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Background@#Ovarian, fallopian tube, and peritoneal cancer patients with advanced-stage diagnosis or recurrences spread to the peritoneal surface of the abdomen. Hyperthermic intraperitoneal chemotherapy (HIPEC) can penetrate and eradicate tumors that are microscopic up to those with a diameter of 2.5 cm from the peritoneal surface following cytoreductive surgery (CRS). @*Objectives@#The study aimed to determine the efficacy and safety of CRS with HIPEC versus CRS alone for patients with epithelial ovarian, fallopian tube, and peritoneal cancer. @*Materials and Methods@#This retrospective cohort study included 50 patients (20 patients underwent CRS + HIPEC, while 30 patients underwent CRS alone). Records of these patients from January 2014 to June 2020 were reviewed, tabulated, and analyzed.@*Results@#The difference in recurrence rate between CRS with HIPEC and CRS alone was not statistically significant (50% vs. 43%, P = 0.774). The median time to recurrence was 10 and 9 months, respectively (P = 0.636). Five percent in the HIPEC group succumbed to the disease, while 13% died in the CRS alone group (P = 0.636). More post-operative complications were noted in the HIPEC group (45% vs. 10%, P = 0.007), but among these, only 2 cases had grade 3 to 4 complications (10%). The addition of HIPEC in the management of these patients resulted in a longer operative time (360 vs. 240 min, P < 0.001) and postoperative hospital stay (8 vs. 6 days, P = 0.026). There were no intra- or peri-operative mortalities in both groups.@*Conclusion@#CRS with HIPEC and CRS alone showed similar time to recurrence and recurrence rate. CRS with HIPEC had low risk of grade 3-4 complications and may still be considered as a treatment option for advanced, progressive, and recurrent epithelial ovarian, fallopian tube, and peritoneal cancer.
Subject(s)
Cytoreduction Surgical Procedures , Hyperthermic Intraperitoneal Chemotherapy , Ovarian NeoplasmsABSTRACT
Peritoneal cancer originates from a wide range of tumor sources and is associated with poor prognosis. Standardized therapy is of great significance in the treatment for patients with peritoneal cancer. The Peritoneal Surface Oncology Group International (PSOGI) instituted guidelines for peritoneal metastases. This article uses the Chinese version, which is divided into four parts: preoperative evaluation, surgery, chemotherapy, and clinical pathway. The preoperative evaluation consists of preoperative computed tomography, prognostic evaluation model, diagnostic laparoscopic exploration, the peritoneal cancer index, and the cytoreduction score. Peritoneal cancer treatment primarily consists of comprehensive treatment with cytoreductive surgery (CRS) and intraperitoneal hyperthermic chemotherapy. However, complete CRS is the key to the long-term survival of patients. Peritoneal cancer chemotherapy generally includes perioperative chemotherapy and regional chemotherapy. Finally, this guide outlines the clinical pathways. The Chinese version of the guidelines was published under the permission of the Secretary-General of the PSOGI Executive Committee.
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Pseudomyxoma peritonei (PMP) is a rare clinical syndrome. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is gradually being accepted as the standard treatment for PMP. At Aerospace Hospital, we have been treating patients with PMP since 2008 and performing total peritoneal resection since 2016. This study summarizes the experience at our center and collates past data. Methods: We performed a retrospective analysis of a prospectively maintained database of all patients who had undergone CRS and HIPEC for PMP at our center. Clinical data, such as the surgical approach, completeness of cytoreduction, and surgical complications, were collected. The results from follow-up were analyzed to simultaneously evaluate the clinical value of CRS+HIPEC and peritonectomy procedures. Results: A total of 854 consecutive patients with PMP were included in the study. Their mean age was 50 years. The median modified peritoneal cancer index (PCI) was 29. Of the patients, 25.5% under-
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Objective: To investigate the value of MSCT in preoperative assessing operitoneal cancer index (PCI) in patients with pseudomyxoma peritonei (PMP). Methods MSCT data of histopathologically proved PMP in 108 patients were retrospectively analyzed. MSCT-PCI scores were evaluated and compared with intraoperative PCI scores, 0-8 was assigned to the omentum area, the liver area, the small omental sac area, the spleen area, the descending colon area, the left iliac area, the pelvic area, the right iliac area and the ascending colon area, respectively, whereas 9 to 12 were assigned to the small intestine area. The consistency between MSCT-PCI scores and the intraoperative PCI scores in different regions and MSCT-PCI scores in different regions between different observers were analyzed. The efficacy of MSCT in diagnosing PMP in different regions was calculated. Results Among 108 patients, the consistency between MSCT-PCI and intraoperative PCI scores in 1-3 regions was good, of 0, 4-9 regions was moderate, while of the 10-12 regions was fair. The consistency of MSCT-PCI scores in 0, 4 and 7 regions between 2 observers was better, of 1-3, 5, 8-10 regions was good, of 6, 11, 12 regions was moderate. The sensitivity of MSCT in diagnosis of PMP in 0-12 regions was 92.63% (88/95), 97.94% (95/97), 95.83% (92/96), 95.79% (91/95), 89.69% (87/97), 95.00% (95/100), 96.08% (98/102), 96.12% (99/103), 94.90% (93/98), 87.78% (79/90), 88.89% (80/90), 86.17% (81/94) and 85.71% (84/98); the specificity was 84.62% (11/13), 100% (11/11), 91.67% (11/12), 84.62% (11/13), 100% (11/11), 87.50% (7/8), 83.33% (5/6), 100% (5/5), 100% (10/10), 83.33% (15/18), 83.33% (15/18), 85.71% (12/14) and 80.00% (8/10); and the accuracy was 91.67% (99/108), 98.15% (106/108), 95.37% (103/108), 94.44% (102/108), 90.74% (98/108), 94.44% (102/108), 95.37% (103/108), 96.30% (104/108), 95.37% (103/108), 87.04% (94/108), 87.96% (95/108), 86.11% (93/108) and 85.19% (92/108). Conclusion MSCT can accurately assess PCI of PMP, therefore providing references for clinical development of treatment plan.
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Resumen ANTECEDENTES El cáncer de ovario es una importante causa de muerte de mujeres, responsable de 150,000 fallecimientos anuales en el mundo, con una supervivencia a 5 años inferior a 45%. OBJETIVO Exponer los avances en diagnóstico y tratamiento de la carcinogénesis de los tumores serosos ováricos y las repercusiones de los nuevos conceptos en el tratamiento clínico y quirúrgico. METODOLOGÍA Estudio retrospectivo basado en la búsqueda sistemática de artículos con las palabras clave (MeSH): neoplasmas serosos de ovario, carcinogénesis, carcinoma seroso de bajo grado y carcinoma seroso de alto grado. La selección de los artículos estuvo a cargo, de forma independiente, de dos investigadores. De la misma forma dos patólogos evaluaron los artículos preseleccionados. RESULTADOS Se seleccionaron y analizaron 66 artículos. CONCLUSIONES Para la creación y adopción de estrategias en prevención primaria, diagnóstico y tratamiento de esta patología se requiere mayor comprensión de la fisiopatología y de los hallazgos encontrados en la última década, sobre todo los relacionados con las mutaciones en el gen BRCA, antecedentes familiares de tumores serosos del ovario, cáncer de mama o peritoneal de tipo epitelial, entre otras. La atención multidisciplinaria y actualizada repercutirá, significativamente, en la supervivencia de las pacientes.
Abstract BACKGROUND Globally, ovarian cancer is the seventh neoplasm and the eight oncologic cause of death in women, responsible of 150,000 deaths per year, with a 5 year survival under the 45%, mainly represented by high-grade serous carcinomas. Findings such as serous intraepithelial carcinomas and genetic predisposition have become a constant for the vast majority of cases. OBJECTIVE To summarize and review the most recent advances about the carcinogenesis of the ovarian serous tumors, its implications on the pathological diagnosis and the consequences of these new concepts for the clinical and surgical therapies. MATERIALS AND METHODS We performed a systematic search to select all kinds of languages articles, using the keywords "serous ovarian neoplasms" AND "carcinogenesis" AND "low-grade serous carcinoma" OR "high-grade serous carcinoma". Two investigators independently extracted characteristics and results to select the articles. Two pathologists independently did the assessment of the preselected articles selecting the most appropriate ones, based on their utility for this review. RESULTS 66 articles were selected and included in the bibliography for this review. CONCLUSIONS A better understanding of the physiopathology and many other new findings that have been done during the last decade are essential for the treatment of this patients, for the creation and application of strategies for primary prevention and screening for the risk, and the medical and surgical interventions, mainly directed to patients with mutations on BRCA, family history of breast, ovarian or peritoneal cancer, among other conditions. A multidisciplinary and updated approach will affect significantly the long-term survival.
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INTRODUCTION: Serous carcinomas are the most frequent histologic type of ovarian and peritoneal cancers, and can also be detected in the endometrium and fallopian tubes. Serous carcinomas are usually high-grade neoplasms when diagnosed, yet the identification of an associated precursor lesion remains challenging. Pathological examination of specimens obtained from prophylactic bilateral salpingo-oophorectomies that were performed for patients harboring BRCA1/2 mutations suggests that high-grade serous carcinomas may arise in the fallopian tubes rather than in the ovaries. OBJECTIVE: To investigate the presence and extent of fallopian tube involvement in cases of serous pelvic carcinomas. METHODS: Thirty-four cases of serous pelvic carcinoma with clinical presentations suggesting an ovarian origin were analyzed retrospectively. Histologic samples of fallopian tube tissues were available for these cases and were analyzed. Probable primary site, type of tubal involvement, tissues involved in the neoplasia and vascular involvement were evaluated. RESULTS: Fallopian tube involvement was observed in 24/34 (70.6 percent) cases. In 4 (11.8 percent) of these cases, an intraepithelial neoplasia was present, and therefore these cases were hypothesized to be primary from fallopian tubes. For an additional 7/34 (20.6 percent) cases, a fallopian tube origin was considered a possible primary. CONCLUSIONS: Fallopian tubes can be the primary site for a subset of pelvic high-grade serous carcinomas.
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Adult , Aged , Female , Humans , Middle Aged , Young Adult , Carcinoma/pathology , Fallopian Tube Neoplasms/etiology , Fallopian Tubes/pathology , Ovarian Neoplasms/pathology , Pelvic Neoplasms/pathology , Diagnosis, Differential , Fallopian Tube Neoplasms/pathology , Genes, BRCA1 , Retrospective StudiesABSTRACT
Primary peritoneal cancer is a rare tumor, which may be mesothelial or mullerian in nature. It can develop from unifocal or multifocal origin and the clinical and histologic disease entities are similar to those of primary papillary serous carcinoma of the ovary, but the main features of primary peritoneal cancer are widely disseminated malignancy along the peritoneal surfaces, the omentum, and abdominal viecera, with minimal or no ovarian involvement. Recently investigators have analyzed the morphology of these tumors and have used histochemical, eletron microscopic and immunohistologic techniques in an attempt to identify, characterize, and categorize. We have experienced a case of a primary peritoneal cancer which developed in the patient who had probably a previous total hysterectomy and both salpingooophorectomy.