Impact of extent of parietal peritonectomy on oncological outcome after cytoreductive surgery and HIPEC.

BACKGROUND: In peritoneal surface malignancy (PSM), in spite of optimal cytoreductive surgery (CRS), majority of recurrences that occur are intraperitoneal. In patients with PSM, studies employing fluorescent imaging and microscopic examination have shown normal looking peritoneum may harbor active disease. This study was done to assess the recurrence pattern, oncological outcomes, and morbidity and mortality of the extent of peritonectomy in patients who underwent total parietal peritonectomy (TPP) or involved field peritonectomy (IFP) as a part of the procedure during CRS and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: This was a retrospective analysis of prospectively collected data, from February 2013 to December 2017. A total of 163 patients with PSM underwent TPP or IFP with CRS plus HIPEC. Their oncological outcomes, recurrence pattern, postoperative morbidity and mortality were analyzed. RESULTS: Of the 163 cases, the primary organs of origin were ovary, colorectal, appendicular pseudomyxoma, stomach, mesothelioma and others (67.4%, 16.5%, 6.1%, 4.9%, 2% and 2%), respectively. TPP was performed in 70 patients and IFP in 93 patients. TPP group had higher mean PCI (16 vs. 14), longer duration of surgery (11 vs. 9 h), and more blood loss (1,243 vs. 675 mL). Overall G3-G4 morbidity was comparable in both groups (42.8% vs. 33.3%) as was mortality (5.7% vs. 4.4%). Kaplan-Meier analysis showed that with a median follow-up of 45 months, TPP group had a recurrence-free survival (RFS) of 26 months and overall survival (OS) was yet to be achieved, whereas the IFP group had a RFS and OS of 21 and 43 months, respectively. CONCLUSIONS: Performing TPP reduces the chance of missing the microscopic disease, therefore can minimize local recurrence, and better oncological outcomes. TPP can be performed with acceptable morbidity and mortality, at the cost of increased duration of surgery and higher blood loss.

Malignant melanoma of the choroid presenting as orbital cellulitis: report of two cases with a review of the literature.

Orbital cellulitis can be the initial presentation of malignant melanoma of the choroid when such tumors undergo necrosis or extrascleral extension. We report two unusual cases of malignant melanoma of the choroid presenting with gradual dimness of vision for only two months. Histopathology revealed malignant melanoma of the choroid with extensive necrotic hemorrhages within the tumor. There was extensive infiltration of the sclera with acute inflammatory cells. No evidence of intra- or extrascleral extension by the tumor was seen. Metastatic work-up revealed no evidence of secondary deposits. An unusual presentation of malignant melanoma of the choroid is reported, together with the pathogenic mechanisms and a review of the literature.