higher survival rate(all P<0.05).5-year OS was 88.9%(95%CI:68.3%-100.0%)in CCR-0 patients,77.6%(95%CI:62.7%-92.5%)in CCR-1 patients,and 42.0%(95%CI:29.5%-54.5%)in CCR-2/3 patients.CONCLUSION The application of CRS+HIPEC in PMP is safe and feasible,and the survival benefit is high,especially in those who achieve satisfactory CRS,which can significantly extend the OS.展开更多
Objective: To observe the time of ascites disappearance, time to ascites recurrence, improvement rate in quality of life, and the effective rate of ascites treatment in patients with advanced gastric and ovarian cance...Objective: To observe the time of ascites disappearance, time to ascites recurrence, improvement rate in quality of life, and the effective rate of ascites treatment in patients with advanced gastric and ovarian cancer with ascites following hypotonic hyperthermic intraperitoneal chemotherapy. Methods: Forty patients with advanced gastric and ovarian cancer with ascites, treated in our hospital from January 2021 to August 2024, were selected as research subjects. They were divided into a treatment group and a reference group using a random number table method. The treatment group received hypotonic hyperthermic intraperitoneal chemotherapy, while the reference group received conventional treatment. The treatment effects of the two groups were compared. Results: In the treatment group, the ascite disappearance time was (6.13 ± 1.32) days, and the recurrence time was (22.58 ± 8.21) months. The ascite disappearance time was significantly shorter than that of the reference group, and the ascite recurrence time was significantly longer. Both P-values were less than 0.05, indicating statistical significance. The effective rate of quality of life improvement was 95%, with only 1 patient showing a decrease in quality of life. The effective rate of ascites treatment was 95%, with only 1 patient showing an increase in ascites. Both the quality of life improvement rate and the effective rate of ascites treatment were significantly higher than those of the reference group, with P-values of 0.037 and 0.018, respectively, indicating statistical significance. Conclusion: For patients with advanced gastric and ovarian cancer with ascites, hypotonic hyperthermic intraperitoneal chemotherapy can accelerate ascites disappearance, prolong the time to recurrence, and significantly improve both the quality of life improvement rate and the effective rate of ascites treatment.展开更多
Objective:Ventral hernia is an anterior abdominal wall hernia,with an incidence of 2%-13%.Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique prov...Objective:Ventral hernia is an anterior abdominal wall hernia,with an incidence of 2%-13%.Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option.This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh(IPOM)or intraperitoneal onlay mesh with defect closure(IPOM PLUS)technique with the usage of variety of synthetic meshes intraperitoneally.Methods:A retrospective study of 821 patients of a single institution for a decade was conducted.Longterm outcomes such as pain,mesh infections,enterocutaneous fistula,bowel adhesions and recurrence were assessed.Results:There were 801 primary,12 incisional,and 8 recurrent hernia cases,including 532 females and 289 males with a mean age of 45.62±9.37 years.IPOM PLUS were underwent in 674(82.10%)cases.Polypropylene,dual,titanium,composite meshes were applied in 473(57.61%),208(25.33%),82(9.99%),and 58(7.06%)cases respectively.Intraoperative bleeding occurred in 3(0.37%)cases,seroma in 8(0.97%),wound infection in 4(0.49%),stitch abscess in 2(0.24%).Recurrence was found in 8(0.97%)cases,with 5 used polypropylene mesh and 3 used dual mesh.Mesh infections were discovered in 6(2.88%)cases used dual,and foreign body sensation in 4(0.85%)cases used polypropylene.Three(0.37%)patients had suture site hernia,and 3(0.37%)had chronic sinus.Conclusion:IPOM or IPOM PLUS holds good in small or medium sized ventral hernias.The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes.A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence.Absorbable suture can be considered as alternative to tackers.展开更多
Advanced gastric cancer （GC） has been recognized as lethal disease when peritoneal metastases （PM） occurred.There is no standard treatment for advanced GC with PM.Until 1980s,the therapeutic arena for these patien...Advanced gastric cancer （GC） has been recognized as lethal disease when peritoneal metastases （PM） occurred.There is no standard treatment for advanced GC with PM.Until 1980s,the therapeutic arena for these patients had remained stagnant,with no therapeutic approach having shown a survival gain in GC with PM.However,cytoreductive surgery （CRS） with peritonectomy procedures and intraperitoneal chemotherapy （IPC） promising new combined therapeutic approach to achieve disease control for GC with PM.The recent publications changed the GC with PM treatment landscape by providing an evidence that CRS and IPC led to prolongation in overall survival （OS）.This review will provide an overview of the evolving role of CRS and IPC in the management of advanced GC with PM in the current era.展开更多
AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).
Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usual...Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usually suffer abdominal distension, intestinal obstruction and various complications before they succumb after a median of 3 - 6 months. Although not adopted in most international treatment guidelines, intraperitoneal chemotherapy has growing evidence compared with conventional systemic chemotherapy for the treatment of peritoneal carcinomatosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is well-established for clinical benefit but is technically demanding with substantial treatment-related morbidities and mortality. On the other hand, normothermic intraperitoneal chemotherapy in the form of bidirectional neoadjuvant treatment is promising with various newer chemotherapeutic agents. Regardless of the treatment technique applied, the essential element of success is meticulous patient selection and availability of expertise. Future direction is along the line of personalized treatment with the application of translational science.展开更多
Advanced stage epithelial ovarian cancer(EOC) is diffi cult to treat with low overall cure rates. A new strategy combining maximal cytoreductive surgery(CRS) with intraoperative hyperthermic intraperitoneal chemothera...Advanced stage epithelial ovarian cancer(EOC) is diffi cult to treat with low overall cure rates. A new strategy combining maximal cytoreductive surgery(CRS) with intraoperative hyperthermic intraperitoneal chemotherapy(HIPEC) has been proposed to treat advanced stage EOC in the primary setting. Numerous small, heterogeneous studies have been conducted exploring outcomes in patients with predominantly advanced, recurrent or refractory disease treated with CRS + HIPEC. Although morbidity rates approaching 35% have been reported, oncologic outcomes are promising. Incorporation of HIPEC for the treatment of primary EOC has continued to gain interest. Several prospective phase 2 clinical trials were recently completed evaluating the impact of CRS + HIPEC in the primary setting. This article will briefl y discuss the benefi ts of optimal surgical cytoreduction and the theoretical basis of intraperitoneal chemotherapy in patients with advanced stage EOC, and will then review existing literature describing oncologic outcomes in EOC patients treated with HIPEC in the primary setting.展开更多
Objective To study the antineoplastic effect of the calcium channel blocker verapamil and 5-fluorouracil intraperitoneal chemotherapy onhepatocarcinoma-bearing rats, and examine the action between calcium channel bloc...Objective To study the antineoplastic effect of the calcium channel blocker verapamil and 5-fluorouracil intraperitoneal chemotherapy onhepatocarcinoma-bearing rats, and examine the action between calcium channel blockers and cytotoxic drugs.Methods We adopted the method of subcapsular implantation of carcinoma tissues of walker-256 in the left liver lobe as a model of livercarcinoma-bearing rats. All experimental animals were divided into four groups. On the sixth day post implantation, in group A (controlgroup) 6 ml of saline was injected intraperitoneally once a day for 3 days. In group B (single chemotherapy group) 6 ml of 5-Fu 75 mg/kg was injected intraperitoneally once a day for 3 days. In group C (combination of treatment group) both 5-Fu (75 mg/kg) and verapamil(25 mg/kg) were administered simultaneously as in A and B. In group D (simple verapamil group) only 6 ml of verapamil (25 mg/kg)was administered as above.Results Compared with groups A, B and D, The volume of cancer and the contents of liver cancer DNA and protein were significantlyreduced. The rates of inhibiting cancer (89.9% in group C and 35.4% in group B) were significantly increased in group C. Group C hadsignificantly long survival time compared to groups A, B and D ( P < 0.05) . By light microscopy, a number of focal necroses were foundin cancer tissue in group C.Conclusion Calcium channel blockers can enhance the antineoplastic effect of 5-Fu intraperitoneal chemotherapy to liver cancer ; Theuse of verapamil can not increase the toxicity of 5-Fu.展开更多
This article is to offer a concise review on the use of cytoreductive surgery （CRS） plus intraperitoneal hyperthermic chemotherapy （IPHC） for the treatment of peritoneal carcinomatosis （PC）. Traditionally, PC wa...This article is to offer a concise review on the use of cytoreductive surgery （CRS） plus intraperitoneal hyperthermic chemotherapy （IPHC） for the treatment of peritoneal carcinomatosis （PC）. Traditionally, PC was treated with systemic chemotherapy alone with very poor response and a median survival of less than 6 too. With the establishment of several phase Ⅱ studies, a new trend has been developed toward the use of CRS plus IPHC as a standard method for treating selected patients with PC, in whom sufficient cytoreduction could be achieved. In spite of the need for more high quality phase Ⅲ studies, there is now a consensus among many surgical oncology experts throughout the world about the use of this new treatment strategy as standard care for colorectal cancer patients with PC. This review summarizes the current status and possible progress in future.展开更多
基金Bethune Charitable Foundation Project,No.HZB-20190528-10Natural Science Foundation of Fujian Province,No.2020J011230.
文摘BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.
文摘BACKGROUND Prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)is one of the methods to prevent peritoneal metastasis of advanced gastric cancer(AGC).However,the prognosis of gastric cancer patients who receive this treatment are different.AIM To investigate whether inflammation and nutritional indicators affect the pro-gnosis of AGC patients undergoing gastrectomy and prophylactic HIPEC,and to develop a novel inflammatory nutritional prognostic index(INPI).Additionally,we aimed to construct a nomogram model to visually predict the prognosis of these patients and provide more accurate guidance for clinical decision-making.METHODS Clinical data from 181 Locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected.Multicollinearity analysis and least absolute shrinkage and selection operator(LASSO)Cox regression were utilized to construct the INPI.Survival analyses were performed using the Kaplan-Meier method and log-rank test.Both univariate and multivariate Cox proportional hazards regression models were used to analyze independent prognostic factors,and a prognostic nomogram was generated.And the model was validated using the bootstrap method.RESULTS Clinical data from 181 locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected.Multicollinearity analysis and LASSO Cox regression were utilized to construct the INPI.Survival analyses were performed using the Kaplan-Meier method and log-rank test.Both univariate and multivariate Cox proportional hazards regression models were applied to analyze independent prognostic factors,and a prognostic nomogram was generated.And the model was validated using the bootstrap method.CONCLUSION Inflammation and nutrition indicators are associated with the prognosis of AGC patients undergoing gastrectomy and prophylactic HIPEC.The nomogram based on the INPI and clinical features supports personalized treatment strategies improving prognosis for AGC patients undergoing gastrectomy and prophylactic HIPEC.
文摘Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to correct an error in Figure 3 in which the flow cytometric scattergram of CD4/CD44 for the control group was erroneously used for the scattergram of CD8/CD44 for the PVIDSC group.The correct scattergram of CD8/CD44 for the PVIDSC group is provided below.The error does not affect the conclusion of the study.The authors apologize for the error and the inconvenience it might have caused to readers.
文摘Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although these treatments can be lifesaving,patients often experience a significant decrease in their overall quality of life(QoL),especially in the early stages of recovery,owing to the physical burden of surgery and the effects of chemotherapy.Many traditional QoL questionnaires have been used to measure CRS and HIPEC.However,these classical current QoL assessment tools often fail to capture the unique challenges faced by this population,including bowel dysfunction,stoma-related distress,and long-term survivorship issues.Therefore,additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.
文摘Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.
基金supported by the National Nature Science Foundation of China(No.81402308)Science Foundation of Peking University Cancer Hospital(No.2021-24)+2 种基金Natural Science Foundation of Beijing Municipal(No.7242020)Science Foundation of Peking University Cancer Hospital(No.BJCH2025GG04)the National Nature Science Foundation of China(No.82173151).
文摘Objective:The trial was designed to evaluate the efficacy of prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)with cisplatin for patients with locally advanced gastric cancer(LAGC).Methods:Between March 2015 and November 2016,a phase Ⅱ clinical trial was performed.Fifty consecutive patients with LAGC were randomly assigned to two groups:the experimental group(radical gastrectomy+HIPEC with cisplatin+adjuvant chemotherapy)and the control group(radical gastrectomy+adjuvant chemotherapy).Survival rates were closely monitored.Results:The 5-year overall survival(OS)rate of all patients was 80.0%.The 5-year OS rate in the experimental group was lower than that in the control group,at 75.8%and 88.2%,respectively,with no statistical significance.In addition,5-year recurrence-free survival(RFS)rates of patients who underwent HIPEC or not were also 75.8%and 88.2%,respectively.In the multivariate analysis,only pT stage[risk ratio(RR)=7.079,P=0.018]was significantly associated with prognosis.The most common recurrence pattern was peritoneal recurrence in both groups.The experimental group had a lower incidence of peritoneal recurrence than the control group with no statistical significance.Conclusions:This trial clearly revealed that prophylactic HIPEC with cisplatin neither decrease the risk of peritoneal recurrence nor improve the prognosis of patients with LAGC.Thus,HIPEC with cisplatin is not recommended as a prophylactic treatment for peritoneal recurrence of LAGC after radical gastrectomy.
文摘Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectomy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has emerged as a promising approach.This minireview explores the influence of ERAS on surgical and oncological outcomes in this multifaceted procedure.Recent evidence suggests that ERAS,comprising multimodal strategies,improves postoperative recovery,reduces complications,and enhances quality of life.It may also contribute to better survival outcomes by minimizing perioperative morbidity and thereby facilitating the timely initiation of adjuvant therapy.Mechanistically,ERAS promotes early mobilization,attenuates postoperative immunosuppression,and supports timely adjuvant therapies,which are crucial in managing carcinomatosis.This minireview underscores the importance of multidisciplinary collaboration and individualized patient care to maximize ERAS benefits.Large-scale,prospective investigations are warranted to validate these findings and refine ERAS protocols for this specialized patient cohort.Further research will facilitate ongoing advancements in oncological surgery and perioperative care,ultimately improving outcomes for patients with gastric cancer and PC.
文摘BACKGROUND Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects.The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy(HIPEC)has been shown to increase survival rates in these patients.Despite these advancements,debates persist regarding the magnitude of survival improvement attributed to this treatment modality.The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis,and it took a comparative analysis of patients exhibiting positive and negative cytological findings.Between April 2013 and March 2020,84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts:HIPEC(20 patients with peritoneal metastasis),cytology-positive(23 patients without peritoneal nodules but with positive wash cytology),and cytology-negative(41 patients with advanced gastric cancer,no peritoneal nodules,and negative wash cytology).The HIPEC cohort underwent gastrectomy with HIPEC,while the cytology-positive and cytology-negative groups received gastrectomy alone.The demographic,pat-hological,and survival data of the groups were compared.RESULTS The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss.Nevertheless,the complication rates were consistent across all three groups.Median survival in the HIPEC group was 20.00±4.89 months,with 1-year,2-year,and 3-year overall survival rates of 73.90%,28.70%,and 9.60%,respectively.These figures paralleled the survival rates of the cytology-positive group(52.20%at 1 year,28.50%at 2 years,and 19.00%at 3 years).Notably,47%of patients experienced peritoneal recurrence.CONCLUSION HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis,mirroring the outcomes in cytology-positive patients.However,peritoneal recurrence remained high.
基金supported by grants from Scientific Research Fund of Anhui Medical University(No.2021xkj034)Clinical Research Cultivation Program of the Second Affiliated Hospital of Anhui Medical University(No.2020LCYB18)Anhui Institute of Translational Medicine(No.2023zhyx-C84).
文摘Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1,2020 to July 31,2021,80 patients were enrolled,including 40 undergoing intraperitoneal Pringle maneuver(IPM)and 40 extraperitoneal Pringle maneuver(EPM).The observation indices included basic preoperative clinical characteristics and intraoperative and postoperative liver function indices.Results:There were no significant differences in the basic characteristics or types of hepatectomy,intraoperative blood loss,intraoperative blood transfusion,or hepatectomy time between the IPM and EPM groups.However,the blocking and operation time in the IPM group was shorter than that in the EPM group.There were no significant differences in alanine aminotransferase(ALT)or aspartate aminotransferase(AST)levels on the first day after surgery or in total bilirubin(TBIL)or albumin(ALB)levels on the first,third,or fifth days after surgery.However,C-reactive protein(CRP)levels on the first and third days,ALT and AST levels on the third and fifth days were lower,and hospital stay after surgery was shorter in the IPM group than in the EPM group.Conclusion:IPM using bulldog clamps is simple,safe,and effective.The inflammatory reaction is less severe,the degree of liver function injury is lower,and recovery is faster.
基金the Chang Gung Medical Foundation,No.CMRPG6L0091,No.CMRPG6L0092,and No.CMRPG6L0093.
文摘BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary significantly.AIM To identify the clinical factors associated with progression-free survival(PFS)after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal,ovarian,and gastric cancers.METHODS We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival(OS)in patients recruited between 2015 and 2020.Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year.Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS.RESULTS Of the 80 enrolled patients,39 had an unfavorable PFS(<1 year)and 41 had a favorable PFS(≥1 year).Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0(CC-0)or length of CRS≤6 h had a favorable PFS[odds ratio(OR)=0.141,P=0.004;and OR=0.361,P=0.027,respectively].In multiple logistic regression,achieving CC-0 was the strongest prognostic factor for a favorable PFS(OR=0.131,P=0.005).A peritoneal cancer index score>12 was associated with a lower rate of achieving CC-0(P=0.027).The favorable PFS group had a significantly longer OS(median 81.7 mo vs 17.0 mo,P<0.001).CONCLUSION Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival.This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.
文摘BACKGROUND Tuberculous peritonitis(TBP)is a chronic,diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis.The route of infection can be by direct spread of intraperitoneal tuberculosis(TB)or by hematogenous dissemination.The former is more common,such as intestinal TB,mesenteric lymphatic TB,fa-llopian tube TB,etc.,and can be the direct primary lesion of the disease.CASE SUMMARY We present an older male patient with TBP complicated by an abdominal mass.The patient's preoperative symptoms,signs and imaging data suggested a poss-ible abdominal tumor.After surgical treatment,the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by com-bining past medical history,postoperative pathology,and positive results of TB-related laboratory tests.The patient's symptoms were significantly reduced after surgical treatment,and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.CONCLUSION This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.
文摘BACKGROUND Pseudomyxoma peritonei is a rare tumor that can produce a biological behavior similar to that of a malignant tumor.Surgical resection combined with chemo-therapy is the traditional treatment method,but the effect is not good.Cell reduction(CRS)combined with intraperitoneal thermoperfusion chemotherapy(HIPEC)has become a new method for the treatment of peritoneal pseudomy-xoma(PMP).AIM To find out if CRS and HIPEC can be used safely and effectively to treat PMP.METHODS This is an observational study.Clinical data of PMP patients treated with CRS+HIPEC at our hospital from January 2013 to June 2023 was collated and analyzed.The main outcome measures were overall survival(OS),and the secondary outcome measures were the incidence of surgical complications and serious adverse events.Complications were graded according to common adverse event evaluation criteria.Peritoneal tumor staging was performed using the peritoneal tumor index(PCI)scoring system,and a cell reduction degree(CCR)score was performed after CRS.CCR-0 and CCR-1 were considered satisfactory CRS.RESULTS A total of 186 patients with PMP were included,with a median age of 56(48-64)years,65(34.9%)years in males,and 121(65.1%)years in females.The median PCI score was 28(20-34)points.The median operative time was 300(211-430)minutes,and no significant complications occurred.91.4%(170/186)were from the appendix,53.2%(99/186)were from the low grade,and 30.6%(57/186)were from the high grade.CCR scores showed that 55 patients(29.6%)achieved satisfactory CRS,and 113 patients(60.8%)did not achieve satisfactory CRS.The fatality rate at 30 days after surgery was 2.7%(5/186),1.6%(3/186)needed a second operation,and the fatality rate at 90 days was 4.3%(8/186).The total incidence of III-IV complications was 43.0%(80/186),among which the higher incidence was mainly anemia(27.4%,51/186),electrolyte disturbance(11.6%,21/181),and albumin decrease(7.5%,14/186).The main compli-cations associated with abdominal surgery were gastrointestinal anastomotic leakage(2.2%,4/186),abdominal hemorrhage(2.2%,4/186),and abdominal infection(4.3%,8/186).The median follow-up was 38.1(95%CI:31.2-45.1)months.The 5-year OS of PMP patients treated with CRS+HIPEC was 50.3%(95%CI:40.7%-59.9%),and the median survival time was 66.1(95%CI:43.1-89.1)months.The results of the survival analysis showed that patients with a low pathological grade,a low PCI,and a satisfactory CCR score had a higher survival rate(all P<0.05).5-year OS was 88.9%(95%CI:68.3%-100.0%)in CCR-0 patients,77.6%(95%CI:62.7%-92.5%)in CCR-1 patients,and 42.0%(95%CI:29.5%-54.5%)in CCR-2/3 patients.CONCLUSION The application of CRS+HIPEC in PMP is safe and feasible,and the survival benefit is high,especially in those who achieve satisfactory CRS,which can significantly extend the OS.
文摘Objective: To observe the time of ascites disappearance, time to ascites recurrence, improvement rate in quality of life, and the effective rate of ascites treatment in patients with advanced gastric and ovarian cancer with ascites following hypotonic hyperthermic intraperitoneal chemotherapy. Methods: Forty patients with advanced gastric and ovarian cancer with ascites, treated in our hospital from January 2021 to August 2024, were selected as research subjects. They were divided into a treatment group and a reference group using a random number table method. The treatment group received hypotonic hyperthermic intraperitoneal chemotherapy, while the reference group received conventional treatment. The treatment effects of the two groups were compared. Results: In the treatment group, the ascite disappearance time was (6.13 ± 1.32) days, and the recurrence time was (22.58 ± 8.21) months. The ascite disappearance time was significantly shorter than that of the reference group, and the ascite recurrence time was significantly longer. Both P-values were less than 0.05, indicating statistical significance. The effective rate of quality of life improvement was 95%, with only 1 patient showing a decrease in quality of life. The effective rate of ascites treatment was 95%, with only 1 patient showing an increase in ascites. Both the quality of life improvement rate and the effective rate of ascites treatment were significantly higher than those of the reference group, with P-values of 0.037 and 0.018, respectively, indicating statistical significance. Conclusion: For patients with advanced gastric and ovarian cancer with ascites, hypotonic hyperthermic intraperitoneal chemotherapy can accelerate ascites disappearance, prolong the time to recurrence, and significantly improve both the quality of life improvement rate and the effective rate of ascites treatment.
文摘Objective:Ventral hernia is an anterior abdominal wall hernia,with an incidence of 2%-13%.Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option.This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh(IPOM)or intraperitoneal onlay mesh with defect closure(IPOM PLUS)technique with the usage of variety of synthetic meshes intraperitoneally.Methods:A retrospective study of 821 patients of a single institution for a decade was conducted.Longterm outcomes such as pain,mesh infections,enterocutaneous fistula,bowel adhesions and recurrence were assessed.Results:There were 801 primary,12 incisional,and 8 recurrent hernia cases,including 532 females and 289 males with a mean age of 45.62±9.37 years.IPOM PLUS were underwent in 674(82.10%)cases.Polypropylene,dual,titanium,composite meshes were applied in 473(57.61%),208(25.33%),82(9.99%),and 58(7.06%)cases respectively.Intraoperative bleeding occurred in 3(0.37%)cases,seroma in 8(0.97%),wound infection in 4(0.49%),stitch abscess in 2(0.24%).Recurrence was found in 8(0.97%)cases,with 5 used polypropylene mesh and 3 used dual mesh.Mesh infections were discovered in 6(2.88%)cases used dual,and foreign body sensation in 4(0.85%)cases used polypropylene.Three(0.37%)patients had suture site hernia,and 3(0.37%)had chronic sinus.Conclusion:IPOM or IPOM PLUS holds good in small or medium sized ventral hernias.The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes.A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence.Absorbable suture can be considered as alternative to tackers.
文摘Advanced gastric cancer （GC） has been recognized as lethal disease when peritoneal metastases （PM） occurred.There is no standard treatment for advanced GC with PM.Until 1980s,the therapeutic arena for these patients had remained stagnant,with no therapeutic approach having shown a survival gain in GC with PM.However,cytoreductive surgery （CRS） with peritonectomy procedures and intraperitoneal chemotherapy （IPC） promising new combined therapeutic approach to achieve disease control for GC with PM.The recent publications changed the GC with PM treatment landscape by providing an evidence that CRS and IPC led to prolongation in overall survival （OS）.This review will provide an overview of the evolving role of CRS and IPC in the management of advanced GC with PM in the current era.
基金Supported by Cancer Research United KingdomWessex Medical Research
文摘AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).
文摘Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usually suffer abdominal distension, intestinal obstruction and various complications before they succumb after a median of 3 - 6 months. Although not adopted in most international treatment guidelines, intraperitoneal chemotherapy has growing evidence compared with conventional systemic chemotherapy for the treatment of peritoneal carcinomatosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is well-established for clinical benefit but is technically demanding with substantial treatment-related morbidities and mortality. On the other hand, normothermic intraperitoneal chemotherapy in the form of bidirectional neoadjuvant treatment is promising with various newer chemotherapeutic agents. Regardless of the treatment technique applied, the essential element of success is meticulous patient selection and availability of expertise. Future direction is along the line of personalized treatment with the application of translational science.
文摘Advanced stage epithelial ovarian cancer(EOC) is diffi cult to treat with low overall cure rates. A new strategy combining maximal cytoreductive surgery(CRS) with intraoperative hyperthermic intraperitoneal chemotherapy(HIPEC) has been proposed to treat advanced stage EOC in the primary setting. Numerous small, heterogeneous studies have been conducted exploring outcomes in patients with predominantly advanced, recurrent or refractory disease treated with CRS + HIPEC. Although morbidity rates approaching 35% have been reported, oncologic outcomes are promising. Incorporation of HIPEC for the treatment of primary EOC has continued to gain interest. Several prospective phase 2 clinical trials were recently completed evaluating the impact of CRS + HIPEC in the primary setting. This article will briefl y discuss the benefi ts of optimal surgical cytoreduction and the theoretical basis of intraperitoneal chemotherapy in patients with advanced stage EOC, and will then review existing literature describing oncologic outcomes in EOC patients treated with HIPEC in the primary setting.
文摘Objective To study the antineoplastic effect of the calcium channel blocker verapamil and 5-fluorouracil intraperitoneal chemotherapy onhepatocarcinoma-bearing rats, and examine the action between calcium channel blockers and cytotoxic drugs.Methods We adopted the method of subcapsular implantation of carcinoma tissues of walker-256 in the left liver lobe as a model of livercarcinoma-bearing rats. All experimental animals were divided into four groups. On the sixth day post implantation, in group A (controlgroup) 6 ml of saline was injected intraperitoneally once a day for 3 days. In group B (single chemotherapy group) 6 ml of 5-Fu 75 mg/kg was injected intraperitoneally once a day for 3 days. In group C (combination of treatment group) both 5-Fu (75 mg/kg) and verapamil(25 mg/kg) were administered simultaneously as in A and B. In group D (simple verapamil group) only 6 ml of verapamil (25 mg/kg)was administered as above.Results Compared with groups A, B and D, The volume of cancer and the contents of liver cancer DNA and protein were significantlyreduced. The rates of inhibiting cancer (89.9% in group C and 35.4% in group B) were significantly increased in group C. Group C hadsignificantly long survival time compared to groups A, B and D ( P < 0.05) . By light microscopy, a number of focal necroses were foundin cancer tissue in group C.Conclusion Calcium channel blockers can enhance the antineoplastic effect of 5-Fu intraperitoneal chemotherapy to liver cancer ; Theuse of verapamil can not increase the toxicity of 5-Fu.
基金New-Century Excellent Talents Supporting Program of the Ministry of Education of China NCET-04-0669Foundation for the Author of National Excellent Doctoral Dissertation of China+2 种基金 FANEDD-200464Young Talents Supporting Program of Hubei Province 301161202National Natural Science Foundation of China No. 20675058
文摘This article is to offer a concise review on the use of cytoreductive surgery （CRS） plus intraperitoneal hyperthermic chemotherapy （IPHC） for the treatment of peritoneal carcinomatosis （PC）. Traditionally, PC was treated with systemic chemotherapy alone with very poor response and a median survival of less than 6 too. With the establishment of several phase Ⅱ studies, a new trend has been developed toward the use of CRS plus IPHC as a standard method for treating selected patients with PC, in whom sufficient cytoreduction could be achieved. In spite of the need for more high quality phase Ⅲ studies, there is now a consensus among many surgical oncology experts throughout the world about the use of this new treatment strategy as standard care for colorectal cancer patients with PC. This review summarizes the current status and possible progress in future.
