Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal carcinomatosis. Preliminary results and cost from two centers in Greece.

PURPOSE: To report our preliminary experience in the combined treatment of peritoneal carcinomatosis (PC) using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). PATIENTS AND METHODS: This prospective study included patients with PC from gynaecological, gastric and colon cancer, treated in two centers. Cytoreductive surgery included the peritonectomy procedures described by Jacquet and Sugarbaker as well as multivisceral resections in order to achieve a complete macroscopical cancer eradication. The HIPEC that followed was performed via the open abdomen technique. RESULTS: Twenty-four patients (3 men and 21 women, mean age 60 years) were treated. Twelve patients had PC from ovarian cancer, 7 from colon, 3 from gastric and 2 from uterine cancer. The mean duration of the procedure was 7.83 h (range 5 -12.30). Macroscopically, complete cytoreduction (CC) was achieved in 18 (75%) patients. Two (8.3%) patients died in the first 30 days. The overall morbidity was 42% and 2 patients were reoperated. The mean follow up was 22 months (range 3-36). The overall 1-year survival was 59.1%; concerning the gynaecological cancers it was 53.8% (mean survival 11.7 months) and for gastrointestinal cancers it was 44.4% (mean survival 9.5 months). CONCLUSION: Our preliminary data suggest that the combined treatment of cytoreduction plus HIPEC for PC is associated with acceptable mortality and morbidity and offers an improved survival in these patients. An optimal patient selection and establishment of experienced centres are of paramount importance.

Is local excision and chemoradiation an acceptable alternative in the treatment of early rectal cancer?

Local excision has a limited but important role in the modern management of patients with rectal tumors. The main criticism of the local treatment of early rectal cancer (T1N0M0 or T2N0M0) is the neglect of any potential metastatic mesorectal lymph nodes. This article presents the combined experience of several trials and indicates that neoadjuvant preoperative or adjuvant postoperative treatment may reduce the risk of local recurrence in a selected group of patients, and local excision results in overall survival comparable to the most aggressive treatment. Although the hypothetical improvement in morbidity and quality of life with local excision has not been demonstrated, the advantages of the local excision vs. radical surgery in the oncologic results seem obvious and require prospective randomized studies comparing both types of treatment.

Simple closure of chronic duodenal ulcer perforation in the era of Helicobacter pylori: an old procedure, today's solution.

BACKGROUND/AIMS: To evaluate the risk of recurrence in our patients with chronic duodenal ulcer perforation, who underwent a simple closure and postoperative Helicobacter pylori eradication therapy. METHODOLOGY: Within 4.5 years (3/1996 to 7/2000), 21 patients with chronic duodenal ulcer perforation, were operated in our hospital. All of them underwent simple closure with omental patch repair plus Helicobacter pylori eradication with omeprazole, clarithromycin and amoxycillin for two weeks. On December 2000, in 14 (66.6%) of these patients, urea breath test for Helicobacter pylori was performed, followed by endoscopy. RESULTS: The mean age of our 14 patients is 55 years. The urea breath test was positive for Helicobacter pylori in 3 (21.4%) patients. Two of them had endoscopically gastritis, confirmed by pathological examination. None of our patients had ulcer relapse. The three patients with positive urea breath test received another course of the same eradication therapy. CONCLUSIONS: Simple closure of perforated chronic duodenal ulcer in combination with postoperative Helicobacter pylori eradication, seems to be an accepted treatment, so the immediate acid-reduction surgery (vagotomy) in the contaminated environment caused by perforation, is probably unnecessary.