Intraperitoneal chemotherapy for gastric cancer with peritoneal carcinomatosis: study protocol of a phase ii trial / Quimioterapia intraperitoneal para o câncer gástrico com carcinomatose peritoneal: protocolo de estudo de um ensaio de fase ii

ABSTRACT BACKGROUND: Peritoneal carcinomatosis in gastric cancer is considered a fatal disease, without expectation of definitive cure. As systemic chemotherapy is not sufficient to contain the disease, a multimodal approach associating intraperitoneal chemotherapy with surgery may represent an alternative for these cases. AIMS: The aim of this study was to investigate the role of intraperitoneal chemotherapy in stage IV gastric cancer patients with peritoneal metastasis. METHODS: This study is a single institutional single-arm prospective clinical trial phase II (NCT05541146). Patients with the following inclusion criteria undergo implantation of a peritoneal catheter for intraperitoneal chemotherapy: Stage IV gastric adenocarcinoma; age 18-75 years; Peritoneal carcinomatosis with peritoneal cancer index<12; Eastern Cooperative Oncology Group 0/1; good clinical status; and lab exams within normal limits. The study protocol consists of four cycles of intraperitoneal chemotherapy with paclitaxel associated with systemic chemotherapy. After treatment, patients with peritoneal response assessed by staging laparoscopy undergo conversion gastrectomy. RESULTS: The primary outcome is the rate of complete peritoneal response. Progression-free and overall survivals are other outcomes evaluated. The study started in July 2022, and patients will be screened for inclusion until 30 are enrolled. CONCLUSIONS: Therapies for advanced gastric cancer patients have been evaluated in clinical trials but without success in patients with peritoneal metastasis. The treatment proposed in this trial can be promising, with easy catheter implantation and ambulatory intraperitoneal chemotherapy regime. Verifying the efficacy and safety of paclitaxel with systemic chemotherapy is an important progress that this study intends to investigate.

RESUMO RACIONAL: A carcinomatose peritoneal no câncer gástrico é considerada uma doença fatal, sem expectativa de cura definitiva. Como a quimioterapia sistêmica não é suficiente para conter a doença, uma abordagem multimodal associando a quimioterapia intraperitoneal à cirurgia pode representar uma alternativa para esses casos. OBJETIVOS: Investigar o papel da quimioterapia intraperitoneal em pacientes com câncer gástrico estágio IV com metástases peritoneais. MÉTODOS: Trata-se de um ensaio clínico prospectivo unicêntrico, braço único, fase II (NCT05541146). Pacientes com os seguintes critérios de inclusão serão submetidos à implantação de cateter peritoneal para quimioterapia intraperitoneal: adenocarcinoma gástrico estágio IV; idade 18-75 anos; carcinomatose peritoneal com índice de câncer peritoneal<12; ECOG 0/1; bom estado clínico e exames laboratoriais dentro da normalidade. O protocolo do estudo consiste em 4 ciclos de quimioterapia intraperitoneal com Paclitaxel associado à quimioterapia sistêmica. Após o tratamento, os pacientes com resposta peritoneal avaliada por laparoscopia serão submetidos à gastrectomia de conversão. RESULTADOS: O desfecho primário é a taxa de resposta peritoneal completa. A sobrevida livre de progressão e global são outros desfechos avaliados. O estudo foi iniciado em julho de 2022 e os pacientes serão selecionados para inclusão até que 30 sejam inscritos. CONCLUSIONS: Terapias para pacientes com câncer gástrico avançado foram avaliadas em ensaios clínicos, mas sem sucesso em pacientes com metástase peritoneal. O tratamento proposto neste estudo pode ser promissor, com fácil implantação do cateter e regime de quimioterapia intraperitoneal ambulatorial. Verificar a eficácia e segurança do Paclitaxel associado à quimioterapia sistêmica é um progresso importante que o presente estudo pretende investigar.

Estadificación laparoscópica en pacientes con carcinomatosis peritoneal. Un enfoque desde la cirugía citorreductiva / Laparoscopic staging in patients with peritoneal carcinomatosis. An approach from cytoreductive surgery

Introducción. Las metástasis peritoneales representan un estado avanzado de muchos cánceres intraabdominales y suelen dar un pronóstico ominoso a los pacientes que las desarrollan. Hasta hace poco la única opción terapéutica para este escenario era la quimioterapia paliativa. Sin embargo, la mayoría de los tumores metastásicos al peritoneo continúan siendo relativamente resistentes a las drogas citotóxicas y citostáticas administradas por vía endovenosa y, en general, a las terapias individuales. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, SciELO y Google Scholar utilizando las palabras claves: laparoscopia, carcinomatosis peritoneal, estadificación, citorreducción. Se incluyeron para la revisión los artículos con mayor relevancia publicados en inglés y español. Discusión. La cirugía citorreductiva asociada a técnicas de quimioterapia hipertérmica intraperitoneal se ofrece actualmente a pacientes con indicaciones precisas según el primario subyacente. Es aquí donde la laparoscopia de estadificación realizada de manera correcta y completa juega un papel determinante, puesto que ha demostrado ser un método fiable para realizar una aproximación del compromiso peritoneal. Conclusión. Todos los especialistas quirúrgicos, en especial los cirujanos generales, deben estar familiarizados en cómo realizar de forma completa una laparoscopia de estadificación, de manera que se pueda hacer una mejor aproximación al grado de compromiso peritoneal, contribuyendo en el manejo integral oncológico del paciente.

Introduction. Peritoneal metastases represent an advanced stage of many intra-abdominal neoplasms and often give an ominous prognosis. Recently, the only therapeutic option for this setting was palliative chemotherapy. However, most tumors metastatic to the peritoneum remain relatively resistant to intravenously administered cytotoxic and cytostatic drugs and, in general, to individual therapies. Methods. A literature search was performed in PubMed, SciELO and Google Scholar databases using the keywords: laparoscopy, peritoneal carcinomatosis, staging, cytoreduction. The most relevant articles published in English and Spanish were included in the review. Discussion. Cytoreductive surgery associated with intraperitoneal hyperthermic chemotherapy techniques is currently offered to patients with precise indications according to the underlying primary. It is here where staging laparoscopy performed in a complete and correct manner plays a determining role, since it has proven to be a reliable method for approximating peritoneal involvement. Conclusion. All surgical specialists, especially general surgeons, should be familiar with how to perform a complete staging laparoscopy, leading to a correct approach of the degree of peritoneal involvement and contributing to the integral oncologic management of the patient.

Staging laparoscopy is still a valuable tool for optimal gastric cancer management / A laparoscopia diagnóstica ainda é uma ferramenta essencial para o tratamento do câncer gástrico

ABSTRACT BACKGROUND: Complete surgical resection is the main determining factor in the survival of advanced gastric cancer patients, but is not indicated in metastatic disease. The peritoneum is a common site of metastasis and preoperative imaging techniques still fail to detect it. AIM: The aim of this study was to evaluate the role of staging laparoscopy in the staging of advanced gastric cancer patients in a Western tertiary cancer center. METHODS: A total of 130 patients with gastric adenocarcinoma who underwent staging laparoscopy from 2009 to 2020 were evaluated from a prospective database. Clinicopathological characteristics were analyzed to identify factors associated with the presence of peritoneal metastasis and were also evaluated the accuracy and strength of agreement between computed tomography and staging laparoscopy in detecting peritoneal metastasis and the change in treatment strategy after the procedure. RESULTS: The peritoneal metastasis was identified in 66 (50.76%) patients. The sensitivity, specificity, and accuracy of computed tomography in detecting peritoneal metastasis were 51.5, 87.5, and 69.2%, respectively. According to the Kappa coefficient, the concordance between staging laparoscopy and computed tomography was 38.8%. In multivariate analysis, ascites (p=0.001) and suspected peritoneal metastasis on computed tomography (p=0.007) were statistically correlated with peritoneal metastasis. In 40 (30.8%) patients, staging and treatment plans changed after staging laparoscopy (32 patients avoided unnecessary laparotomy, and 8 patients, who were previously considered stage IVb by computed tomography, were referred to surgical treatment). CONCLUSION: The staging laparoscopy demonstrated an important role in the diagnosis of peritoneal metastasis, even with current advances in imaging techniques.

RESUMO RACIONAL: A ressecção cirúrgica é o principal fator determinante na sobrevida de pacientes com câncer gástrico, mas não é indicada na presença de doença metastática. O peritônio é local comum de metástase, porém os métodos de imagem ainda falham na sua detecção. OBJETIVO: Avaliar o papel da Laparoscopia Diagnóstica no estadiamento de pacientes com câncer gástrico avançado em um centro oncológico ocidental terciário. MÉTODOS: Foram avaliados 130 pacientes com adenocarcinoma gástrico submetidos a Laparoscopia Diagnóstica de 2009 a 2020, a partir de um banco de dados prospectivo. As características clínico-patológicas foram analisadas para identificar fatores associados à presença de metástase peritoneal. Foram também avaliadas a acurácia e concordância entre a tomografia computadorizada e a Laparoscopia Diagnóstica na detecção de metástase peritoneal e na mudança de conduta após a Laparoscopia Diagnóstica. RESULTADOS: As metástases peritoneais foram identificadas em 66 pacientes (50,76%). A sensibilidade, especificidade e acurácia da tomografia computadorizada na sua detecção foram de 51,5%, 87,5% e 69,2%, respectivamente. De acordo com o coeficiente Kappa, a concordância entre a Laparoscopia Diagnóstica e a tomografia computadorizada foi de 38,8%. Na análise multivariada, ascite (p=0,001) e suspeita de metástase peritoneal na tomografia computadorizada (p=0,007) foram estatisticamente correlacionadas com metástase peritoneal. Em 40 pacientes (30,8%), o estadiamento e as estratégias de tratamento mudaram após a Laparoscopia Diagóstica (32 pacientes evitaram laparotomia e 8 pacientes, anteriormente considerados estágio IVb, foram tratados cirurgicamente). CONCLUSÕES: A Laparoscopia Diagnóstica demonstrou um papel importante no diagnóstico de metástases peritoneais, mesmo com métodos de imagem avançados.

Medidas de segurança ocupacional no transoperatório de quimioterapia hipertérmica intraperitoneal: scoping review / Medidas de seguridad ocupacional en el transoperatorio de quimioterapia hipertérmica intraperitoneal: scoping review / Occupational safety measures in the intraoperative period of hyperthermic intraperitoneal chemotherapy: scoping review

Resumo Objetivo Mapear as medidas de segurança ocupacional recomendadas aos profissionais envolvidos no atendimento transoperatório de pacientes submetidos à Quimioterapia Intraperitoneal Hipertérmica. Métodos Estudo qualitativo com ênfase em scoping review, fundamentado no Instituto Joanna Briggs. Realizou-se buscas nas bases de dados Pubmed, BVS, ScIELO, Scopus, Web of Science, Google Scholar, The Chocrane Library e literatura cinzenta. Pergunta de pesquisa utilizou o acrônimo PCC: quais medidas de segurança ocupacional são necessárias no Centro Cirúrgico para profissionais que atuam, direta ou indiretamente, no transoperatório da HIPEC? A Busca de artigos ocorreu entre 2015 a 2019. Resultados Evidenciou-se escassa literatura sobre a temática. Selecionados dez artigos: uma revisão sistemática; dois casos-controle; dois estudos descritivos; quatro estudos de revisão bibliográfica; um relato de experiência. Análise dos artigos evidenciou as medidas de segurança recomendadas para profissionais que atuam direta ou indiretamente nesse procedimento cirúrgico, a saber: educação e capacitação da equipe envolvida; utilização de equipamentos de proteção individual e coletiva; oferecer infraestrutura e orientações gerais. Conclusão Medidas de segurança recomendadas para os profissionais envolvidos no atendimento transoperatório do paciente submetido à Quimioterapia Intraperitoneal Hipertérmica são: capacitação da equipe; utilização de equipamentos específicos de proteção individual e coletiva; infraestrutura necessária como ajuste do ar condicionado com pressão maior dentro da sala cirúrgica; e orientações gerais em relação à organização da sala cirúrgica, descarte dos resíduos, limpeza da sala/materiais utilizados e acompanhamento da saúde ocupacional da equipe envolvida em procedimento cirúrgico.

Resumen Objetivo Mapear las medidas de seguridad ocupacional recomendadas a los profesionales involucrados en la atención transoperatoria de pacientes sometidos a Quimioterapia Intraperitoneal Hipertérmica. Métodos Estudio cualitativo con énfasis en el scoping review, fundamentado en el Instituto Joanna Briggs. Se realizaron búsquedas en las bases de datos Pubmed, BVS, ScIELO, Scopus, Web of Science, Google Scholar, The Chocrane Library y literatura gris. Pregunta de encuesta utilizó el acrónimo PCC: ¿qué medidas de seguridad ocupacional se hacen necesarias en el Quirófano para profesionales que actúan, directa o indirectamente, en el transoperatorio de la HIPEC? La búsqueda de los artículos ocurrió entre el 2015 y el 2019. Resultados Se puso en evidencia una escasa literatura sobre la temática. Seleccionados diez artículos: una revisión sistemática; dos casos-control; dos estudios descriptivos; cuatro estudios de revisión bibliográfica; un relato de experiencia. Análisis de los artículos evidenció las medidas de seguridad recomendadas para profesionales que actúan directa o indirectamente en ese procedimiento quirúrgico, a saber: educación y capacitación del equipo involucrado; utilización de equipos de protección individual y colectiva; brindar infraestructura y orientaciones generales. Conclusión Representan medidas de seguridad recomendadas para los profesionales involucrados en la atención transoperatoria del paciente sometido a Quimioterapia Intraperitoneal Hipertérmica: capacitación del equipo; utilización de equipos específicos de protección individual y colectiva; infraestructura necesaria como ajuste del aire acondicionado con una presión más alta dentro del quirófano; y orientaciones generales con relación a la organización del quirófano, descarte de los deshechos, limpieza de la sala/materiales utilizados y acompañamiento de la salud ocupacional por el equipo involucrado en el procedimiento quirúrgico.

Abstract Objective To map the occupational safety measures recommended to professionals involved in the intraoperative care of patients undergoing Hyperthermic Intraperitoneal Chemotherapy. Methods Qualitative scoping review based on the Joanna Briggs Institute. Searches were performed in Pubmed, VHL, ScIELO, Scopus, Web of Science, Google Scholar, The Chocrane Library databases and gray literature. The PCC acronym was used in the research question: what occupational safety measures are necessary in the operating room for professionals working directly or indirectly in the intraoperative period of HIPEC? A search for articles published between 2015 and 2019 was performed. Results Literature on the subject was scarce. Ten articles were selected: a systematic review; two control cases; two descriptive studies; four literature review studies; an experience report. In the analysis of articles, the recommended safety measures for professionals who work directly or indirectly in this surgical procedure was evidenced, namely: education and training of the staff involved; use of individual and collective protective equipment; provision of infrastructure and general guidelines. Conclusion Recommended safety measures for professionals involved in the intraoperative care of patients undergoing Hyperthermic Intraperitoneal Chemotherapy are: team training; use of specific individual and collective protection equipment; necessary infrastructure, such as adjusting the air conditioning to higher pressure inside the operating room; and general guidelines regarding the organization of the operating room, waste disposal, cleaning of the room/materials used, and monitoring of the occupational health of the team involved in the surgical procedure.

A phase 2 trial of short-course Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) at interval cytoreductive surgery (iCRS) for advanced ovarian cancer / Quimioterapia Intraperitoneal Hipertérmica (HIPEC) de curta duração ao tempo da cirurgia citorredutora de intervalo (iCRS) para câncer de ovário avançado: ensaio clínico de fase 2

ABSTRACT Objective: to report the final analysis of a phase 2 trial assessing the efficacy and safety of short-course hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with advanced epithelial ovarian cancer (EOC). Methods: this was an open-label, multicenter, single-arm trial of HIPEC in patients with advanced EOC who underwent interval cytoreductive surgery (iCRS) after neoadjuvant chemotherapy (NACT). HIPEC was performed as a concentration-based regimen of platinum-based chemotherapy for 30 minutes. Primary endpoint was the rate of disease progression occurring at nine months following iCRS plus HIPEC (PD9). Secondary endpoints were postoperative complications, time to start adjuvant chemotherapy, length of hospital and ICU stay, quality of life (QoL) over treatment, and ultimately 2-year progression-free survival (PFS) and overall survival (OS). Analysis was by intention-to-treat with final database lock for survival outcomes on February 23, 2021. Results: fifteen patients with stage III EOC were enrolled between February 2015 and July 2019, in four centers. The intention to treat PD9 was 6.7%. With a median follow-up of 33 months (IQR, 24.3-46.5), the median PFS was 18.1 months and corresponding 2-year rates of PFS and OS was 33.3% and 93.3%, respectively. Three patients (20%) experienced graded III complications. Median length of hospital and ICU stay was 5 (IQR, 4-6.5) and 1 (IQR, 1-1) days, respectively. Time to restart systemic chemotherapy was 39 (IQR, 35-49.3) days and no significant difference over time in QoL was observed. Conclusions: we demonstrate preliminary efficacy and safety of short-course HIPEC in patient with advanced EOC.

RESUMO Objetivo: apresentar a análise final de ensaio clínico de fase 2 que avaliou a eficácia e a segurança da quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração em pacientes com câncer epitelial de ovário avançado (EOC). Métodos: estudo aberto, multicêntrico, de braço único avaliando a HIPEC em pacientes com EOC avançado submetidos a cirurgia citorredutora de intervalo (iCRS) após quimioterapia neoadjuvante (NACT). A HIPEC foi realizada como regime baseado na concentração de cisplatina, perfundida por 30 minutos. O desfecho primário foi a taxa de progressão da doença 9 meses após a iCRS com HIPEC (PD9). Os desfechos secundários foram complicações pós-operatórias, tempo para iniciar a quimioterapia adjuvante, tempo de internação e permanência em UTI, qualidade de vida (QoL) ao longo do tratamento e, finalmente, sobrevida cumulativa livre de progressão (PSF) e global (OS) em 2 anos. As análises foram em intenção de tratar (ITT) com fechamento dos dados para análise da sobrevida em 23 de fevereiro de 2021. Resultados: quinze pacientes com EOC em estágio III foram incluídos no estudo entre fevereiro de 2015 e julho de 2019 em quatro centros recrutadores. A PD9 por ITT foi de 6,7%. Com acompanhamento mediano de 33 meses (IQR, 24,3-46,5), a PFS mediana foi de 18,1 meses e as taxas correspondentes de PFS e OS em 2 anos foram 33,3% e 93,3%, respectivamente. Três pacientes (20%) apresentaram complicações grau III. O tempo mediano de internamento hospitalar e em UTI foi de 5 (IQR, 4-6,5) e 1 (IQR, 1-1) dias, respectivamente. O tempo para reinício da quimioterapia sistêmica foi de 39 dias (IQR, 35-49,3) e não foi observada diferença significativa na QoL ao longo do tratamento. Conclusões: demonstrou-se eficácia e segurança preliminares da HIPEC de curta duração em pacientes com EOC avançado.

De novo double-hit B-cell precursor leukemia/lymphoma - an unusual presentation as peritoneal lymphomatosis

Peritoneal lymphomatosis (PL) is a rare presentation of extranodal precursor leukemia/lymphoma. The presentation is often non-specific, leading to delayed diagnosis and treatment. In this case, though the preliminary diagnosis was established on ascitic fluid cytology, the disease progressed rapidly, leading to demise before initiating chemotherapy. Immunophenotyping and molecular studies, performed later, established a diagnosis of de novo B-cell precursor leukemia/lymphoma with MYC, BCL2 rearrangements (Double-hit lymphoma). MYC, BCL2 rearrangements are rarely reported in precursor B-lymphoma/leukemia which carry dismal prognosis. In this report, we illustrate autopsy findings of PL in an elderly gentleman who presented with ascites for evaluation.

Sítio Metastático Incomum - Metástases Peritoneais em Melanoma Maligno: Relato de Caso / Unusual Metastatic Site - Peritoneal Metastasis in Malignant Melanoma: Case Report / Sitio Metastásico Raro - Metástasis Peritoneales en Melanoma Maligno: Reporte de Caso

Introdução: O melanoma cutâneo é um tumor com grande capacidade de metastização. Um dos quadros possíveis, mas bastante raro, é quando a metástase se aloja em peritônio (carcinomatose peritoneal). Relato do caso: Paciente feminina, 61 anos, encaminhada por massa inguinal esquerda suspeita e lesão hipercrômica de 2 cm, com área de regressão em membro inferior esquerdo. A paciente foi submetida à linfadenectomia inguinal esquerda e ressecção da lesão de pele, que evidenciou melanoma maligno cutâneo extensivo superficial invasor, de espessura de Breslow 1,2 mm, e nível de Clark II, bem como metástase linfonodal. O tratamento adjuvante incluiu radioterapia e quimioterapia. Durante follow-up, oito meses depois, ultrassonografia e tomografia computadorizada de abdome evidenciaram imagem nodular sólida hipoecoica, heterogênea e bosselada, mal definida e mal delimitada em projeção para-aórtica à esquerda, com 12,7x6,7x4,8 cm. Em laparotomia exploradora, encontrou-se massa volumosa retroperitoneal em flanco esquerdo, com envolvimento do ângulo de Treitz e presença de carcinomatose peritoneal. O laudo anatomopatológico evidenciou neoplasia maligna pouco diferenciada epitelioide infiltrativa, compatível com história clínica de melanoma. A paciente evoluiu a óbito após consulta com oncologia clínica. Conclusão:Existem poucos casos de metástase peritoneal de melanoma relatados na literatura. Contudo, deve-se levar em consideração sua possibilidade de ocorrência e as opções terapêuticas disponíveis, além de também compreender seu impacto no prognóstico do paciente. Apesar de rara, a carcinomatose peritoneal deve ser considerada quando pacientes com histórico pessoal de melanoma apresentarem queixas abdominais inespecíficas, como a paciente do caso relatado.

Introduction: Cutaneous melanoma is a tumor with great capacity for metastasis. One of the possible but quite rare scenarios is when the metastasis is lodged in the peritoneum (peritoneal carcinomatosis). Case report:61-year-old female patient, referred by a suspected left inguinal mass and 2 cm hyperchromic lesion, with regression area in the left lower limb. The patient underwent left inguinal lymphadenectomy and resection of the skin lesion, which revealed invasive extensive superficial cutaneous malignant melanoma, Breslow depth 1.2 mm and Clark II level, as well as lymph node metastasis. Adjuvant treatment included radiotherapy and chemotherapy. During follow-up, 8 months later, abdominal ultrasound and computed tomography showed hypoechoic, heterogeneous, and beveled solid nodular image, poorly defined and delimited in left para-aortic projection, with 12.7x6.7x4.8 cm. In exploratory laparotomy, a large retroperitoneal mass was found on the left flank, involving the Treitz angle, and revealed the presence of peritoneal carcinomatosis. The anatomopathological report showed a poorly differentiated malignant infiltrative epithelioid neoplasm, compatible with the clinical history of melanoma. The patient died after consultation with clinical oncology. Conclusion: There are few cases of peritoneal metastasis of melanoma reported in the literature. However, its possibility of occurrence and the therapeutic options available must be taken into account, in addition to understanding its impact on the patient's prognosis. Although rare, peritoneal carcinomatosis should be considered when patients with a personal history of melanoma have non-specific abdominal complaints, such as the patient in the case reported.

Introducción: El melanoma cutáneo es un tumor con gran capacidad de metástasis. Una de las situaciones posibles, pero bastante rara, es cuando la metástasis se aloja en el peritoneo. Relato del caso: paciente femenina de 61 años, remitida por sospecha de masa inguinal izquierda y lesión hipercrómica de 2 cm, con área de regresión, en miembro inferior izquierdo. La paciente fue sometida a linfadenectomía inguinal izquierda y resección de la lesión cutánea, que demonstró melanoma maligno cutáneo superficial extenso invasivo, Breslow 1,2 mm y nivel de Clark II, así como metástasis ganglionares. El tratamiento adyuvante incluyó radioterapia y quimioterapia. Durante el seguimiento, 8 meses después, la ecografía y la tomografía computarizada de abdomen mostraron una imagen nodular sólida hipoecoica, heterogénea y biselada, mal definida y delimitada en proyección para-aórtica izquierda, con 12,7x6,7x4,8 cm. En la laparotomía exploradora se encontró una gran masa retroperitoneal en el flanco izquierdo, involucrando el ángulo de Treitz y presencia de carcinomatosis peritoneal. El informe anatomopatológico mostró una neoplasia epitelioide infiltrativa maligna mal diferenciada, compatible con la historia clínica de melanoma. El paciente falleció tras consulta con oncología clínica. Conclusión: Hay pocos casos de metástasis peritoneal de melanoma reportados en la literatura. Sin embargo, se debe tener en cuenta su posibilidad de ocurrencia y las opciones terapéuticas disponibles, además de comprender su impacto en el pronóstico del paciente. Aunque es poco común, la carcinomatosis peritoneal debe considerarse cuando los pacientes con antecedentes personales de melanoma tienen molestias abdominales inespecíficas, como la paciente del caso.

Leiomyomatosis peritonealis disseminata during pregnancy: a case report and literature review / 中华围产医学杂志

Objective:To review the clinical and pathological features, pathogenesis, and differential diagnosis of leiomyomatosis peritonealis disseminata (LPD) during pregnancy.Methods:We report the diagnosis and treatment of LPD in a pregnant woman admitted to Jiaozhou Central Hospital of Qingdao. We retrieved relevant literature from China and abroad to review the clinical characteristics and outcomes.Results:(1) Case report: The 33-year-old pregnant woman who had had previous cesarean sections was admitted at 37 +2 weeks gestation due to premature rupture of membranes 30 minutes before arriving at the hospital with a pelvic mass which was first diagnosed seven months earlier, in the first trimester. A lower segment cesarean section was performed, and the pelvic mass was removed on admission. No relapse was reported during the postoperative follow-up for 26 months. (2) Literature review: thirteen papers involving 15 cases, including the present case, were retrieved. The age at onset was 32 years old (19-47 years old); five of them had a history of myomectomy. Twelve cases had no significant symptoms, and the diagnosis was made at delivery or postpartum; the other three had noticeable features, mainly with abdominal pain. Six had obstetrical complications, including hypertensive disorders of pregnancy, premature rupture of membrane, abnormal fetal position, and oligohydramnios. Two cases had a history of assisted reproductive technology. Eleven cases delivered after 32 gestational weeks, three before 28 weeks, one aborted at ten gestational weeks due to severe complications. Twelve had cesarean section and myomectomy and the uterus and appendages were preserved. Three cases had a cesarean hysterectomy and two of them also had bilateral salpingo-oophorectomy. The pathological manifestations of seven cases were extensive and massively distributed small fibroids, similar to malignant tumor infiltration, with the diameter of 0.5 to 1.0 cm; five cases had multiple large fibroids, accompanied by scattered small fibroids. Conclusion:LPD during pregnancy is rare, and usually benign, with no obvious clinical symptoms. LPD is more likely to be misdiagnosed as a malignant tumor before the operation, and the diagnosis is usually confirmed by postoperative histopathology. A common surgical strategy is a cesarean section combined with pelvic mass resection.

Valor de la imagenología (TC y PET-TC) en el diagnóstico de la carcinomatosis peritoneal. Estudio preliminar / Diagnostic value of CT and Pet CT for detection of peritoneal carcinomatosis. Preliminary study / Valor das técnicas de imagem (TC y Pet-TC) no diagnóstico da carcinomatose peritoneal. Estudo preliminar

Resumen: En la evaluación de la carcinomatosis peritoneal (CP) la imagenología contribuye al diagnóstico preciso de compromiso peritoneal, aunque su eficacia es aún limitada. La tomografía computada (TC) es el estudio de imagen más utilizado y el PET-TC es cada vez más solicitado en la valoración de diferentes neoplasias. El objetivo del presente trabajo es evaluar el rendimiento de la TC y el PET-TC en el diagnóstico de CP en tumores digestivos y ginecológicos. Material y método: estudio retrospectivo, observacional, de 11 casos operados de CP en los que previamente se había realizado TC o PET-TC, o ambos. Se analizan los resultados de los estudios imagenológicos por separado y en conjunto, y se comparan con los hallazgos intraoperatorios y anatomopatológicos. Resultados: la TC fue concordante en 8 de 10 casos (S 78%, E 100%, VPP 100%, VPN 33%), mientras que el PET-TC lo fue en 9 de 11 pacientes (S 100%, VPP 81%). Al considerar en conjunto la TC y el PET-TC, la sensibilidad fue de 100% y el VPP de 82%. Conclusiones: en los resultados obtenidos se constata una subestimación de la CP en la imagenología a causa de las características de los nódulos y su patrón de captación. En el PET-TC, un SUV > 6 podría aumentar la probabilidad diagnóstica de carcinomatosis. Esta breve serie de casos permite sugerir que TC y el 18FGD PET-TC deben ser solicitados y analizados en forma conjunta para incrementar su rendimiento, aunque la exploración quirúrgica continúa siendo el método más eficaz para el diagnóstico y evaluación de la CP.

Summary: Imagenology contributes to the accurate diagnosis of peritoneal compromise in the assessment of peritoneal carcinomatosis, although its effectiveness is still limited. CT is the most frequently used study and PET/CT is graduallly more requested in the assessment of different neoplasms. This study aims to assess performance of CT and PET/CT for diagnosis of peritoneal carcinomatosis in digestive and gynecological tumours. Method: retrospective, observational study of 11 cases operated on peritoneal carcinomatosis after a CT and/or PET/CT had been performed. The results of both image studies were analysed separately and altogether and they were subsequently compared to intraoperative and pathology studies. Results: CT matched findings in 8 out of 10 cases (sensitivity 78%, specificity 100%, positive predictive value 100%, negative predictive value 33%), whereas PET/TC matched in 9 out of 11 patients (sensitivity 100%, PPV 81%). When considered together, sensitivity was 100% y el PPV de 82%. Conclusions: the results of the study confirm imagenology studies overestimate peritoneal carcinomatosis based on the characteristics of nodules and its uptake pattern. In CT/PET, SUV> 6 could increase the probability of diagnosing carcinomatosis. This small series of cases enables our suggesting CT and 18F-FDG PET-TC to be requested and analysed together to increase its efficiency, although surgical exploration continues to be the most effective method to diagnose and assess peritoneal carcinomatosis.

Resumo: Na avaliação da carcinomatose peritoneal (CP) as técnicas de imagem contribuem ao diagnóstico preciso do compromisso peritoneal, embora sua eficácia ainda seja limitada. A tomografia computadorizada (TC) é o estudo de imagens mais utilizado e a tomografia computadorizada por emissão de pósitrons (PET-TC) é cada vez mais solicitado na avaliação de diferentes neoplasias. O objetivo do presente trabalho, é avaliar o rendimento da TC e do PET-TC no diagnóstico de CP em tumores digestivos e ginecológicos. Material e método: estudo retrospectivo, observacional de 11 casos de carcinomatose peritoneal operados nos quais previamente se havia realizado TC e/ou PET-TC. Os resultados de ambos estudos foram estudados isoladamente e em conjunto e foram comparados com os achados intraoperatórios e histopatológicos. Resultados: a TC foi concordante em 8 de 10 casos (S 78%, E 100%, VPP 100%, VPN 33%), e o PET-TC em 9 de 11 pacientes (S 100%, VPP 81%). A sensibilidade foi de 100% e o VPP de 82% quando ambos estudos foram analisados conjuntamente. Conclusoes: observa-se nos resultados uma subestimação da CP nas técnicas de imagem, devido às características dos nódulos e seu padrão de captação. No PET-TC, um SUV > 6 poderia aumentar a probabilidade de diagnosticar carcinomatose. Esta breve série de casos permite sugerir que a TC e o 18FGD PET-TC devem ser solicitados e analisados em forma conjunta para aumentar o rendimento. No entanto a exploração cirúrgica continua sendo o método mais eficaz para o diagnóstico e avaliação da CP.

Quality of life in a phase 2 trial of short-course hyperthermic intraperitoneal chemotherapy (HIPEC) at interval debulking surgery for high tumor burden ovarian cancer / Avaliação da qualidade de vida em ensaio clínico de fase 2 envolvendo quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração no momento da citorredução de intervalo em pacientes com câncer de ovário de grande volume tumoral

ABSTRACT Introduction: to evaluate the effect of short-course (i.e.: 30 minutes) HIPEC on health-related quality of life (HRQoL) in our feasibility study; NCT02249013. Methods: a prespecified secondary end-point of our open-label, multicenter, single-arm, phase 2 trial on safety and efficacy was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30, version 3.0). Patients were required to complete the HRQoL questionnaire at baseline, after HIPEC, and after the end of the treatment. Changes of HRQoL over time were assessed by median scores for each domain and analyzed by Friedman`s test at a significant two-sided level of 0.05. Results: fifteen patients with high tumor burden EOC were recruited from our public health system between February 2015 and July 2019. A baseline EORTC QLQ-C30 questionnaire and at least one follow-up questionnaire was received from all of the patients. No significant difference over time in the QLQC30 summary scores was observed (p>0.05). The transitory impairment on patients HRQoL immediately after the short-course HIPEC trended to return to baseline at the end of the multimodal treatment. Conclusions: we found no significant impairment of short-course HIPEC on patients HRQoL into the context of our comprehensive treatment protocol.

RESUMO Objetivo: avaliar o impacto da quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração (i.e.: 30 minutos) na qualidade de vida (QoL) relacionada à saúde (HRQoL) no contexto de ensaio clínico terapêutico piloto; NCT02249013. Métodos: avaliou-se o desfecho secundário predeterminado de HRQoL em ensaio clínico de fase 2 de segurança e eficácia, aberto, multicêntrico, de braço único, utilizando-se o questionário European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30, versão 3.0). As pacientes foram solicitadas a responder o questionário de HRQoL antes do tratamento, após a HIPEC, e ao fim do tratamento interdisciplinar. As variações da HRQoL ao longo do tempo foram avaliadas pelas medianas dos escores de cada domínio e analisadas pelo teste de Friedman, considerando-se nível de significância estatística bicaudal de 5%. Resultados: quinze pacientes com câncer de ovário de grande volume tumoral foram recrutadas do sistema de saúde pública (i.e.: SUS) entre fevereiro de 2015 e julho 2019. Um questionário basal e pelo menos um questionário de acompanhamento foram coletados de todas as pacientes. Não se observou diferença significativa ao longo do tempo na HRQoL em nenhum dos domínios ou sintomas estudados (p> 0,05). O comprometimento transitório da HRQoL imediatamente após a HIPEC de curta duração tendeu a retornar à linha de base ao final do tratamento multimodal. Conclusões: não se observou impacto significativo da HIPEC de curta duração sobre a HRQoL no contexto deste protocolo de tratamento interdisciplinar.

Long-term survival after intraperitoneal chemotherapy with paclitaxel-cisplatin for recurrent primary peritoneal cancer resistant to multiple lines of intravenous chemotherapy

The long-term survival of heavily pretreated patients with primary peritoneal cancer (PPC) is uncommon. Here, we report on a patient with PPC refractory to multiple lines of intravenous chemotherapy, namely, a combined regimen of paclitaxel and carboplatin, and single regimens of topotecan, docetaxel, cisplatin, and gemcitabine. However, after intraperitoneal (IP) chemotherapy with paclitaxel-cisplatin, the patient's condition improved, and she has been progression-free for more than 4 years. Interestingly, before the IP chemotherapy, the recurrences were limited to the peritoneal cavity. These results suggest that IP recurrence might be a predictor of a good response to IP chemotherapy.

Cirugía citorreductiva y quimioterapia intraperitoneal hipertérmica: Conceptos importantes para el anestesiólogo / Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: main concepts for anesthetists

Abstract Introduction: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex therapeutic procedure used to complement cytoreductive surgery and intravenous chemotherapy for the management of primary peritoneal neoplasms and peritoneal carcinomatosis. Objectives: To review considerations regarding the surgical procedure, physiological changes associated with fluid, blood and protein loss, increase in intra-abdominal pressure, metabolic rate, and systemic hyperthermia, from the perspective of the anesthetist. Methods: A nonsystematic search was conducted in the Medline/PUBMED and Google Academics databases using the terms cytoreductive surgery, hyperthermia, HIPEC, peritoneal carcinomatosis, and Sugarbaker. No limits for publication dates were used. The articles were reviewed independently by each of the authors, and the final text was edited and approved by the main author. Results: Overall, 151 articles were identified, and, of these, 64 were included in the review. The aspects studied included the surgical technique, physiological changes during the procedure, and anesthetic management. Conclusion: Cytoreductive surgery with hyperthermic intra-peritoneal chemotherapy is a therapeutic option for patients with peritoneal carcinomatosis. This procedure involves risks for the patient, first because of an initial phase which involves fluid and blood loss, and, second, because the hyperthermic phase gives rise to a hyperdynamic state with hemodynamic instability. Anesthetists must be familiar with the basic aspects of management to reduce complications and improve patient outcomes.

Resumen Introducción: La quimioterapia intraperitoneal hipertérmica (Hyperthermic Peritoneal Chemotherapy - HIPEC) es un procedimiento terapéutico complejo, utilizado como complemento de la cirugía citorreductiva (CCR) y de la quimioterapia endovenosa, para manejo de las neoplasias peritoneales primarias y la carcinomatosis peritoneal. Objetivos: Revisar desde la perspectiva del anestesiólogo, conceptos generales sobre el procedimiento quirúrgico, los cambios fisiológicos asociados a la pérdida de fluidos, sangre y proteínas, al aumento de la presión intra-abdominal, la tasa metabólica y la hipertermia sistémica. Métodos: Se realizó una búsqueda no sistemática en las bases de datos Medline/PUBMED y Google Academics utilizando los términos cytoreductive surgery, hyperthermia, HIPEC, peritoneal carcinomatosis y Sugarbaker. No se establecieron límites para fecha de publicación. Los artículos fueron revisados de manera independiente por cada uno de los autores y el texto final fue editado y aprobado por el autor principal. Resultados: Fueron identificados 151 artículos, de los cuales se incluyeron 64 para la revisión. Los aspectos estudiados incluyeron la técnica quirúrgica, los cambios fisiológicos durante el procedimiento y el manejo anestésico. Conclusión: La cirugía citorreductiva más quimioterapia intraperitoneal hipertérmica es una alternativa terapéutica para los pacientes con carcinomatosis peritoneal. Este procedimiento supone riesgos para el paciente, tanto por una primera fase que implica pérdidas de fluidos y sangre, como por la fase de hipertermia que genera un estado hiperdinámico con inestabilidad hemodinámica. El anestesiólogo debe conocer los aspectos fundamentales del manejo para disminuir las complicaciones y mejorar los desenlaces de los pacientes.

PET/CT 18F-FDG en carcinomatosis peritoneal: revisión de la fisiopatología y presentación de dos casos / PET/CT 18F-FDG in peritoneal carcinomatosis: A review of the pathophysiology and a presentation of two cases

Resumen La carcinomatosis peritoneal corresponde a la diseminación o extensión en la cavidad peritoneal de un cáncer originado en algún órgano o viscera del abdomen, generalmente asociado a tumores digestivos o ginecológicos. También puede presentarse en forma primaria en patologías como el mesotelioma y el adenocarcinoma primario peritoneal. Las imágenes anatómicas son el pilar de la evaluación de las siembras peritoneales, pero pequeños implantes neoplásicos pueden ser difíciles de detectar con TAC o resonancia magnética. El PET/CT 18F-FDG tiene el poder de mejorar la detección de las metástasis peritoneales. Está indicado en pacientes con marcadores tumorales elevados, con imágenes anatómicas negativas o no conclusivas y en pacientes seleccionados para citorreducción completa. Se suma a las imágenes convencionales en la detección y estadificación de la carcinomatosis peritoneal, y es una herramienta diagnóstica útil en el monitoreo de la respuesta a la terapia y en el seguimiento a largo plazo.

Abstract Peritoneal carcinomatosis is the dissemination or extension in the peritoneal cavity of a cancer originated in some organ or abdominal viscera, generally associated with digestive or gynaecological neoplasms. It can also occur in primary form, as in mesothelioma and primary peritoneal adenocarcinoma. Anatomical images are essential for the evaluation of peritoneal seeding, but small neoplastic implants can be difficult to detect with CT or MR imaging. PET/CT 18F-FDG can improve the detection of peritoneal metastases. It is indicated in patients with elevated tumour markers, with negative or inconclusive anatomical images, and in patients selected for complete debulking. PET/CT 18F-FDG adds to conventional images in the detection and staging of peritoneal carcinomatosis, and is a useful diagnostic tool in monitoring the response to therapy and in long-term follow-up.

Prevalence of germline BRCA mutations among women with carcinoma of the peritoneum or fallopian tube / 부인종양

OBJECTIVE: The aim of the present study was to assess the frequency of germline mutations in patients with peritoneal carcinoma (PC) or the fallopian tube carcinoma (FTC), using a multi-gene panel. METHODS: Twenty-six patients diagnosed with either PC or FTC between January 2013 and December 2016 were recruited consecutively. Germline DNA was sequenced using a 6-gene next generation sequencing (NGS) panel following genetic counseling. Surgico-medical information was obtained from hospital records. Genetic variations were detected using the panel and were cross-validated by Sanger direct sequencing. RESULTS: Germline BRCA1/2 mutations were identified in 6 patients (23.1%). Four were detected in patients with PC and 2 were in FTC patients. No mutations were detected in TP53, PTEN, CDH1, or PALB2. We identified 11 variant of uncertain significance (VUS) in 9 patients; 2 in BRCA1, 3 in BRCA2, 2 in TP53, and 4 in CDH1. We also detected a CDH1 c.2164+16->A VUS in 3 patients. CONCLUSION: The prevalence of germline BRCA1/2 mutations in patients with PC or FTC is comparable to that of BRCA1/2 mutations in epithelial ovarian cancer patients.

Diagnostic Value of Carcinoembryonic Antigen in Ascites for Colorectal Cancer with Peritoneal Carcinomatosis / 대한소화기학회지

BACKGROUND/AIMS: Diagnostic tests for carcinoembryonic antigen (CEA) in ascites have been performed in various malignant cases, but there is only few data on the applicability of CEA for colorectal cancer (CRC) patients with peritoneal carcinomatosis. We aimed to determine the usefulness of CEA in ascites (aCEA) as a diagnostic parameter for CRC with peritoneal carcinomatosis. METHODS: Between January 2000 and May 2013, the medical records of 259 patients who underwent paracentesis for the evaluation of ascites were retrospectively reviewed. CRC patients with ascites (n=82) and patients with non-malignant ascites (n=177) were evaluated. Patients who had other malignancies, including gastric or ovarian cancer, with ascites were excluded. The optimal diagnostic cut-off value of aCEA for CRC with peritoneal carcinomatosis was determined using receiver operating characteristic curve analysis. The value of aCEA for predicting the occurrence of peritoneal carcinomatosis was evaluated using a logistic regression model. RESULTS: The optimal cut-off value of aCEA to diagnose CRC with peritoneal carcinomatosis was 3.89 ng/mL, and the area under the curve for aCEA was 0.996 (sensitivity 96.3%, specificity 100%, positive predictive value 100%, negative predictive value 98.3%). Multivariate logistic regression analysis showed that aCEA was an independent factor predicting the occurrence of peritoneal carcinomatosis. CONCLUSIONS: In this study, we showed that aCEA may be a useful parameter for diagnosing CRC with peritoneal carcinomatosis, and we propose an optimal aCEA cut-off value of 3.89 ng/mL. Further study that includes patients with other malignant ascites may be necessary to validate these findings.

Quimioterapia Aerossolizada e Pressurizada Intraperitoneal (PIPAC) por monoportal: aplicação alternativa no controle das metástases peritoneais / Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) through a single port: alternative delivery for the control of peritoneal metastases

RESUMO A carcinomatose peritoneal é a evolução natural das neoplasias gastrointestinais, ginecológicas e primárias do peritônio. Nos últimos anos, a carcinomatose passou a ser considerada uma doença confinada ao peritônio, e não mais uma doença disseminada. Desta forma, a associação de citorredução cirúrgica associada à quimioterapia intraperitoneal se tornou o ponto chave no controle das metástases peritoneais. Tradicionalmente, a quimioterapia intraperitoneal é aplicada utilizando soluções líquidas. Uma nova modalidade de infusão da quimioterapia na cavidade abdominal surge como uma alternativa ao método tradicional. A chamada PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) transforma a solução terapêutica líquida em um spray aerossolizado, potencializando a distribuição e penetração da quimioterapia intraperitoneal. Este relato tem por objetivo descrever essa nova técnica cirúrgica inovadora, realizada pela primeira vez por um monoportal no Brasil, alterando a forma descrita originalmente para a aplicação da PIPAC.

ABSTRACT Peritoneal carcinomatosis is the natural course of gastrointestinal, gynecologic, and primary peritoneal neoplasms. In recent years, our understanding of carcinomatosis has changed; it is no longer considered a disseminated condition, but rather a disease confined to the peritoneum. Thus, the combination of cytoreductive surgery and intraperitoneal chemotherapy has become the cornerstone of control of peritoneal metastases. Traditionally, intraperitoneal chemotherapy is delivered in the form of liquid solutions. However, a new mode of chemotherapy delivery to the abdominal cavity has arisen as an alternative to the conventional method. In Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC), the liquid solution is aerosolized into a spray, potentiating the distribution and penetration of the chemotherapeutic agent intraperitoneally. The present study aims to describe a novel form of this innovative surgical technique performed for the first time in Brazil, in a modification of the technique originally described for PIPAC: delivery through a single-port device.

Treatment for peritoneal metastasis of colorectal cancer / 中华外科杂志

Peritoneal metastasis is the second leading cause of death of colorectal cancer patients. Cytoreductive surgery (CRS) combined with hyperthermia intraperitoneal chemotherapy (HIPEC) is the primary method to treat peritoneal metastasis of colorectal cancer, though there remain some controversies. We reviewed current studies of colorectal peritoneal carcinomatosis (PC) and CRS+ HIPEC, and discussed some issues with regard to the scoring system for peritoneal metastasis, selection criteria for CRS+ HIPEC treatment, and the new drug application for colorectal PC. Peritoneal carcinomatosis index (PCI) is the most useful scoring system for peritoneal metastasis and CRS+ HIPEC is the primary treatment for colorectal PC. Patients with PCI<20 should receive thorough assessment on the feasibility of R0 or R1 resection and CRS+ HIPEC treatment. For patients with unresectable PC at the initial stage, active drug therapy should be adopted to achieve tumor regression, so that some of them would have the opportunity to receive CRS+ HIPEC treatment.

Clinicopathologic characteristics of pseudomyxoma peritonei / 中华病理学杂志

Objective@#To analyze the relationship between clinicopathologic characteristics of pseudomyxoma peritonei (PMP) and its prognosis.@*Methods@#Fifty-two cases of PMP collected from 2012 to 2017 at Beijing Shijitan Hospital, Capital Medical University were reviewed using the diagnostic criteria of WHO 2010. The histopathologic features, including original location, neural invasion and calcification were observed; and the relationship with prognosis was analyzed. Immunohistochemical staining for CK7, CK20 and CDX2 was performed on all cases. ER, PR, and p16 were additionally performed on those without clear origin.@*Results@#Patients′ mean age was 52.0 years, and included 29 males and 23 females. Thirty-two cases were derived from appendix; among them, 23 were low grade and 29 were high grade. Signet ring-cells, neural invasion and calcification were detected in 15, 12 and 9 cases respectively. Neural invasion was associated with adverse prognosis (P=0.025) and signet ring cell morphology (P<0.01). Prognosis was not related to gender, age, original location or grade.@*Conclusion@#Neural invasion is not uncommon in PMP and predicts a bad prognosis.

A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma / Proposta de padronização da Sociedade Brasileira de Cirurgia Oncológica (BSSO/SBCO) para procedimentos de citorredução cirúrgica (CRS) e quimioterapia intraperitoneal hipertérmica (HIPEC) no Brasil: pseudomixoma peritoneal, tumores do apêndice cecal e mesotelioma peritoneal maligno

ABSTRACT Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.

RESUMO A cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica emergiu como um importante tratamento das neoplasias peritoneais e é, atualmente, o padrão de atendimento para neoplasias epiteliais do apêndice associadas à síndrome de pseudomixoma peritoneal, bem como para o mesotelioma peritoneal maligno difuso. No mundo, existem algumas variações reconhecidas das técnicas de cirurgia citorredutora e quimioterapia intraperitoneal hipertérmica, entretanto nenhuma técnica até agora demonstrou sua superioridade sobre o outra. Portanto, a padronização destes procedimentos poderia melhorar a prática clínica e permitir a comparação adequada entre os resultados. Neste cenário, a Sociedade Brasileira de Cirurgia Oncológica considera importante a apresentação de uma proposta de padronização de procedimentos de cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica no Brasil, com um foco especial na produção de dados homogêneos para o desenvolvimento do registro brasileiro das neoplasias peritoneais.

A double-catheter washing and aspiration system for the treatment of gastrointestinocutaneous fistula after peritoneal cancer resection / 中华普通外科杂志

Objective To evaluate double catheterization of cannula persistent irrigation and negative pressure system to treat gastrointestinocutaneous fistula (GIF) after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for peritoneal cancer.Methods A self-made double catheterization of cannula persistent bathe and negative pressure system was implanted into the site of fistula,to ensure efficient drainage.The patient was treated with anti-sepsis,nutrition support and other conservative measures.Results GIFs occurred in 13 patients.The negative pressure drainage system was successfully implanted into the fistula site to keep an efficient drainage.By this conservative treatment fistula healed in 8 patients after 50 days (range 12 to 84 days).In other three patients fistula output significantly reduced and general conditions greatly improved.The mortality rate was 15％ (2/13).Conclusion The double catheterization of cannula persistent bathe and negative pressure aspiration system is a simple and efficient method to treat GIF.