BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperiton...BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperitoneal chemotherapy(HIPEC).C-reactive protein(CRP)is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications,as is the neutrophil-to-lymphocyte ratio(NLR).In patients with peritoneal carcinomatosis,postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections(OPIs)after CRS+/-HIPEC.METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital,in whom complete or optimal cytoreduction was achieved,were analyzed retrospectively.A total of 111 patients were included in this study.CRP and NRL evaluated.RESULTS Of the 111 patients included,19 presented OPI and 8 intra-abdominal infections.Patients with infections had a higher number of digestive anastomoses than those without(1 vs 0.5,P=0.053 and 1.2 vs 0.6,P=0.049)and longer length of stay(19 vs 14.9 days,P=0.022 and 22.3 vs 15.1 days,P=0.006).CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7%and a specificity of 74.2%to detect OPI.No differences in NLR values were observed.Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI.Subsequently,on POD3 and POD4,patients with OPI presented with higher levels of CRP than patients without infection,regardless of the immunonutrition intake.CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS.A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.展开更多
BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and ga...BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and gastric cancers,as well as for certain primary peritoneal tumors such as pseudomyxoma peritonei.However,evidence supporting its role in other uncommon indications remains limited,largely due to the rarity and heterogeneity of these malignancies and the absence of standardized treatment protocols.Understanding the potential survival benefit and safety profile of CRS+HIPEC in these contexts may help refine patient selection and guide clinical decision-making.AIM To evaluate surgical and oncologic outcomes,particularly overall survival(OS),in this heterogeneous patient population and assess perioperative morbidity and mortality to better define the safety profile of this aggressive multimodal strategy.METHODS We retrospectively reviewed data from five tertiary cancer centers on patients who underwent CRS+HIPEC between January 2004 and December 2021 for PM from uncommon histologies,defined as any primary tumor other than colorectal,gastric,or ovarian carcinomas,pseudomyxoma peritonei,or malignant peritoneal mesothelioma.Baseline characteristics,operative details,complications(graded by the Clavien-Dindo classification),and survival outcomes were analyzed.OS was estimated using Kaplan-Meier analysis.Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.The discriminatory ability and overall fit of the final model were assessed by the concordance index(C-index)and likelihood ratio test,respectively.RESULTS A total of 60 CRS+HIPEC procedures were performed in 60 patients(mean age=58.5 years,78.3%female).The most frequent primary tumors were uterine(35%)and breast cancer(20%).Median operative time was 405 minutes,and 75%of patients required perioperative transfusions.Major complications(Clavien-Dindo≥3)occurred in 21.6%of patients,and 90-day mortality was 1.6%.Median OS for the entire cohort was 28 months.Kaplan-Meier analysis showed that breast cancer patients achieved the longest survival(median OS=75 months)compared with uterine cancer(32 months)and other primaries(17 months).Multivariate analysis confirmed tumor origin as the strongest independent predictor of OS(C-index=0.81;likelihood ratio test=40.07;P<0.001).CONCLUSION Our findings suggest that CRS+HIPEC can be performed safely in highly selected patients with PM from uncommon primary tumors,achieving meaningful long-term survival in subsets such as breast and uterine cancers.Tumor biology,rather than clinical factors,emerged as the key determinant of survival.Given the rarity and heterogeneity of these malignancies,collaborative multicenter efforts and prospective registries are essential to establish standardized selection criteria and optimize outcomes.展开更多
This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024...This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024 and December 2024 were randomly assigned to two groups,with the observation group receiving APD and the reference group receiving CAPD.Renal function indicators,nutritional indicators,mineral metabolism,urine volume,and ultrafiltration volume changes were compared between the two groups.After treatment,the observation group showed lower renal function indicators,higher nutritional indicators,and better mineral metabolism levels compared to the reference group(P<0.05).While there was no significant difference in urine volume between the two groups(P>0.05),the observation group demonstrated superior ultrafiltration volume(P<0.05).These findings suggest that APD offers better clinical outcomes than CAPD by improving renal function,nutritional status,mineral metabolism regulation,and ultrafiltration efficiency in patients with end-stage renal disease.展开更多
As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is...As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is maximal cytoreductive surgery(CRS)combined with platinum-based chemotherapy.Compared with intravenous chemotherapy,traditional intraperitoneal(IP)chemotherapy exhibits obvious pharmacokinetic(PK)advantages and systemic safety and has shown significant survival benefits in several clinical studies of OC patients.However,there remain several challenges in traditional IP chemotherapy,such as insufficient drug retention,a lack of tumor targeting,inadequate drug penetration,gastrointestinal toxicity,and limited inhibition of tumor metastasis and chemoresistance.Nanomedicine-based IP targeting delivery systems,through specific drug carrier design with tumor cells and tumor environment(TME)targeting,make it possible to overcome these challenges and maximize local therapy efficacy while reducing side effects.In this review article,the rationale and challenges of nanomedicine-based IP chemotherapies,as well as their in vivo fate after IP administration,which are crucial for their rational design and clinical translation,are firstly discussed.Then,current strategies for nanomedicine-based targeting delivery systems and the relevant clinical trials in IP chemotherapy are summarized.Finally,the future directions of the nanomedicine-based IP targeting delivery system for OC and its peritoneal metastasis are proposed,expecting to improve the clinical development of IP chemotherapy.展开更多
In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in t...In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in the medical oncology community.A randomized trial(PRODIGE 7)on cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin.Nevertheless,isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver.Another tool is required in those patients to achieve more local control of the disease.Surgical groups in peritoneal surgery continue to use HIPEC in their procedures,using other agents than oxaliplatin for peritoneal cavity infusion,such as mitomycin C.These patients present with complex surgical issues to manage,and consequently a large burden of complications has to be anticipated.Therefore,identifying patients who will benefit from CRS with or without HIPEC would be of great interest.展开更多
BACKGROUND End-stage kidney disease is a growing global health burden with many patients requiring urgent kidney replacement therapy.Urgent-start peritoneal dialysis(PD)has emerged as a viable alternative to hemodialy...BACKGROUND End-stage kidney disease is a growing global health burden with many patients requiring urgent kidney replacement therapy.Urgent-start peritoneal dialysis(PD)has emerged as a viable alternative to hemodialysis particularly in resourcelimited settings.However,concerns remain regarding catheter-related complications associated with early initiation of PD.Automated PD(APD)offers enhanced flexibility and fluid management,but evidence regarding its safety and outcomes in urgent-start scenarios with shortened break-in periods is limited.AIM To evaluate the clinical outcomes and biochemical changes associated with urgent-start APD with a shortened break-in period.METHODS This was a single center,observational study that included 62 patients with endstage kidney disease who required urgent-start dialysis,underwent PD catheter placement,and received APD.Patients were stratified based on catheter opening time(<12 hours vs>12 hours).Catheter-related complications,biochemical parameters,and dialysis efficacy were analyzed.RESULTS The median catheter opening time was 11 h(interquartile range:8-14 hours).No significant differences in catheterrelated complications were observed between groups(P>0.05).Catheter dysfunction,migration,leakage,and replacement occurred in 14.5%,9.7%,12.9%,and 11.3%of patients,respectively.APD led to significant reductions in serum creatinine,blood urea nitrogen,urea,phosphorus,and potassium(P<0.05),alongside correction of metabolic acidosis.No cases of peritonitis or hemoperitoneum were observed.CONCLUSION Urgent-start APD with shortened break-in appears safe with low complication rates and improved biochemical outcomes.展开更多
Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due...Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.展开更多
BACKGROUND Peritoneal metastases(PM)represent the most frequent and lethal form of dissemination in advanced gastric cancer(GC),with limited efficacy of systemic chemotherapy[median overall survival(OS):2-9 months].Ov...BACKGROUND Peritoneal metastases(PM)represent the most frequent and lethal form of dissemination in advanced gastric cancer(GC),with limited efficacy of systemic chemotherapy[median overall survival(OS):2-9 months].Over the past decades,hyperthermic intraperitoneal chemotherapy(HIPEC),often combined with cytoreductive surgery(CRS),has emerged as a locoregional strategy to improve peritoneal disease control.Retrospective studies have suggested promising survival benefits(median OS:18.8 months);however,conflicting results from prospective trials have limited its widespread adoption.This systematic review hypothesizes that selected patients with advanced or high-risk GC may benefit from HIPEC and evaluates whether such benefits have been confirmed in recent prospective evidence.AIM To evaluate the role and outcomes of HIPEC in advanced and high-risk GC through a systematic review of prospective trials.METHODS A systematic review of prospective randomized and controlled clinical trials(2010-2024)was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.Studies were selected from PubMed,Cochrane,Scopus,and ClinicalTrials.gov.No geographical restrictions were applied in the search process.Eligible studies included patients with advanced GC(T3+,positive peritoneal cytology/PM)receiving HIPEC in either therapeutic or prophylactic settings.Exclusion criteria included retrospective studies,single-arm trials,and those lacking survival outcomes.Risk of bias was assessed using Risk of Bias 2.0 and Risk of Bias in Non-Randomized Studies of Interventions tools;sensitivity and heterogeneity analyses were also conducted.RESULTS Thirteen prospective studies(eight therapeutic,five prophylactic)were included.In therapeutic settings,CRS combined with HIPEC yielded a median OS of 11-24.9 months vs 4-6 months with systemic therapy alone.Completeness of cytoreduction(CC-0)was achieved in 67.3%of cases,and associated with improved disease-free survival.In prophylactic settings,HIPEC significantly reduced peritoneal recurrence,particularly in T4 tumors.Sensitivity analyses confirmed robustness of findings,though benefit was driven by a few key trials.Heterogeneity was moderate across studies;lack of standardized HIPEC protocols and patient selection criteria limited comparability.CONCLUSION HIPEC may improve survival and reduce recurrence in selected GC patients,particularly those with low peritoneal burden and CC-0 resection.Further standardization and prospective trials are needed.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
Locoregional spread of abdominopelvic malignant tumors frequently results in peritoneal carcinomatosis(PC). The prognosis of PC patients treated by conventional systemic chemotherapy is poor, with a median survival of...Locoregional spread of abdominopelvic malignant tumors frequently results in peritoneal carcinomatosis(PC). The prognosis of PC patients treated by conventional systemic chemotherapy is poor, with a median survival of < 6 mo. However, over the past three decades, an integrated treatment strategy of cytoreductive surgery(CRS) + hyperthermic intraperitoneal chemotherapy(HIPEC) has been developed by the pioneering oncologists, with proved efficacy and safety in selected patients. Supported by several lines of clinical evidence from phases Ⅰ, Ⅱ and Ⅲ clinical trials, CRS + HIPEC has been regarded as the standard treatment for selected patients with PC in many established cancer centers worldwide. In China, an expert consensus on CRS + HIPEC has been reached by the leading surgical and medical oncologists, under the framework of the China Anti-Cancer Association. This expert consensus has summarized the progress in PC clinical studies and systematically evaluated the CRS + HIPEC procedures in China as well as across the world, so as to lay the foundation for formulating PC treatment guidelines specific to the national conditions of China.展开更多
Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen r...Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen ratio(AFR)for PC in patients with gastric cancer and to develop two preoperative prediction models.Methods A total of 745 gastric cancer patients were included in this study.Preoperative AFR,along with other serum markers and clinical tumor characteristics,was assessed.Univariate and multivariate logistic regression analyses were performed to determine the odds ratios(ORs)and 95%confidence intervals(CIs)of the independent variables.Propensity score matching(PSM)was used to control for potential confounders,and one-way ANOVA was conducted to evaluate differences in distribution between groups.Two prediction models incorporating the independent predictive indicators were constructed and validated via receiver operating characteristic(ROC)curves.Results Poorly differentiated type(OR 2.679;P=0.001),nondiffuse morphological type(OR 2.123;P=0.040),BMI<23.550 kg/m^(2)(OR 4.635;P=0.001),AFR<11.275(OR 2.895;P=0.003)and CA199≥73.615 U/mL(OR 2.040;P=0.037)were identified as independent risk factors for PC in patients with gastric cancer.After PSM,the AFR remained the only inflammatory marker that was independently associated with PC(P=0.003).AFR demonstrated consistent robustness in predicting PC across multiple sample sets.Among all the independent risk factors,the AFR had the highest area under the curve(AUC)for ROC analysis(AUC 0.648;95%CI 0.580–0.715).Two combination models incorporating the AFR demonstrated enhanced predictive ability:Combination Model 1(AUC 0.759;95%CI 0.699–0.820)and Combination Model 2(AUC 0.801;95%CI 0.744–0.859).Conclusions The preoperative AFR serves as a useful indicator for predicting PC.Two reliable prediction models based on the AFR have been developed.展开更多
Ovarian cancer has as its predominant pattern of dissemination metastases to the peritoneal surfaces and disease spread within the abdomen and pelvis that most commonly causes the patients demise. To combat peritoneal...Ovarian cancer has as its predominant pattern of dissemination metastases to the peritoneal surfaces and disease spread within the abdomen and pelvis that most commonly causes the patients demise. To combat peritoneal metastases, cytoreductive surgery with peritoneal and visceral resections is combined with intraperitoneal and systemic chemotherapy. Chemotherapy given in the operating room after the complete visible removal of ovarian cancer is hyperthermic intraperitoneal chemotherapy. The results of the combined treatment are determined by the extent of prior surgery, the extent of disease as established by the peritoneal cancer index, and the quality of the cytoreduction as measured by the completeness of cytoreduction score. Recent clinical information on patients with recurrent ovarian cancer suggest a median overall survival of up to 60 mo. These data are greatly improved over the one year survival observed in the past.展开更多
BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female pat...BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.展开更多
The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte rati...The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte ratio(NLR)as a predictor of overall survival(OS)and developed a nomogram incorporating NLR,hemoglobin(Hb),and peritoneal cancer index(PCI)to estimate 1-and 2-year survival.Although the nomogram shows high accuracy,the group of patients analyzed is heterogeneous with respect to the surgical treatment received,and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI(≥20).Patient selection for cytoreductive surgery with hyper-thermic intraperitoneal chemotherapy requires a multidisciplinary approach.Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.While methodologically sound,the study does not consider the effect of treatment received on OS,thus introducing a potential bias.展开更多
BACKGROUND Studies on the application of recombinant human endostatin(RH-endostatin)intraperitoneal perfusion in gastric cancer(GC)with malignant ascites are limited.AIM To explore the effectiveness,prognosis,and safe...BACKGROUND Studies on the application of recombinant human endostatin(RH-endostatin)intraperitoneal perfusion in gastric cancer(GC)with malignant ascites are limited.AIM To explore the effectiveness,prognosis,and safety of intraperitoneal RH-endostatin perfusion in treating patients with GC and malignant ascites.METHODS Patients with GC and malignant ascites were divided into the cisplatin intraperi-toneal perfusion(control group)group and the cisplatin combined with RH-endostatin intraperitoneal perfusion group(RH-endostatin group).Efficient ascites control,overall survival(OS),quality of life,and adverse events were observed,and possible influencing factors on prognosis outcomes analyzed.RESULTS We identified no significant differences in baseline characteristics between the control and RH-endostatin groups.The latter group had higher ascites control rates than the control group.Treatment methods were identified as an independent OS factor.Clinically,RH-endostatin-treated patients had significantly improved OS rates when compared with control patients,particularly in those with small and moderate ascites volumes.Quality of life improvements in control patients were significantly lower when compared with RH-endostatin patients.Adverse events were balanced between the groups.CONCLUSION Overall,intraperitoneal RH-endostatin improved treatment efficacy and prolonged prognosis in patients with GC and malignant ascites.This approach may benefit further clinical applications for treating GC.展开更多
In this article,we critically appraise the study by Wu et al,which investigated the prognostic value of preoperative inflammatory and nutritional markers in colorectal cancer patients with peritoneal metastasis.This r...In this article,we critically appraise the study by Wu et al,which investigated the prognostic value of preoperative inflammatory and nutritional markers in colorectal cancer patients with peritoneal metastasis.This retrospective cohort study included 133 patients.The findings indicate that patients with high neutrophil-to-lymphocyte ratios(NLRs)or lower hemoglobin(Hb)levels have significantly shorter overall survival(OS)than those with lower NLRs or normal Hb levels,respectively.Furthermore,age,carbohydrate antigen 199 levels,the NLR,Hb,and the peritoneal cancer index were identified as independent prognostic factors for OS.A nomogram was subsequently developed,demon-strating its ability to accurately predict the OS of colorectal cancer patients with peritoneal metastasis.This study introduces a potentially valuable prognostic tool for these patients.However,further validation in multicenter cohorts is needed to confirm its clinical applicability,to assess its limitations,and to elucidate the underlying mechanism of these identified biomarkers.展开更多
BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct p...BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.展开更多
BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM T...BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1,and to evaluate the optimal postoperative chemotherapy regimen.METHODS This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy,excluding those with macroscopic peritoneal dissemination.Data from 13 institutions(2015-2019)were reviewed.RESULTS Overall,82 patients met the inclusion criteria.The median overall survival was 22.8 months,and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors.The 5-year survival rate was 82.4%for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8%for those with S-1 monotherapy or a cisplatin-based regimen.Median overall survival was not reached in the fluoropyrimidine+docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group.Chemotherapy regimen was an independent prognostic factor(hazard ratio=5.47,P=0.004).The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%,with significantly more patients achieving a relative dose intensity≥80%than in the S-1 monotherapy or cisplatin-based group(P=0.001).CONCLUSION Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer.Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.展开更多
BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy ...BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients.Achieving complete cytoreduction,indicated by a low completeness of cytoreduction(CCR)score,is a key factor in extending survival.Here,we present a case in which multimodal therapy yielded long-term survival in a patient,even though she had a CCR score of 3.CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention.Cytoreductive surgery was not completed due to the extent of the disease(CCR score:3).The patient underwent palliative omen-tectomy,followed by hyperthermic intraperitoneal chemotherapy with mitomycin C,and early postoperative intraperitoneal chemotherapy.She subsequently received systemic chemotherapy,which was terminated after 19 cycles and two dose reductions due to side effects.She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease,even with high CCR scores.展开更多
BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly s...BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.展开更多
文摘BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperitoneal chemotherapy(HIPEC).C-reactive protein(CRP)is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications,as is the neutrophil-to-lymphocyte ratio(NLR).In patients with peritoneal carcinomatosis,postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections(OPIs)after CRS+/-HIPEC.METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital,in whom complete or optimal cytoreduction was achieved,were analyzed retrospectively.A total of 111 patients were included in this study.CRP and NRL evaluated.RESULTS Of the 111 patients included,19 presented OPI and 8 intra-abdominal infections.Patients with infections had a higher number of digestive anastomoses than those without(1 vs 0.5,P=0.053 and 1.2 vs 0.6,P=0.049)and longer length of stay(19 vs 14.9 days,P=0.022 and 22.3 vs 15.1 days,P=0.006).CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7%and a specificity of 74.2%to detect OPI.No differences in NLR values were observed.Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI.Subsequently,on POD3 and POD4,patients with OPI presented with higher levels of CRP than patients without infection,regardless of the immunonutrition intake.CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS.A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.
文摘BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and gastric cancers,as well as for certain primary peritoneal tumors such as pseudomyxoma peritonei.However,evidence supporting its role in other uncommon indications remains limited,largely due to the rarity and heterogeneity of these malignancies and the absence of standardized treatment protocols.Understanding the potential survival benefit and safety profile of CRS+HIPEC in these contexts may help refine patient selection and guide clinical decision-making.AIM To evaluate surgical and oncologic outcomes,particularly overall survival(OS),in this heterogeneous patient population and assess perioperative morbidity and mortality to better define the safety profile of this aggressive multimodal strategy.METHODS We retrospectively reviewed data from five tertiary cancer centers on patients who underwent CRS+HIPEC between January 2004 and December 2021 for PM from uncommon histologies,defined as any primary tumor other than colorectal,gastric,or ovarian carcinomas,pseudomyxoma peritonei,or malignant peritoneal mesothelioma.Baseline characteristics,operative details,complications(graded by the Clavien-Dindo classification),and survival outcomes were analyzed.OS was estimated using Kaplan-Meier analysis.Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.The discriminatory ability and overall fit of the final model were assessed by the concordance index(C-index)and likelihood ratio test,respectively.RESULTS A total of 60 CRS+HIPEC procedures were performed in 60 patients(mean age=58.5 years,78.3%female).The most frequent primary tumors were uterine(35%)and breast cancer(20%).Median operative time was 405 minutes,and 75%of patients required perioperative transfusions.Major complications(Clavien-Dindo≥3)occurred in 21.6%of patients,and 90-day mortality was 1.6%.Median OS for the entire cohort was 28 months.Kaplan-Meier analysis showed that breast cancer patients achieved the longest survival(median OS=75 months)compared with uterine cancer(32 months)and other primaries(17 months).Multivariate analysis confirmed tumor origin as the strongest independent predictor of OS(C-index=0.81;likelihood ratio test=40.07;P<0.001).CONCLUSION Our findings suggest that CRS+HIPEC can be performed safely in highly selected patients with PM from uncommon primary tumors,achieving meaningful long-term survival in subsets such as breast and uterine cancers.Tumor biology,rather than clinical factors,emerged as the key determinant of survival.Given the rarity and heterogeneity of these malignancies,collaborative multicenter efforts and prospective registries are essential to establish standardized selection criteria and optimize outcomes.
文摘This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024 and December 2024 were randomly assigned to two groups,with the observation group receiving APD and the reference group receiving CAPD.Renal function indicators,nutritional indicators,mineral metabolism,urine volume,and ultrafiltration volume changes were compared between the two groups.After treatment,the observation group showed lower renal function indicators,higher nutritional indicators,and better mineral metabolism levels compared to the reference group(P<0.05).While there was no significant difference in urine volume between the two groups(P>0.05),the observation group demonstrated superior ultrafiltration volume(P<0.05).These findings suggest that APD offers better clinical outcomes than CAPD by improving renal function,nutritional status,mineral metabolism regulation,and ultrafiltration efficiency in patients with end-stage renal disease.
基金supported by the National Key R&D Program of China(No.2020YFE0201700)the Liaoning Revitalization Talents Program(No.XLYC1908031)。
文摘As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is maximal cytoreductive surgery(CRS)combined with platinum-based chemotherapy.Compared with intravenous chemotherapy,traditional intraperitoneal(IP)chemotherapy exhibits obvious pharmacokinetic(PK)advantages and systemic safety and has shown significant survival benefits in several clinical studies of OC patients.However,there remain several challenges in traditional IP chemotherapy,such as insufficient drug retention,a lack of tumor targeting,inadequate drug penetration,gastrointestinal toxicity,and limited inhibition of tumor metastasis and chemoresistance.Nanomedicine-based IP targeting delivery systems,through specific drug carrier design with tumor cells and tumor environment(TME)targeting,make it possible to overcome these challenges and maximize local therapy efficacy while reducing side effects.In this review article,the rationale and challenges of nanomedicine-based IP chemotherapies,as well as their in vivo fate after IP administration,which are crucial for their rational design and clinical translation,are firstly discussed.Then,current strategies for nanomedicine-based targeting delivery systems and the relevant clinical trials in IP chemotherapy are summarized.Finally,the future directions of the nanomedicine-based IP targeting delivery system for OC and its peritoneal metastasis are proposed,expecting to improve the clinical development of IP chemotherapy.
文摘In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in the medical oncology community.A randomized trial(PRODIGE 7)on cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin.Nevertheless,isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver.Another tool is required in those patients to achieve more local control of the disease.Surgical groups in peritoneal surgery continue to use HIPEC in their procedures,using other agents than oxaliplatin for peritoneal cavity infusion,such as mitomycin C.These patients present with complex surgical issues to manage,and consequently a large burden of complications has to be anticipated.Therefore,identifying patients who will benefit from CRS with or without HIPEC would be of great interest.
文摘BACKGROUND End-stage kidney disease is a growing global health burden with many patients requiring urgent kidney replacement therapy.Urgent-start peritoneal dialysis(PD)has emerged as a viable alternative to hemodialysis particularly in resourcelimited settings.However,concerns remain regarding catheter-related complications associated with early initiation of PD.Automated PD(APD)offers enhanced flexibility and fluid management,but evidence regarding its safety and outcomes in urgent-start scenarios with shortened break-in periods is limited.AIM To evaluate the clinical outcomes and biochemical changes associated with urgent-start APD with a shortened break-in period.METHODS This was a single center,observational study that included 62 patients with endstage kidney disease who required urgent-start dialysis,underwent PD catheter placement,and received APD.Patients were stratified based on catheter opening time(<12 hours vs>12 hours).Catheter-related complications,biochemical parameters,and dialysis efficacy were analyzed.RESULTS The median catheter opening time was 11 h(interquartile range:8-14 hours).No significant differences in catheterrelated complications were observed between groups(P>0.05).Catheter dysfunction,migration,leakage,and replacement occurred in 14.5%,9.7%,12.9%,and 11.3%of patients,respectively.APD led to significant reductions in serum creatinine,blood urea nitrogen,urea,phosphorus,and potassium(P<0.05),alongside correction of metabolic acidosis.No cases of peritonitis or hemoperitoneum were observed.CONCLUSION Urgent-start APD with shortened break-in appears safe with low complication rates and improved biochemical outcomes.
文摘Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.
文摘BACKGROUND Peritoneal metastases(PM)represent the most frequent and lethal form of dissemination in advanced gastric cancer(GC),with limited efficacy of systemic chemotherapy[median overall survival(OS):2-9 months].Over the past decades,hyperthermic intraperitoneal chemotherapy(HIPEC),often combined with cytoreductive surgery(CRS),has emerged as a locoregional strategy to improve peritoneal disease control.Retrospective studies have suggested promising survival benefits(median OS:18.8 months);however,conflicting results from prospective trials have limited its widespread adoption.This systematic review hypothesizes that selected patients with advanced or high-risk GC may benefit from HIPEC and evaluates whether such benefits have been confirmed in recent prospective evidence.AIM To evaluate the role and outcomes of HIPEC in advanced and high-risk GC through a systematic review of prospective trials.METHODS A systematic review of prospective randomized and controlled clinical trials(2010-2024)was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.Studies were selected from PubMed,Cochrane,Scopus,and ClinicalTrials.gov.No geographical restrictions were applied in the search process.Eligible studies included patients with advanced GC(T3+,positive peritoneal cytology/PM)receiving HIPEC in either therapeutic or prophylactic settings.Exclusion criteria included retrospective studies,single-arm trials,and those lacking survival outcomes.Risk of bias was assessed using Risk of Bias 2.0 and Risk of Bias in Non-Randomized Studies of Interventions tools;sensitivity and heterogeneity analyses were also conducted.RESULTS Thirteen prospective studies(eight therapeutic,five prophylactic)were included.In therapeutic settings,CRS combined with HIPEC yielded a median OS of 11-24.9 months vs 4-6 months with systemic therapy alone.Completeness of cytoreduction(CC-0)was achieved in 67.3%of cases,and associated with improved disease-free survival.In prophylactic settings,HIPEC significantly reduced peritoneal recurrence,particularly in T4 tumors.Sensitivity analyses confirmed robustness of findings,though benefit was driven by a few key trials.Heterogeneity was moderate across studies;lack of standardized HIPEC protocols and patient selection criteria limited comparability.CONCLUSION HIPEC may improve survival and reduce recurrence in selected GC patients,particularly those with low peritoneal burden and CC-0 resection.Further standardization and prospective trials are needed.
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.
基金Supported by Key Project of the National Natural Science Foundation of China,No.81230031
文摘Locoregional spread of abdominopelvic malignant tumors frequently results in peritoneal carcinomatosis(PC). The prognosis of PC patients treated by conventional systemic chemotherapy is poor, with a median survival of < 6 mo. However, over the past three decades, an integrated treatment strategy of cytoreductive surgery(CRS) + hyperthermic intraperitoneal chemotherapy(HIPEC) has been developed by the pioneering oncologists, with proved efficacy and safety in selected patients. Supported by several lines of clinical evidence from phases Ⅰ, Ⅱ and Ⅲ clinical trials, CRS + HIPEC has been regarded as the standard treatment for selected patients with PC in many established cancer centers worldwide. In China, an expert consensus on CRS + HIPEC has been reached by the leading surgical and medical oncologists, under the framework of the China Anti-Cancer Association. This expert consensus has summarized the progress in PC clinical studies and systematically evaluated the CRS + HIPEC procedures in China as well as across the world, so as to lay the foundation for formulating PC treatment guidelines specific to the national conditions of China.
文摘Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen ratio(AFR)for PC in patients with gastric cancer and to develop two preoperative prediction models.Methods A total of 745 gastric cancer patients were included in this study.Preoperative AFR,along with other serum markers and clinical tumor characteristics,was assessed.Univariate and multivariate logistic regression analyses were performed to determine the odds ratios(ORs)and 95%confidence intervals(CIs)of the independent variables.Propensity score matching(PSM)was used to control for potential confounders,and one-way ANOVA was conducted to evaluate differences in distribution between groups.Two prediction models incorporating the independent predictive indicators were constructed and validated via receiver operating characteristic(ROC)curves.Results Poorly differentiated type(OR 2.679;P=0.001),nondiffuse morphological type(OR 2.123;P=0.040),BMI<23.550 kg/m^(2)(OR 4.635;P=0.001),AFR<11.275(OR 2.895;P=0.003)and CA199≥73.615 U/mL(OR 2.040;P=0.037)were identified as independent risk factors for PC in patients with gastric cancer.After PSM,the AFR remained the only inflammatory marker that was independently associated with PC(P=0.003).AFR demonstrated consistent robustness in predicting PC across multiple sample sets.Among all the independent risk factors,the AFR had the highest area under the curve(AUC)for ROC analysis(AUC 0.648;95%CI 0.580–0.715).Two combination models incorporating the AFR demonstrated enhanced predictive ability:Combination Model 1(AUC 0.759;95%CI 0.699–0.820)and Combination Model 2(AUC 0.801;95%CI 0.744–0.859).Conclusions The preoperative AFR serves as a useful indicator for predicting PC.Two reliable prediction models based on the AFR have been developed.
文摘Ovarian cancer has as its predominant pattern of dissemination metastases to the peritoneal surfaces and disease spread within the abdomen and pelvis that most commonly causes the patients demise. To combat peritoneal metastases, cytoreductive surgery with peritoneal and visceral resections is combined with intraperitoneal and systemic chemotherapy. Chemotherapy given in the operating room after the complete visible removal of ovarian cancer is hyperthermic intraperitoneal chemotherapy. The results of the combined treatment are determined by the extent of prior surgery, the extent of disease as established by the peritoneal cancer index, and the quality of the cytoreduction as measured by the completeness of cytoreduction score. Recent clinical information on patients with recurrent ovarian cancer suggest a median overall survival of up to 60 mo. These data are greatly improved over the one year survival observed in the past.
文摘BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.
文摘The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte ratio(NLR)as a predictor of overall survival(OS)and developed a nomogram incorporating NLR,hemoglobin(Hb),and peritoneal cancer index(PCI)to estimate 1-and 2-year survival.Although the nomogram shows high accuracy,the group of patients analyzed is heterogeneous with respect to the surgical treatment received,and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI(≥20).Patient selection for cytoreductive surgery with hyper-thermic intraperitoneal chemotherapy requires a multidisciplinary approach.Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.While methodologically sound,the study does not consider the effect of treatment received on OS,thus introducing a potential bias.
基金Supported by Scientific Research Project of Tianjin Municipal Education Commission,No.2018KJ015.
文摘BACKGROUND Studies on the application of recombinant human endostatin(RH-endostatin)intraperitoneal perfusion in gastric cancer(GC)with malignant ascites are limited.AIM To explore the effectiveness,prognosis,and safety of intraperitoneal RH-endostatin perfusion in treating patients with GC and malignant ascites.METHODS Patients with GC and malignant ascites were divided into the cisplatin intraperi-toneal perfusion(control group)group and the cisplatin combined with RH-endostatin intraperitoneal perfusion group(RH-endostatin group).Efficient ascites control,overall survival(OS),quality of life,and adverse events were observed,and possible influencing factors on prognosis outcomes analyzed.RESULTS We identified no significant differences in baseline characteristics between the control and RH-endostatin groups.The latter group had higher ascites control rates than the control group.Treatment methods were identified as an independent OS factor.Clinically,RH-endostatin-treated patients had significantly improved OS rates when compared with control patients,particularly in those with small and moderate ascites volumes.Quality of life improvements in control patients were significantly lower when compared with RH-endostatin patients.Adverse events were balanced between the groups.CONCLUSION Overall,intraperitoneal RH-endostatin improved treatment efficacy and prolonged prognosis in patients with GC and malignant ascites.This approach may benefit further clinical applications for treating GC.
文摘In this article,we critically appraise the study by Wu et al,which investigated the prognostic value of preoperative inflammatory and nutritional markers in colorectal cancer patients with peritoneal metastasis.This retrospective cohort study included 133 patients.The findings indicate that patients with high neutrophil-to-lymphocyte ratios(NLRs)or lower hemoglobin(Hb)levels have significantly shorter overall survival(OS)than those with lower NLRs or normal Hb levels,respectively.Furthermore,age,carbohydrate antigen 199 levels,the NLR,Hb,and the peritoneal cancer index were identified as independent prognostic factors for OS.A nomogram was subsequently developed,demon-strating its ability to accurately predict the OS of colorectal cancer patients with peritoneal metastasis.This study introduces a potentially valuable prognostic tool for these patients.However,further validation in multicenter cohorts is needed to confirm its clinical applicability,to assess its limitations,and to elucidate the underlying mechanism of these identified biomarkers.
文摘BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.
文摘BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1,and to evaluate the optimal postoperative chemotherapy regimen.METHODS This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy,excluding those with macroscopic peritoneal dissemination.Data from 13 institutions(2015-2019)were reviewed.RESULTS Overall,82 patients met the inclusion criteria.The median overall survival was 22.8 months,and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors.The 5-year survival rate was 82.4%for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8%for those with S-1 monotherapy or a cisplatin-based regimen.Median overall survival was not reached in the fluoropyrimidine+docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group.Chemotherapy regimen was an independent prognostic factor(hazard ratio=5.47,P=0.004).The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%,with significantly more patients achieving a relative dose intensity≥80%than in the S-1 monotherapy or cisplatin-based group(P=0.001).CONCLUSION Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer.Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.
基金Supported by a Research Fund from Dankook University in 2024,No.R202400759.
文摘BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients.Achieving complete cytoreduction,indicated by a low completeness of cytoreduction(CCR)score,is a key factor in extending survival.Here,we present a case in which multimodal therapy yielded long-term survival in a patient,even though she had a CCR score of 3.CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention.Cytoreductive surgery was not completed due to the extent of the disease(CCR score:3).The patient underwent palliative omen-tectomy,followed by hyperthermic intraperitoneal chemotherapy with mitomycin C,and early postoperative intraperitoneal chemotherapy.She subsequently received systemic chemotherapy,which was terminated after 19 cycles and two dose reductions due to side effects.She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease,even with high CCR scores.
文摘BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.
