This issue of the Surgical Oncology Clinics of North America, Guest Edited by Dr. Jesus Esquivel, will focus on the current status and future directions of the treatment of the most common peritoneal surface malignancies: appendix cancer, colorectal cancer, ovarian cancer, gastric cancer, and peritoneal mesothelioma. This issue will also outline some of the most common issues that arise regarding cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), such as pharmacokinetic rationale of heat and intraperitoneal chemotherapy, HIPEC techniques and safety considerations, how to start a peritoneal surface malignancy program, anesthesia considerations during cytoreductive surgery and HIPEC, patient selection for cytoreductive surgery and HIPEC, and the role of dystemic chemotherapy in the management of peritoneal surface malignancies of appendiceal and colorectal origin.
This book has been designed to provide the full description of the comprehensive management of peritoneal surface malignancies as a new emerging specialty. Combined treatment of cytoreductive surgery (CRS) and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) introduced by our leader Paul H. Sugarbaker are performed to treat peritoneal metastases by surgeons all around the world. Therefore this book is focused on detailed surgical anatomy of the peritoneum, preoperative clinical assessment of the peritoneal surface malignancy, patient preparation and operation room equipments, different surgical procedures for CRS and reconstruction, intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and neoadjuvant intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy (EPIC) and molecular basis of peritoneal surface malignancies. The chapter on molecular mechanisms of the formation of peritoneal carcinomatosis provides insight into a rapidly expanding knowledge within this speciality. This book should be valuable for surgical oncologists who deal with multimodal treatment for peritoneal surface malignancies, as well as for the trained peritonectomy surgeons. For the senior surgeons, it will also introduce new techniques and approaches in this field such as dealing with the omental cakes and massive organ involvement that requires multi-organ resection.
The widespread acceptance among the oncology community at large of cytoreductive surgery and HIPEC as a potentially curative treatment for peritoneal metastases has paved the way for innovative new therapies that could benefit a larger proportion of patients. Much has been and continues to be published on this subject. This book provides comprehensive reviews on the various aspects of managing peritoneal metastases. The authors highlight essential practical issues that surgical oncologists encounter in their day-to-day practice, and try to before provide evidence based answers to address them. All chapters were written and/or reviewed by leading experts in this field.
This issue of the Surgical Oncology Clinics of North America, Guest Edited by Dr. Jesus Esquivel, will focus on the current status and future directions of the treatment of the most common peritoneal surface malignancies: appendix cancer, colorectal cancer, ovarian cancer, gastric cancer, and peritoneal mesothelioma. This issue will also outline some of the most common issues that arise regarding cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), such as pharmacokinetic rationale of heat and intraperitoneal chemotherapy, HIPEC techniques and safety considerations, how to start a peritoneal surface malignancy program, anesthesia considerations during cytoreductive surgery and HIPEC, patient selection for cytoreductive surgery and HIPEC, and the role of dystemic chemotherapy in the management of peritoneal surface malignancies of appendiceal and colorectal origin.
This monograph summarizes state of the art knowledge regarding peritoneal surface malignancies, with in-depth description of treatment options and the results achieved to date. It explores the most challenging problems on the basis of the authors’ very extensive clinical experience and examines the most relevant clinical trials. A comprehensive summary is provided of all phase 2 studies (the only available completed studies) and of ongoing and future phase 3 studies. Particular attention is paid to the results of integrated treatment comprising cytoreduction (peritonectomy) and hyperthermic intraperitoneal chemotherapy (HIPEC). Helpful background information is also included on the definition and clinical assessment of each clinical form. The book, drawing on data from the entire Italian experience as well as world literature, will be an outstanding benchmark for health professionals and researchers.
This issue of Surgical Oncology Clinics of North America, guest edited by Dr. Edward A. Levine, is devoted to Treatment of Peritoneal Metastasis. Dr. Levine has assembled expert authors to review the following topics: History of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy; Imaging for peritoneal metastases; Patient selection for cytoreductive surgery; Pharmacodynamics and pharmacokinetics of intraperitoneal chemotherapy; Genomics and peritoneal metastases; Techniques and safety issue for intraperitoneal chemotherapy; Learning curve for cytoreductive surgery; Peritoneal metastases from gastric cancer; Peritoneal metastases from mesothelioma; Peritoneal metastases from appendiceal cancer; Peritoneal metastasis from colorectal cancer; Peritoneal metastases from ovarian cancer; Palliative care of advanced peritoneal disease; and more!
This issue of Surgical Oncology Clinics of North America, guest edited by Dr. Michael I. D'Angelica, is devoted to Management of Metastatic Liver Tumors. Dr. D'Angelica has assembled expert authors to review the following topics: Surgical management of liver metastases of colorectal cancer; Surgical management of liver metastases of breast cancer; Surgical management of liver metastases of neuroendocrine tumors; Surgical management of liver metastases of sarcoma (including GIST); Surgical management of liver metastases of gynecologic cancers; Surgical management of liver metastases of genitourinary cancers; Surgical management of liver metastases of uveal and dermal melanoma; Is there a role for locoregional therapies for non-colorectal GI malignancies?; Intra-arterial chemotherapy for liver metastases; External beam radiation for liver metastases; Isolated hepatic perfusion for liver metastases; Debate: Improvements in systemic therapies for liver metastases will soon render locoregional treatments obsolete; Debate: Improvements in systemic therapies for liver metastases will increase the role of locoregional treatments; and more!
Peritoneal dissemination is a common route of cancer metastasis. The benefit of administering chemotherapy directly into the peritoneal cavity is supported by preclinical and pharmacokinetic data. In comparison to intravenous (IV) treatment, intraperitoneal (IP) administration results in a several-fold increase in drug concentration within the abdominal cavity. There is now growing evidence from clinical studies showing a survival advantage for IP chemotherapy in various tumor typies, including ovarian, gastric and colorectal cancer. However, while the use of IP chemotherapy is slowly gaining acceptance, it is not universal, largely due to the greater toxicity associated with this approach. Moreover, efficacy of IP chemotherapy is limited by poor distribution within the abdominal cavity and by poor tissue penetration. A new way of IP chemotherapy is the application of cytotoxics in form of a pressurized aerosol into the abdominal of thoracic cavity. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is applied through laparoscopic access using two balloon trocars in an operating room equipped with laminar air-flow. In a first step,a normothermic capnoperitoneum is established with a pressure of 12 mmHg. A cytotoxic solution (about 10% of a normal systemic dose) is nebulized with a micropump into the abdominal cavity, and maintained for 30 min. The aerosol is then removed through a closed suction system. Applying an aerosol in the peritoneal cavity allows a homogeneous distribution of the chemotherapeutic agent within the abdomen. Furthermore, an artificial pressure gradient is generated that overcomes tumoral interstitial fluid pressure, an obstacle in cancer therapy. This results in a higher local drug concentration compared to conventional IP or IV chemotherapy. At the same time the plasma concentration of the chemotherapeutic agent remains low. In first clinical studies with limited number of patients in ovarian, gastric and colorectal cancer, as well as peritoneal mesothelioma, PIPAC has obtained encouraging tumor response rates and survival, with a low-side effects profile. Larger clinical trials are currently ongoing to examine if these data can be reproduced and extrapolated to other situations.
This is the first volume to provide a multidisciplinary approach to peritoneal carcinomatosis encompassing molecular mechanisms, histopathology, regional and systemic cytotoxic therapy, and surgical options. Illustrations aid the reader throughout in the many facets of this disease. The book will be of particular interest for medical, surgical and gynecological oncologists faced with the complexities of decision making in patients suffering from PC.
