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She Y, Cui J, Ye J, Pan F, Liang W, He X, Wu D, Ji X, Wang C. Nanomotor-driven precision therapy for peritoneal metastasis. Biomaterials 2025; 322:123354. [PMID: 40286575 DOI: 10.1016/j.biomaterials.2025.123354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 04/09/2025] [Accepted: 04/20/2025] [Indexed: 04/29/2025]
Abstract
Peritoneal metastasis (PM) is a terminal stage of gastrointestinal cancers, often resulting in poor survival outcomes. Traditional treatments like cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown some effectiveness but are associated with significant risks. This study presents a novel nanomotor-based drug delivery system (M@MnO2-Au-mSiO2@CDDP) designed to enhance the efficacy of PM treatment. By utilizing an oxygen-driven heterojunction nanomotor (MnO2-Au-mSiO2), coated with membrane of M1-type macrophages, the system targets PM tumors with high precision through intraperitoneal perfusion. These biomimetic NMs promote deep tumor penetration, enhance reactive oxygen species (ROS) generation, and activate the STING pathway, a critical component in immune regulation. The catalytic properties of MnO2 within the nanomotors enhance drug permeability and retention, enabling targeted and controlled drug release. Both in vitro and in vivo experiments demonstrated the system's ability to significantly inhibit tumor growth, induce apoptosis, and activate immune responses. In addition, the synergistic effect of targeted drug delivery, catalytic therapy and immunotherapy of this system was further confirmed by constructing an in vitro gastric cancer organoid model, showing great clinical application potential. The study also confirmed excellent biocompatibility and stability, making these NMs a promising clinical tool for the treatment of PM. This research underscores the potential of nanotechnology to revolutionize cancer treatment by overcoming the limitations of traditional therapies and paving the way for future innovations in targeted cancer therapies.
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Affiliation(s)
- Yaoguang She
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; Medical School of Chinese PLA, Beijing, 100853, China
| | - Jianxin Cui
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiamin Ye
- State Key Laboratory of Advanced Medical Materials and Devices, Medical College, Tianjin University, Tianjin, 300072, China
| | - Fei Pan
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wenquan Liang
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaofeng He
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Di Wu
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; Medical School of Chinese PLA, Beijing, 100853, China
| | - Xiaoyuan Ji
- State Key Laboratory of Advanced Medical Materials and Devices, Medical College, Tianjin University, Tianjin, 300072, China.
| | - Chunxi Wang
- Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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Bitar I, Waggoner R, Alzayadi H, Abushaban K. A Case of Primary Peritoneal Adenocarcinoma: Diagnostic and Therapeutic Challenges. Cureus 2025; 17:e82140. [PMID: 40357085 PMCID: PMC12068416 DOI: 10.7759/cureus.82140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2025] [Indexed: 05/15/2025] Open
Abstract
Primary peritoneal adenocarcinoma (PPA) is a rare and aggressive malignancy that closely resembles high-grade serous ovarian carcinoma but originates from the peritoneal lining with minimal ovarian involvement. We present the case of a 72-year-old female patient with a history of endometrial cancer who developed progressive ascites, recurrent hospitalizations, and a hypercoagulable state. Imaging revealed peritoneal carcinomatosis, and paracentesis confirmed high-grade serous carcinoma through immunohistochemical staining. Despite initial plans for chemotherapy, treatment was deferred for outpatient initiation. Due to disease progression, she underwent cytoreductive surgery with tumor debulking, but pathology confirmed metastatic spread. Postoperative complications included hypotension and ileus, which extended hospitalization. This case highlights the diagnostic and therapeutic challenges of PPA, emphasizing the need for a multidisciplinary approach to optimize patient outcomes.
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Affiliation(s)
- Imran Bitar
- School of Medicine, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Ryan Waggoner
- School of Medicine, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Hassan Alzayadi
- Department of Biology, The University of Michigan-Dearborn, Dearborn, USA
| | - Kamil Abushaban
- Department of Radiology, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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Nieciecki VF, Blum FC, Johnson RC, Testerman TL, McAvoy TJ, King MC, Gushchin V, Whitmire JM, Frey KG, Glang L, Peña-Gomez D, Bishop-Lilly KA, Sardi A, Merrell DS, Metcalf JL. Cross-laboratory replication of pseudomyxoma peritonei tumor microbiome reveals reproducible microbial signatures. mSphere 2025; 10:e0065224. [PMID: 39976448 PMCID: PMC11934312 DOI: 10.1128/msphere.00652-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 01/21/2025] [Indexed: 02/21/2025] Open
Abstract
Recent work has demonstrated that cancer-specific microbial communities often colonize tumor tissues. However, untangling low-biomass signals from environmental contamination makes this research technically challenging. We utilize pseudomyxoma peritonei (PMP), a cancer characterized by the spread of mucus-secreting cells throughout the peritoneal cavity, to develop a robust workflow for identifying reproducible tumor microbiomes. Typically originating from the rupture of an appendiceal tumor into the peritoneal cavity, metastasized tumors have been previously shown to harbor a core set of microbes. However, that work did not control for the potential contamination of these low microbial biomass samples. We expand upon these prior findings by characterizing the microbiome of 70 additional PMP tumors and six normal peritoneal control tissues along with appropriate laboratory controls. Additionally, DNA from a subset of 25 tissues was extracted and sequenced at an independent laboratory. We found evidence of reproducible microbial signatures between the replicates of six different PMP tumors that include a set of core taxa that may be introduced from surgical contamination, as well as patient-specific taxa that are also commonly implicated in colorectal cancer. In addition, preoperative chemotherapy treatment was found to reduce tumor microbiome diversity. Our findings demonstrate how independent sample replication can be a powerful approach to investigate low-biomass microbial communities associated with tumor tissues that will improve low microbial biomass research.IMPORTANCERecent work has demonstrated that microbial communities colonize over 30 different types of tumor tissues. The origin of these communities and their possible involvement in carcinogenesis or cancer treatment outcomes remains an unclear, yet important area of research. A current major challenge in characterizing low-biomass, tumor-associated microbiomes is the introduction of environmental contamination during collection, handling, DNA extraction, PCR, and sequencing. Here, we provide a framework for replicating low-biomass tumor microbiome samples to help identify tumors with robust microbial signals and low background contamination. Using this replication approach, we show that pseudomyxoma peritonei (PMP) tumors host reproducible microbial communities, including organisms that have previously been associated with colorectal cancer. Incorporating sample replication into future tumor microbiome studies is a promising approach that will help identify robust signals and increase reproducibility in the field.
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Affiliation(s)
- Victoria F. Nieciecki
- Graduate Program in Cell & Molecular Biology, Colorado State University, Fort Collins, Colorado, USA
- Department of Animal Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Faith C. Blum
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | | | - Traci L. Testerman
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Tom J. McAvoy
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland, USA
| | - Mary Caitlin King
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, Maryland, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, Maryland, USA
| | - Jeannette M. Whitmire
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | - Kenneth G. Frey
- Genomics & Bioinformatics Department, Naval Medical Research Command, NMRC-Frederick, Fort Detrick, Maryland, USA
| | - Lindsay Glang
- Genomics & Bioinformatics Department, Naval Medical Research Command, NMRC-Frederick, Fort Detrick, Maryland, USA
- Leidos, Reston, Virginia, USA
| | - Dessiree Peña-Gomez
- Genomics & Bioinformatics Department, Naval Medical Research Command, NMRC-Frederick, Fort Detrick, Maryland, USA
- Leidos, Reston, Virginia, USA
| | - Kimberly A. Bishop-Lilly
- Genomics & Bioinformatics Department, Naval Medical Research Command, NMRC-Frederick, Fort Detrick, Maryland, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, Maryland, USA
| | - D. Scott Merrell
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | - Jessica L. Metcalf
- Graduate Program in Cell & Molecular Biology, Colorado State University, Fort Collins, Colorado, USA
- Department of Animal Sciences, Colorado State University, Fort Collins, Colorado, USA
- Canadian Institute for Advanced Research Global Scholar, Toronto, Ontario, Canada
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Lin Q, Chen C, Li K, Cao W, Wang R, Fichera A, Han S, Zou X, Li T, Zou P, Wang H, Ye Z, Yuan Z. A deep-learning model to predict the completeness of cytoreductive surgery in colorectal cancer with peritoneal metastasis☆. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109760. [PMID: 40174333 DOI: 10.1016/j.ejso.2025.109760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 02/26/2025] [Accepted: 03/09/2025] [Indexed: 04/04/2025]
Abstract
BACKGROUND Colorectal cancer (CRC) with peritoneal metastasis (PM) is associated with poor prognosis. The Peritoneal Cancer Index (PCI) is used to evaluate the extent of PM and to select Cytoreductive Surgery (CRS). However, PCI score is not accurate to guide patient's selection for CRS. OBJECTIVE We have developed a novel AI framework of decoupling feature alignment and fusion (DeAF) by deep learning to aid selection of PM patients and predict surgical completeness of CRS. METHODS 186 CRC patients with PM recruited from four tertiary hospitals were enrolled. In the training cohort, deep learning was used to train the DeAF model using Simsiam algorithms by contrast CT images and then fuse clinicopathological parameters to increase performance. The accuracy, sensitivity, specificity, and AUC by ROC were evaluated both in the internal validation cohort and three external cohorts. RESULTS The DeAF model demonstrated a robust accuracy to predict the completeness of CRS with AUC of 0.9 (95 % CI: 0.793-1.000) in internal validation cohort. The model can guide selection of suitable patients and predict potential benefits from CRS. The high predictive performance in predicting CRS completeness were validated in three external cohorts with AUC values of 0.906(95 % CI: 0.812-1.000), 0.960(95 % CI: 0.885-1.000), and 0.933 (95 % CI: 0.791-1.000), respectively. CONCLUSION The novel DeAF framework can aid surgeons to select suitable PM patients for CRS and predict the completeness of CRS. The model can change surgical decision-making and provide potential benefits for PM patients.
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Affiliation(s)
- Qingfeng Lin
- Department of Colorectal Surgery and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Can Chen
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China; College of Computers, Central South University, Changsha, China
| | - Kangshun Li
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
| | - Wuteng Cao
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Renjie Wang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Alessandro Fichera
- Colon and Rectal Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Shuai Han
- General Surgery Center, Department of Gastrointestinal Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangjun Zou
- College of Intelligent Manufacturing and Modern Industry (School of Mechanical Engineering), Xinjiang University, Urumqi, China
| | - Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Peiru Zou
- Department of Colorectal Surgery and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Hui Wang
- Department of Colorectal Surgery and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
| | - Zaisheng Ye
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China.
| | - Zixu Yuan
- Department of Colorectal Surgery and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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Stockley C, Bouchard‐Fortier A, Mateshaytis J, Taqi K, Mack L, Nelson G, Chong M, Deban M. Implementation of a Multidisciplinary Enhanced Recovery After Surgery (ERAS) Program for Cytoreductive Surgery (CRS) With Hyperthermic Intraperitoneal Chemotherapy (HIPEC). J Surg Oncol 2025; 131:527-534. [PMID: 39359111 PMCID: PMC12044283 DOI: 10.1002/jso.27931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 09/08/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND AND OBJECTIVES Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can be associated with prolonged hospital stays. A novel Enhanced Recovery After Surgery (ERAS) based on ERAS Society guidelines was designed and implemented. The primary outcome was ERAS compliance. Secondary outcomes included length of stay (LOS) and postoperative complications. METHODS A retrospective study on patients who underwent CRS/HIPEC between 2018 and 2022, with ERAS implementation in 2022. Health records were reviewed. Statistical analysis included descriptive statistics, Wilcoxon tests, Student t-test, and χ2 and binomial negative regression. Health Ethics Research Board approval was obtained. RESULTS Eighty patients underwent CRS/HIPEC: 59 in the pre-ERAS group and 21 in the post-ERAS group. Groups were similar in age, comorbidities, and Peritoneal Carcinomatosis Index. ERAS compliance increased from 32.8% to 70.8% (p < 0.001). Median LOS decreased from 14 to 9 days (p < 0.001). Comparing pre-ERAS to post-ERAS showed no significant difference in the major morbidity rate (13.6% vs. 9.5%) or 30-day readmission (9.4% vs. 4.8%) and no mortalities. Controlling for patient characteristics, the mean LOS decreased by 6.94 days (p < 0.001). CONCLUSION Implementation of an ERAS CRS/HIPEC program is safe and allows for improved compliance to ERAS protocols and a significant reduction in LOS.
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Affiliation(s)
- Cecily Stockley
- Department of Surgery and OncologyUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Jennifer Mateshaytis
- Department of Obstetrics and GynecologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Kadhim Taqi
- Department of Surgery and OncologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Lloyd Mack
- Department of Surgery and OncologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Gregg Nelson
- Department of Obstetrics and GynecologyUniversity of CalgaryCalgaryAlbertaCanada
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Michael Chong
- Department of AnesthesiologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Melina Deban
- Department of Surgery and OncologyUniversity of CalgaryCalgaryAlbertaCanada
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Fernando DG, Sparapani R, Mogal H. Role of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) in the Treatment of Peritoneal Carcinomatosis From Small Bowel Adenocarcinoma-A Systematic Review and Meta-Analysis. J Surg Oncol 2025; 131:725-733. [PMID: 39552156 DOI: 10.1002/jso.27956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/01/2024] [Accepted: 10/07/2024] [Indexed: 11/19/2024]
Abstract
INTRODUCTION While systemic chemotherapy (SC) is the mainstay of treatment of peritoneal carcinomatosis from small bowel adenocarcinomas (SBA-PC), its efficacy and outcomes remain poor. Therefore, the role of curative-intent surgery needs to be better defined. Using a systematic review and meta-analysis, this study aims to define the role of CRS/HIPEC in patients with SBA-PC. METHODS A systematic literature search was performed using PubMed and MEDLINE following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies published between 1990 and 2023. Articles were scored and incorporated within approximate normality of means/proportions formulae to compare outcomes of CRS/HIPEC and SC alone. RESULTS Ten studies with 461 patients undergoing CRS/HIPEC and seven studies with 285 patients undergoing SC alone were identified. In the CRS/HIPEC group, 215 (46.6%) were male and the median age was 46.5-66 years. The primary tumor was located mostly in the duodenum (n = 169, 36.7%) and ileum (n = 108, 23.4%). Grade was unspecified in most patients (n = 232, 50.3%). Median Peritoneal Cancer Index (PCI) ranged between 10 and 12, and 93.1% underwent complete cytoreduction (CC 0/1). CRS/HIPEC-related major morbidity and mortality was 20.7% (SD = 2.5, 95% CI 15.6-25.6) and 1.7% (SD = 0.8, 95% CI 0.1-3.3), respectively. With a median follow-up of 21.1 (SD = 1.1, 95% CI 18.9-23.3) months, CRS/HIPEC demonstrated median overall survival of 32.3 (SD = 1.19, 95% CI 30-34.6) versus 14.5 (SD = 0.19, 95% CI 14.1-14.9) months for SC alone (p < 0.0003). CONCLUSION In comparison to SC alone, CRS/HIPEC may result in long-term survival with acceptable perioperative morbidity, in select SBA-PC patients with low-volume disease undergoing complete cytoreduction.
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Affiliation(s)
- Deemantha G Fernando
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rodney Sparapani
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Harveshp Mogal
- Division of General Surgery, University of Washington, Seattle, Washington
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El Halabieh MA, Lodoli C, Ferracci F, Santullo F, Pacelli F, Foschi N. Scrotal wall necrosis after hipec using mitomycin-c: Case report and review of the literature. Int J Surg Case Rep 2025; 126:110797. [PMID: 39753069 PMCID: PMC11755072 DOI: 10.1016/j.ijscr.2024.110797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 12/23/2024] [Accepted: 12/27/2024] [Indexed: 01/15/2025] Open
Abstract
INTRODUCTION Hyperthermic intraperitoneal chemotherapy (HIPEC) is a current treatment option for peritoneal carcinosis (PC) after cytoreductive surgery (CRS). Genital skin alterations are rare complications reported variously after HIPEC using Mitomycin-C. PRESENTATION OF CASE A 42-year-old man with a diagnosis of stage IV colorectal cancer underwent CRS and HIPEC using mitomycin-C. On postoperative day 75, he developed scrotal wall necrosis not responding to any medical treatment. After he underwent surgery to remove the necrotic tissue and primarily suture the scrotal wound with success. DISCUSSION Genital skins disorders are rarely drugs-related effects and few cases after HIPEC using Mitomycin-C are reported in literature. The most accepted hypothesis to explain the occurrence of scrotal ulcers after CRS and HIPEC is the extravasation reaction to Mitomycin-C that inhibits wound healing and induces skin necrosis. CONCLUSION Correct diagnosis and immediate surgical debridement are the preferable management.
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Affiliation(s)
- Mriam Attalla El Halabieh
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Claudio Lodoli
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy.
| | - Federica Ferracci
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Fabio Pacelli
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Nazario Foschi
- Urology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
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Chen CY, Wang TY, Chang HY, Chen MC, Yang LY. A prospective pilot study of kidney-specific biomarkers to detect acute kidney injury after cytoreduction and hyperthermic intraperitoneal chemotherapy. ASIAN BIOMED 2024; 18:268-280. [PMID: 39697218 PMCID: PMC11650413 DOI: 10.2478/abm-2024-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a critical morbidity after cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). OBJECTIVE This study was conducted to investigate the use of kidney-specific biomarkers to evaluate the diagnostic accuracy of post-HIPEC AKI. METHODS Patients who received CRS/HIPEC were prospectively enrolled in this study. We serially sampled urine neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C (sCyC), and β2 microglobulin (sβ2-MG) on the day before CRS/HIPEC and then 2 h, 1 d, 2 d, 3 d, and 7 d after CRS/HIPEC. The primary outcome was the occurrence of AKI during the first 7 d. The areas under the receiver operating characteristic curve (AUCs) were calculated to evaluate the detection performance. RESULTS A total of 75 patients were eligible, of whom 5 (6.7%) fulfilled the criteria of AKI during the study period (AKI group) and 70 did not (non-AKI group). No significant differences were observed in these biomarkers between the two groups, except for sβ2-MG on day 3 (P = 0.025). Regarding changes in biomarker concentrations, the AKI group had a significantly higher concentration range of sCyC on day 3 (P = 0.009) and sβ2-MG on day 1 and day 3 (P = 0.013 and 0.019). CONCLUSIONS This is the first prospective study to evaluate the value of kidney-specific biomarkers in patients after CRS/HIPEC. We found that AKI cannot be predicted by simply using the absolute measurements of these biomarkers because of the heterogeneous characteristics of the patients.
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Affiliation(s)
- Chao-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital,Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Early Childhood Care and Education, Shu-Zen Junior College of Medicine and Management,Kaohsiung, Taiwan
| | - Ting-Yao Wang
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital,Chiayi, Taiwan
| | - Hung-Yu Chang
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital,Chiayi, Taiwan
| | - Min-Chi Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital,Chiayi, Taiwan
- Biostatistics Unit of Clinical Trial Center, Chang Gung Memorial Hospital,Linkou, Taiwan
| | - Lan-Yan Yang
- Division of Clinical Trial, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
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Salas PS, Urdzik J, Graf W, Isaksson B, Birgisson H. The Extent of Tumor in the Peritoneum and Liver Influences Outcomes After Surgery for Synchronous Liver and Peritoneal Colorectal Metastases: A Cohort Study. J Gastrointest Cancer 2024; 56:19. [PMID: 39537942 PMCID: PMC11561098 DOI: 10.1007/s12029-024-01139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRSH) or liver resection have led to increased survival in patients with peritoneal or liver metastases of colorectal cancer. Selected patients undergo concomitant CRSH and liver resection. Differences in survival and morbidity between patients who underwent concomitant surgery, CRSH or liver resection for peritoneal and/or liver metastases were compared. METHODS Patients who underwent liver resection and/or CRSH for colorectal liver and/or peritoneal metastases, 2006-2016, were included. Regression analysis was used to evaluate the associations between baseline characteristics and survival. RESULTS Overall, 634 patients were studied. Twenty-eight patients had peritoneal and liver metastases, 121 patients had peritoneal metastases only, and 485 patients had isolated liver metastases. Median survival after concomitant treatment was 23.8 months (95% CI 12.8-43.8), after CRSH 34.5 months (95% CI 27.1-41.9), and after liver resection 54.2 months (95% CI 47.4-61.0) (p < 0.001). Increased hepatic tumor burden (HR 3.2, 95% CI 1.8-5.8) and high-volume peritoneal disease (HR 6.0, 95% CI 3.7-9.8) were associated with decreased survival in multivariate analysis. Postoperative complications according to a Clavien-Dindo score > 3a were observed in 11% in the liver resection group, 15% in the CRSH group, and 11% in the concomitant treatment group (p = 0.945). CONCLUSIONS Patients treated with concomitant surgery for liver and peritoneal metastases experienced a shorter median overall survival than patients treated for metastases at an isolated site but had a similar rate of severe postoperative complications. The extent of peritoneal spread seemed to impact survival more than the tumor burden in the liver.
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Affiliation(s)
- Pearl Sanchez Salas
- Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
- Department of Surgery, Orthopedics and Urology, Södertälje Sjukhus, 152 86, Södertälje, Sweden.
| | - Jozef Urdzik
- Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
- Department of Surgery, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Wilhelm Graf
- Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
- Department of Surgery, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
- Department of Surgery, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Helgi Birgisson
- Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
- Department of Surgery, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
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Ji ZH, Zhao QD, Li Y. The Effects of HIPEC on Survival of Gastric Cancer Patients With Peritoneal Metastasis. J Surg Oncol 2024; 130:1190-1195. [PMID: 39552020 DOI: 10.1002/jso.27877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 08/26/2024] [Indexed: 11/19/2024]
Abstract
Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has been recommended by Peritoneal Surface Oncology Group International (PSOGI) and several other academic organizations as the treatment of choice for selected patients with gastric cancer peritoneal metastasis (GCPM). This review updates the recent progress in CRS+HIPEC for GCPM, with particular focus on the potential curing effects of this approach for subclinical GCPM patients.
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Affiliation(s)
- Zhong-He Ji
- Department of Surgical Oncology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qi-Di Zhao
- Department of Surgical Oncology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yan Li
- Department of Surgical Oncology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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11
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Lario-Perez S, Macia JJ, Lillo-Garcia C, Caravaca I, Lopez-Rodriguez F, Calero A, Tomas-Rodriguez MI, Moya-Martinez A, Arroyo A, Lacueva FJ. Home-Based Trimodal Prehabilitation in Patients with Peritoneal Carcinomatosis Undergoing Cytoreductive Surgery: Effect on Functional Walking Capacity and Skeletal Muscle Mass. Ann Surg Oncol 2024; 31:7133-7141. [PMID: 39012464 DOI: 10.1245/s10434-024-15756-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Patients with peritoneal carcinomatosis often suffer from loss of skeletal muscle mass and require extensive surgery. Multimodal prehabilitation may improve physical status but its benefits for these specific patients remain unknown. This study aimed to evaluate the effect of prehabilitation on functional walking capacity and skeletal muscle mass, as well as its association with postoperative complications. PATIENTS AND METHODS A prospective study of patients with peritoneal carcinomatosis following a home-based trimodal prehabilitation program was carried out. Functional walking capacity was assessed with the 6-min walk test (T6MWT), and by the appendicular skeletal muscle index (ASMI) estimated by bioelectrical impedance analysis. Data were collected at the first medical appointment and on the day before surgery. A 90-day postoperative morbidity was registered according to the Clavien-Dindo classification. RESULTS A total of 62 patients were included in the analysis. Women were more prevalent (77.4%) and peritoneal metastasis from ovarian origin accounted for 48.4%. Clavien II-V grades occurred in 30 (57.7%) patients. After prehabilitation, functional walking capacity improved by 42.2 m (39.62-44.72 m) compared with baseline data (p < 0.001), but no improvement was observed in the ASMI (p = 0.301). Patients able to walk at least 360 m after prehabilitation suffered fewer Clavien-Dindo II-V postoperative complications (p = 0.016). A T6MWT of less than 360 m was identified as an independent risk factor in the multivariable analysis (OR 3.99; 1.01-15.79 p = 0.048). CONCLUSIONS This home-based trimodal prehabilitation program improved functional walking capacity but not ASMI scores in patients with peritoneal metastasis before surgery. A T6MWT of less than 360 m was found to be a risk factor for postoperative complications.
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Affiliation(s)
- S Lario-Perez
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
| | - J-J Macia
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
| | - C Lillo-Garcia
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
| | - I Caravaca
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
| | - F Lopez-Rodriguez
- Colorectal Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - A Calero
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - M I Tomas-Rodriguez
- Center for Translational Research in Physiotherapy, Pathology and Surgery Department, Miguel Hernandez University of Elche, Elche, Spain
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - A Moya-Martinez
- Statistical Department, FISABIO, University General Hospital of Elche, Elche, Spain
| | - A Arroyo
- Colorectal Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - F-J Lacueva
- Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain.
- Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
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12
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Gonzalez-Gil A, Gomez-Ruiz ÁJ, Gonzalez-Pérez C, Gil-Gomez E, Olivares-Ripoll V, Martinez J, Barceló F, Cascales-Campos PA. Systematic Cholecystectomy During Cytoreductive Surgery Plus HIPEC: A Critical Analysis of an Empirical Tradition. Ann Surg Oncol 2024; 31:7157-7164. [PMID: 39060691 PMCID: PMC11413086 DOI: 10.1245/s10434-024-15863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Some procedures performed during cytoreductive surgery (CRS) and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) are based on empirical data. One of these procedures is systematic cholecystectomy. This study aimed to perform a critical analysis of the need for systematic cholecystectomy during CRS+HIPEC of patients with peritoneal carcinomatosis using long-term follow-up data. METHODS Patients with peritoneal surface malignancies who were candidates for CRS+HIPEC and underwent surgery between January 2008 and December 2022 were analyzed. For patients with gallbladder involvement due to the disease or for patients whose preoperative study showed the presence of cholelithiasis, cholecystectomy was performed as part of the surgery, which was avoided for the remaining patients. All postoperative adverse events that occurred in the first 90 days were recorded, and clinical records focused on the development of biliary pathology during the follow-up period were studied. RESULTS The results from a consecutive series of 443 patients with peritoneal surface malignancies who underwent surgery between January 2008 and December 2022 were analyzed. The average age of the cohort was 50 years. The median follow-up period for the cohort was 41 months (range, 12-180 months), with a disease-free survival of 17 months. For 373 of the patients, CRS+HIPEC was completed without an associated cholecystectomy, and in 16 of them, the appearance of cholelithiasis was detected during the follow-up period. Only two patients in the series showed complications derived from gallstones and required a delayed cholecystectomy. CONCLUSIONS Although cholecystectomy is a safe procedure in the context of CRS+HIPEC, it is not risk free, and its routine performance may be unnecessary.
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Affiliation(s)
- Alida Gonzalez-Gil
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Álvaro Jesús Gomez-Ruiz
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Carmen Gonzalez-Pérez
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Elena Gil-Gomez
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Vicente Olivares-Ripoll
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jerónimo Martinez
- Departamento de Oncología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Barceló
- Departamento de Ginecología y Obstetricia, Unidad de Ginecología Oncológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pedro Antonio Cascales-Campos
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
- Servicio de Cirugía y Aparato Digestivo- Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
- Departamento de Cirugía, Universidad de Murcia, Murcia, Spain.
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Chen CY, Huang TH, Lee LW, Lung J, Ou YC, Hung CH, Chuang HC, Chen MC, Wang TY. Prognostic factors of early recurrence after complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Clin Cases 2024; 12:6057-6069. [PMID: 39328856 PMCID: PMC11326106 DOI: 10.12998/wjcc.v12.i27.6057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 07/29/2024] Open
Abstract
BACKGROUND Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) offer the potential for long-term survival in peritoneal carcinomatosis, outcomes following CRS/HIPEC vary significantly. AIM To identify the clinical factors associated with progression-free survival (PFS) after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal, ovarian, and gastric cancers. METHODS We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival (OS) in patients recruited between 2015 and 2020. Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year. Kaplan-Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS. RESULTS Of the 80 enrolled patients, 39 had an unfavorable PFS (< 1 year) and 41 had a favorable PFS (≥ 1 year). Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0 (CC-0) or length of CRS ≤ 6 h had a favorable PFS [odds ratio (OR) = 0.141, P = 0.004; and OR = 0.361, P = 0.027, respectively]. In multiple logistic regression, achieving CC-0 was the strongest prognostic factor for a favorable PFS (OR = 0.131, P = 0.005). A peritoneal cancer index score > 12 was associated with a lower rate of achieving CC-0 (P = 0.027). The favorable PFS group had a significantly longer OS (median 81.7 mo vs 17.0 mo, P < 0.001). CONCLUSION Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival. This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.
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Affiliation(s)
- Chao-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Early Childhood Care and Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Tzu-Hao Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Li-Wen Lee
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Jrhau Lung
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Medical Research and Development, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chien-Hui Hung
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Huei-Chieh Chuang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Min-Chi Chen
- Department of Public Health, Chang Gung University, Taoyuan 333, Taiwan
| | - Ting-Yao Wang
- Department of Early Childhood Care and Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
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14
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Wu ZJ, Lan B, Luo J, Ameti A, Wang H, Hu QY. Impact of preoperative inflammatory and nutritional markers on the prognosis of patients with peritoneal metastasis of colorectal cancer. World J Gastrointest Oncol 2024; 16:3865-3874. [PMID: 39350999 PMCID: PMC11438771 DOI: 10.4251/wjgo.v16.i9.3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/10/2024] [Accepted: 07/16/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Identifying patients with peritoneal metastasis (PMs) of colorectal cancer (CRC) who will benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is crucial before surgery. Inflammatory and nutritional indicators play essential roles in cancer development and metastasis. AIM To investigate the association of preoperative inflammatory and nutritional markers with prognosis in patients with CRC-PM. METHODS We included 133 patients diagnosed with CRC-PM between July 2012 and July 2018. Patients' demographics, overall survival (OS), and preoperative inflammatory and nutritional markers were evaluated. The Kaplan-Meier method and log-rank test were used to estimate differences. RESULTS Of the 133 patients, 94 (70.6%) had normal hemoglobin (Hb) and 54 (40.6%) had a high neutrophil-to-lymphocyte ratio (NLR). The median OS (mOS) was significantly lower for patients with high NLR (7.9 months) than for those with low NLR (25.4 months; P = 0.002). Similarly, patients with normal Hb had a longer mOS (18.5 months) than those with low Hb (6.3 months; P < 0.001). Multivariate analysis identified age, carbohydrate antigen 199 levels, NLR, Hb, and peritoneal cancer index as independent predictors of OS. Based on these findings, a nomogram was constructed, which demonstrated a good capacity for prediction, with a C-index of 0.715 (95% confidence interval: 0.684-0.740). Furthermore, the 1- and 2-year survival calibration plots showed good agreement between predicted and actual OS rates. The areas under the curve for the 1- and 2-year survival predictions of the nomogram were 0.6238 and 0.6234, respectively. CONCLUSION High NLR and low Hb were identified as independent predictive risk factors for poor prognosis in patients with CRC-PM. The established nomogram demonstrated high accuracy in predicting OS for patients with CRC-PM, indicating its potential as a valuable prognostic tool for this patient population.
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Affiliation(s)
- Zhi-Jie Wu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Bing Lan
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Jian Luo
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Ayniyazi Ameti
- Department of Anesthesiology, Kashgar First People’s Hospital, Kashgar 844000, Xinjiang Uygur Autonomous Region, China
| | - Hui Wang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Qiong-Yu Hu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Anesthesiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
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15
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Ding P, Wu H, Wu J, Li T, Gu R, Zhang L, Yang P, Guo H, Tian Y, He J, Yang J, Meng N, Li X, Meng L, Zhao Q. Transcriptomics-based liquid biopsy panel for early non-invasive identification of peritoneal recurrence and micrometastasis in locally advanced gastric cancer. J Exp Clin Cancer Res 2024; 43:181. [PMID: 38937855 PMCID: PMC11212226 DOI: 10.1186/s13046-024-03098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND This study aimed to develop a novel six-gene expression biomarker panel to enhance the early detection and risk stratification of peritoneal recurrence and micrometastasis in locally advanced gastric cancer (LAGC). METHODS We used genome-wide transcriptome profiling and rigorous bioinformatics to identify a six-gene expression biomarker panel. This panel was validated across multiple clinical cohorts using both tissue and liquid biopsy samples to predict peritoneal recurrence and micrometastasis in patients with LAGC. RESULTS Through genome-wide expression profiling, we identified six mRNAs and developed a risk prediction model using 196 samples from a surgical specimen training cohort. This model, incorporating a 6-mRNA panel with clinical features, demonstrated high predictive accuracy for peritoneal recurrence in gastric cancer patients, with an AUC of 0.966 (95% CI: 0.944-0.988). Transitioning from invasive surgical or endoscopic biopsy to noninvasive liquid biopsy, the model retained its predictive efficacy (AUC = 0.963; 95% CI: 0.926-1.000). Additionally, the 6-mRNA panel effectively differentiated patients with or without peritoneal metastasis in 95 peripheral blood specimens (AUC = 0.970; 95% CI: 0.936-1.000) and identified peritoneal micrometastases with a high efficiency (AUC = 0.941; 95% CI: 0.874-1.000). CONCLUSIONS Our study provides a novel gene expression biomarker panel that significantly enhances early detection of peritoneal recurrence and micrometastasis in patients with LAGC. The RSA model's predictive capability offers a promising tool for tailored treatment strategies, underscoring the importance of integrating molecular biomarkers with clinical parameters in precision oncology.
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Affiliation(s)
- Ping'an Ding
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Haotian Wu
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Jiaxiang Wu
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Tongkun Li
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Renjun Gu
- School of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Lilong Zhang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430065, China
| | - Peigang Yang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Honghai Guo
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Yuan Tian
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Jinchen He
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Jiaxuan Yang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China
| | - Ning Meng
- Department of General Surgery, Shijiazhuang People's Hospital , Shijiazhuang, Hebei, 050050, China
| | - Xiaolong Li
- Department of General Surgery, Baoding Central Hospital, Baoding , Hebei, 071030, China
| | - Lingjiao Meng
- Research Center and Tumor Research Institute of the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
| | - Qun Zhao
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China.
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, 050011, China.
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Wang J, Hu Y, Xiong H, Song T, Wang S, Xu H, Xiong B. CT-based deep learning model: a novel approach to the preoperative staging in patients with peritoneal metastasis. Clin Exp Metastasis 2023; 40:493-504. [PMID: 37798391 PMCID: PMC10618318 DOI: 10.1007/s10585-023-10235-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
Peritoneal metastasis (PM) is a frequent manifestation of advanced abdominal malignancies. Accurately assessing the extent of PM before surgery is essential for patients to receive optimal treatment. Therefore, we propose to construct a deep learning (DL) model based on enhanced computed tomography (CT) images to stage PM preoperatively in patients. All 168 patients with PM underwent contrast-enhanced abdominal CT before either open surgery or laparoscopic exploration, and peritoneal cancer index (PCI) was used to evaluate patients during the surgical procedure. DL features were extracted from portal venous-phase abdominal CT scans and subjected to feature selection using the Spearman correlation coefficient and LASSO. The performance of models for preoperative staging was assessed in the validation cohort and compared against models based on clinical and radiomics (Rad) signature. The DenseNet121-SVM model demonstrated strong patient discrimination in both the training and validation cohorts, achieving AUC was 0.996 in training and 0.951 validation cohort, which were both higher than those of the Clinic model and Rad model. Decision curve analysis (DCA) showed that patients could potentially benefit more from treatment using the DL-SVM model, and calibration curves demonstrated good agreement with actual outcomes. The DL model based on portal venous-phase abdominal CT accurately predicts the extent of PM in patients before surgery, which can help maximize the benefits of treatment and optimize the patient's treatment plan.
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Affiliation(s)
- Jipeng Wang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, Hubei, China
- Hubei Key Laboratory of Tumor Biological Behaviors, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Yuannan Hu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hao Xiong
- Department of information Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Tiantian Song
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, Hubei, China
- Hubei Key Laboratory of Tumor Biological Behaviors, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Shuyi Wang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, Hubei, China.
- Hubei Key Laboratory of Tumor Biological Behaviors, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China.
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Bin Xiong
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, Hubei, China.
- Hubei Key Laboratory of Tumor Biological Behaviors, No.169 Donghu Road, Wuchang District, Wuhan, 430071, China.
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Hung HC, Hsu PJ, Lee CW, Hsu JT, Wu TJ. Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal Carcinomatosis: Additional Information Helps to Optimize Patient Selection before Surgery. Cancers (Basel) 2023; 15:2089. [PMID: 37046754 PMCID: PMC10093399 DOI: 10.3390/cancers15072089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
(1) Background: The prognosis of gastric cancer-associated peritoneal carcinomatosis (GCPC) is poor, with a median survival time of less than six months, and current systemic chemotherapy, including targeted therapy, is ineffective. Despite growing evidence that cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for GCPC improves overall survival (OS), optimal patient selection remains unclear. We aimed to evaluate preoperative clinical factors and identify indicative factors for predicting postoperative OS in patients with GCPC undergoing CRS-HIPEC. (2) Methods: We retrospectively reviewed 44 consecutive patients with GCPC who underwent CRS-HIPEC between May 2015 and May 2021. Data on demographics and radiologic assessment were collected and analyzed. (3) Results: Elevated preoperative serum neutrophil-to-lymphocyte ratio > 4.4 (p = 0.003, HR = 3.70, 95% CI = 1.55-8.79) and number of computed tomography risks > 2 (p = 0.005, HR = 3.26, 95% CI = 1.33-7.98) were independently indicative of OS post-surgery. A strong correlation was observed between intraoperative peritoneal cancer index score and number of computed tomography risks (r = 0.534, p < 0.0001). Two patients after CRS-HIPEC ultimately achieved disease-free survival for more than 50 months. (4) Conclusions: Our experience optimizes GCPC patients' selection for CRS-HIPEC, may help to improve outcomes in the corresponding population, and prevent futile surgery in inappropriate patients.
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Affiliation(s)
| | | | | | | | - Ting-Jung Wu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, Chang-Gung University College of Medicine, Taoyuan 33305, Taiwan (J.-T.H.)
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18
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Carias E, Ferreira H, Chuva T, Paiva A, Maximino J. Acute Kidney Injury After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in a Portuguese Population. World J Oncol 2022; 13:370-378. [PMID: 36660215 PMCID: PMC9822680 DOI: 10.14740/wjon1540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 12/26/2022] Open
Abstract
Background Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with a higher rate of major complications, resulting in prolonged hospitalization and increased mortality. Our objective was to evaluate the incidence of AKI and further progression to chronic kidney disease (CKD) in patients submitted to this procedure and recognize the associated risk factors. Methods This retrospective study collected demographic, tumor-related, intraoperative, and postoperative data from 182 patients who underwent CRS/HIPEC from January 2016 to December 2019. Renal impairment was defined according to Kidney Disease Improving Global Outcomes criteria for AKI. We conducted univariate and multiple logistic regression analyses to assess the association between variables of interest and AKI. Results Twenty-three patients (12.6%) developed AKI. In the AKI group, the risk for developing CKD was six times higher (odds ratio (OR) 6.48, confidence interval (CI) 1.601 - 26.255). Multivariate regression identified higher risk of developing AKI in patients who underwent HIPEC with cisplatin (OR 12.21, CI 1.26 - 109.70, P = 0.025), in each additional day spent in the intensive care unit (ICU) (OR 2.42, CI 1.07 - 5.45, P = 0.033), and an association for each unit increase in estimated glomerular filtration rate (eGFR) before HIPEC (OR 0.96, CI 0.94 - 0.98, P = 0.037) and AKI development. Conclusion Patients who are at higher risk of AKI after CRS/HIPEC include those who performed cisplatin HIPEC regimen, had poorer preoperative renal function and had longer ICU stays. Early institution of preventive measures and frequent monitoring should be considered to minimize AKI risk and its associated morbidity, such as CKD progression.
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Affiliation(s)
- Eduarda Carias
- Department of Nephrology, Centro Hospitalar e Universitario do Algarve, Faro, Portugal,Corresponding Author: Eduarda Carias, Department of Nephrology, Centro Hospitalar e Universitario do Algarve, Faro, Portugal.
| | - Hugo Ferreira
- Department of Nephrology, Instituto Portugues de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Teresa Chuva
- Department of Nephrology, Instituto Portugues de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Ana Paiva
- Department of Nephrology, Instituto Portugues de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Jose Maximino
- Department of Nephrology, Instituto Portugues de Oncologia do Porto Francisco Gentil, Porto, Portugal
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Wang YF, Wang TY, Liao TT, Lin MH, Huang TH, Hsieh MC, Chen VCH, Lee LW, Huang WS, Chen CY. Quality of life and symptom distress after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Clin Cases 2022; 10:11775-11788. [PMID: 36405273 PMCID: PMC9669838 DOI: 10.12998/wjcc.v10.i32.11775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/ HIPEC) for peritoneal surface malignancy can effectively control the disease, however it is also associated with adverse effects which may affect quality of life (QoL). AIM To investigate early perioperative QoL after CRS/HIPEC, which has not been discussed in Taiwan. METHODS This single institution, observational cohort study enrolled patients who received CRS/HIPEC. We assessed QoL using the Taiwanese version of the MD Anderson Symptom Inventory (MDASI-T) and European Organization Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Participants completed the questionnaires before CRS/HIPEC (S1), at the first outpatient follow-up (S2), and 3 mo after CRS/HIPEC (S3). RESULTS Fifty-eight patients were analyzed. There was no significant perioperative difference in global health status. Significant changes in physical and role functioning scores decreased at S2, and fatigue and pain scores increased at S2 but returned to baseline at S3. Multiple regression analysis showed that age and performance status were significantly correlated with QoL. In the MDASI-T questionnaire, distress/feeling upset and lack of appetite had the highest scores at S1, compared to fatigue and distress/feeling upset at S2, and fatigue and lack of appetite at S3. The leading interference items were working at S1 and S2 and activity at S3. MDASI-T scores were significantly negatively correlated with the EORTC QLQ-C30 results. CONCLUSION QoL and symptom severity improved or returned to baseline in most categories within 3 mo after CRS/HIPEC. Our findings can help with preoperative consultation and perioperative care.
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Affiliation(s)
- Ya-Fen Wang
- Cancer Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ting-Yao Wang
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tzu-Ting Liao
- Division of Case Management, Cancer Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tzu-Hao Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Chiao Hsieh
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Taoyuan, Taiwan
| | - Li-Wen Lee
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Shih Huang
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chao-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Early Childhood Care and Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Chiayi, Taiwan
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20
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Deng H, Li B, Qin X. The short- and long-term survival of hyperthermic intraperitoneal chemotherapy (HIPEC) in the advanced gastric cancer with/without peritoneal carcinomatosis: a systematic review and meta-analysis of randomized controlled trials. Updates Surg 2022; 74:1805-1816. [DOI: 10.1007/s13304-022-01376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022]
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21
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Drubay V, Nuytens F, Renaud F, Adenis A, Eveno C, Piessen G. Poorly cohesive cells gastric carcinoma including signet-ring cell cancer: Updated review of definition, classification and therapeutic management. World J Gastrointest Oncol 2022; 14:1406-1428. [PMID: 36160745 PMCID: PMC9412924 DOI: 10.4251/wjgo.v14.i8.1406] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/08/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
While the incidence of gastric cancer (GC) in general has decreased worldwide in recent decades, the incidence of diffuse cancer historically comprising poorly cohesive cells-GC (PCC-GC) and including signet ring cell cancer is rising. Literature concerning PCC-GC is scarce and unclear, mostly due to a large variety of historically used definitions and classifications. Compared to other histological subtypes of GC, PCC-GC is nevertheless characterized by a distinct set of epidemiological, histological and clinical features which require a specific diagnostic and therapeutic approach. The aim of this review was to provide an update on the definition, classification and therapeutic strategies of PCC-GC. We focus on the updated histological definition of PCC-GC, along with its implications on future treatment strategies and study design. Also, specific considerations in the diagnostic management are discussed. Finally, the impact of some recent developments in the therapeutic management of GC in general such as the recently validated taxane-based regimens (5-Fluorouracil, leucovorin, oxaliplatin and docetaxel), the use of hyperthermic intraperitoneal chemotherapy as well as pressurized intraperitoneal aerosol chemotherapy and targeted therapy have been reviewed in depth for their relative importance for PCC-GC in particular.
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Affiliation(s)
- Vincent Drubay
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille 59000, France
- Department of Digestive Surgery, Cambrai Hospital Center and Sainte Marie, Group of Hospitals of The Catholic Institute of Lille, Cambrai 59400, France
| | - Frederiek Nuytens
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille 59000, France
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk 8500, Belgium
| | - Florence Renaud
- Department of Pathology, University Lille Hospital, Lille 59000, France
- CNRS, Inserm, UMR9020-U1277-CANTHER-Cancer, University Lille, CHU Lille, Lille 59000, France
- FREGAT Network, Claude Huriez University Hospital, Lille 59000, France
| | - Antoine Adenis
- FREGAT Network, Claude Huriez University Hospital, Lille 59000, France
- Department of Medical Oncology, Montpellier Cancer Institute, Monpellier 34000, France
- IRCM, Inserm, University of Monpellier, Monpellier 34000, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille 59000, France
- CNRS, Inserm, UMR9020-U1277-CANTHER-Cancer, University Lille, CHU Lille, Lille 59000, France
- FREGAT Network, Claude Huriez University Hospital, Lille 59000, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille 59000, France
- CNRS, Inserm, UMR9020-U1277-CANTHER-Cancer, University Lille, CHU Lille, Lille 59000, France
- FREGAT Network, Claude Huriez University Hospital, Lille 59000, France
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22
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Current Trends in Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Disease from Appendiceal and Colorectal Malignancies. J Clin Med 2022; 11:jcm11102840. [PMID: 35628966 PMCID: PMC9143396 DOI: 10.3390/jcm11102840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is a poor prognostic factor for all malignancies. This extent of metastatic disease progression remains difficult to treat with systemic therapies due to poor peritoneal vascularization resulting in limited drug delivery and penetration into tissues. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are surgical interventions that directly target peritoneal tumors and have improved outcomes for PC resulting from appendiceal and colorectal cancer (CRC). Despite these radical therapies, long-term survival remains infrequent, and recurrence is common. The reasons for these outcomes are multifactorial and signal the need for the continued development of novel therapeutics, techniques, and approaches to improve outcomes for these patients. Here, we review landmark historical studies that serve as the foundation for current recommendations, recent discoveries, clinical trials, active research, and areas of future interest in CRS/HIPEC to treat PC originating from appendiceal and colorectal malignancies.
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23
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Kuang X, She G, Shi Y, Yang Z, Li J, Zhang Z. Enteral nutrition provides favorable postoperative outcomes for patients with pseudomyxoma peritonei: a retrospective study. Gland Surg 2022; 11:818-825. [PMID: 35694101 PMCID: PMC9177278 DOI: 10.21037/gs-22-170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/18/2022] [Indexed: 04/06/2025]
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare malignancy, and many uncertainties regarding its treatment and prognosis still remain. The main treatment for PMP is cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC), which can lead to intra-abdominal trauma and systemic reactions. Enteral nutrition (EN) is an important and beneficial perioperative option for major complicated abdominal surgery compared with total parenteral nutrition (TPN). However, the role of EN in PMP after surgery is still unknown. The purpose of this study was to analyze the effects of EN on postoperative outcomes in PMP patients. METHODS The perioperative clinical data of PMP patients from Xiangya Hospital of Central South University who accepted CRS plus HIPEC from January 2011 to December 2018 were collected and analyzed. The effects of EN on the nutritional status, postoperative complications, and hospital stay time of patients with PMP were studied. We further analyzed the risk factors affecting hospital stay and complications in PMP patients after surgery. RESULTS A total of 51 PMP patients accepted CRS and were enrolled in this study, including 25 cases in the EN group and 26 patients in the TPN group. The baseline demographic characteristics and preoperative nutritional status were not significantly different between the two groups. The postoperative absolute lymphocyte count (P<0.001), hemoglobin (P=0.016), and albumin (P<0.001) levels of the EN group were higher than those of the TPN group, but the postoperative hospital stay time (P=0.008) and the complication rate (P=0.03) in the EN group were less than those in the TPN group. Logistic regression analysis showed that age (P=0.031), American Society of Anesthesiologists (ASA) score (P=0.008), and EN (P=0.024) were independent risk factors for postoperative hospital stay in PMP patients. ASA score (P=0.006), number of prior operations (P=0.021), and EN (P=0.035) were independent risk factors for postoperative complications in PMP patients. CONCLUSIONS EN support results in better outcomes and is an independent protective factor for the postoperative hospital stay time and complications of PMP patients.
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Affiliation(s)
- Xuechun Kuang
- Department of Geratology Surgery, Xiangya Hospital, Central South University, Changsha, China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Guie She
- Department of Geratology Surgery, Xiangya Hospital, Central South University, Changsha, China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Yanhui Shi
- Department of Geratology Surgery, Xiangya Hospital, Central South University, Changsha, China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyou Yang
- Department of Geratology Surgery, Xiangya Hospital, Central South University, Changsha, China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Zhipeng Zhang
- Department of Geratology Surgery, Xiangya Hospital, Central South University, Changsha, China
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24
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Abdel Mageed H, Van Der Speeten K, Sugarbaker P. The many faces of intraperitoneal chemotherapy. Surg Oncol 2021; 40:101676. [PMID: 34875459 DOI: 10.1016/j.suronc.2021.101676] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/16/2022]
Abstract
Cytoreductive surgery and intraperitoneal chemotherapy may offer chance for cure for patients with peritoneal metastasis. Many variations emerged, causing uncertainty when choosing the most suitable variant. By reviewing variability encountered in the management of peritoneal metastasis, we aim to raise awareness about this issue and hopefully initiate efforts to solve it. We review variance encountered in all aspects of this complex field of surgical oncology, indications, patient selection criteria, definition and extent of cytoreductive surgery and the numerous variables of intraperitoneal chemotherapy. Best benefit was achieved with pseudomyxoma peritonei, and to lesser extent in colorectal, ovarian and gastric cancer, but Indications keep expanding to include other tumors pathologies. Selection of patients depends on numerous prognostic indicators and criteria, according to tumor extent and pathology. The standard definition of cytoreductive surgery remains the same, but the boundaries of resection expand. Numerous chemotherapy regimens and administration methods are used, in search for best possible benefit. This variance must be reduced, to make the best use of, and further spread this treatment combination. Practical simple guidelines are needed for surgical oncologists willing to utilize this treatment for their patients, to be considered a true standard of care.
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Affiliation(s)
- Hisham Abdel Mageed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt. 27a Baghdad St., Korba, Heliopolis, Cairo, 11341, Egypt.
| | - Kurt Van Der Speeten
- Department of Surgical Oncology, Schiepse Bos 6, Ziekenhuis Oost-Limburg. Genk, Belgium; Hasselt University. Diepenbeek, Belgium.
| | - Paul Sugarbaker
- Program in Peritoneal Surface Malignancy, Washington Cancer Institute, Washington, DC, USA; Sugarbaker Oncology 3629 Fulton St. NW, Washington, DC, 20007, USA.
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25
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Shimura T, Toden S, Kandimalla R, Toiyama Y, Okugawa Y, Kanda M, Baba H, Kodera Y, Kusunoki M, Goel A. Genomewide Expression Profiling Identifies a Novel miRNA-based Signature for the Detection of Peritoneal Metastasis in Patients With Gastric Cancer. Ann Surg 2021; 274:e425-e434. [PMID: 31663973 PMCID: PMC7577555 DOI: 10.1097/sla.0000000000003647] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to conduct a genomewide transcriptomic profiling to develop a microRNA (miRNA)-based signature for the identification of peritoneal metastasis (PM) in patients with gastric cancer (GC). SUMMARY BACKGROUND DATA Even though PM in patients with GC has long been recognized to associate with poor prognosis, currently there is lack of availability of molecular biomarkers for its robust diagnosis. METHODS We performed a systematic biomarker discovery by analyzing miRNA expression profiles in primary tumors from GC patients with and without PM, and subsequently validated the expression of candidate miRNA biomarkers in 3 independent clinical cohorts of 354 patients with advanced GC. RESULTS Five miRNAs (miR-30a-5p, -134-5p, -337-3p, -659-3p, and -3917) were identified during the initial discovery phase; three of which (miR-30a-5p, -659-3p, and -3917) were significantly overexpressed in the primary tumors from PM-positive patients in the testing cohort (P = 0.002, 0.04, and 0.007, respectively), and distinguished patients with versus without peritoneal metastasis with the value of area under the curve (AUC) of 0.82. Furthermore, high expression of these miRNAs also associated with poor prognosis (hazard ratio = 2.18, P = 0.04). The efficacy of the combination miRNA signature was subsequently validated in an independent validation cohort (AUC = 0.74). Finally, our miRNA signature when combined together with the macroscopic Borrmann's type score offered a much superior diagnostic in all 3 cohorts (AUC = 0.87, 0.76, and 0.79, respectively). CONCLUSIONS We have established an miRNA-based signature that have a potential to identify peritoneal metastasis in GC patients.
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Affiliation(s)
- Tadanobu Shimura
- Center for Gastrointestinal Research; Center from Translational Genomics and Oncology, Baylor Scott & White Research Institute and Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA
- Department of Molecular Diagnostics, Therapeutics and Translational Medicine, Beckman Research Institute of City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Shusuke Toden
- Center for Gastrointestinal Research; Center from Translational Genomics and Oncology, Baylor Scott & White Research Institute and Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA
- Department of Molecular Diagnostics, Therapeutics and Translational Medicine, Beckman Research Institute of City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Raju Kandimalla
- Center for Gastrointestinal Research; Center from Translational Genomics and Oncology, Baylor Scott & White Research Institute and Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA
- Department of Molecular Diagnostics, Therapeutics and Translational Medicine, Beckman Research Institute of City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Mie, Japan
| | - Yoshinaga Okugawa
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Mie, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Mie, Japan
| | - Ajay Goel
- Center for Gastrointestinal Research; Center from Translational Genomics and Oncology, Baylor Scott & White Research Institute and Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA
- Department of Molecular Diagnostics, Therapeutics and Translational Medicine, Beckman Research Institute of City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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26
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Davis CH, Alexander HR. What is the Current Role of Hyperthermic Intraperitoneal Chemotherapy in Colorectal Cancer? Adv Surg 2021; 55:159-174. [PMID: 34389090 DOI: 10.1016/j.yasu.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Catherine H Davis
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA. https://twitter.com/CDavisMD
| | - H Richard Alexander
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA.
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27
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Gajardo JA, Matute J, Charles R, Devaud N, Hoefler S, Schmied S, Rigo-Righi D, Butte JM. Starting a peritoneal carcinomatosis treatment program in a developing country: A prospective analysis. J Surg Oncol 2021; 124:1154-1160. [PMID: 34324203 DOI: 10.1002/jso.26626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/31/2021] [Accepted: 07/18/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has become a valuable treatment strategy for selected patients with peritoneal carcinomatosis (PC). In Chile, it is an emerging technique. The aim of this study is to describe our protocol and report our perioperative results. METHODS A prospectively maintained database for patients undergoing exploratory surgery for PC was reviewed. Eligible patients were selected using the peritoneal cancer index in correlation with the primary tumor. Patients underwent HIPEC using mitomycin C. Clinical data and postoperative results were analyzed. RESULTS Seventy-six patients underwent exploratory surgery. Most patients were female (55%) with a median age of 62 years (range, 25-83). Complete CRS and HIPEC were achieved in 53 patients. The most frequent primary tumor site was colon-rectum (49%). The median number of resected organs was 4 (range, 1-13). Overall 90-day incidence of major complications was 26%. After a median follow-up of 26 months, 44 patients (83%) in the resected group were alive with no evidence of disease. CONCLUSIONS The PC treatment program at our institution has been established in a safe manner, with acceptable morbidity comparable to high-volume centers. A comprehensive preoperative evaluation, careful patient selection, and a cohesive team are necessary for successful results.
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Affiliation(s)
- Jorge A Gajardo
- Gastrointestinal Surgical Oncology Service, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Jorge Matute
- Gastrointestinal Surgical Oncology Service, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Roberto Charles
- Gastrointestinal Surgical Oncology Service, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Nicolás Devaud
- Gastrointestinal Surgical Oncology Service, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Sebastian Hoefler
- Gastrointestinal Surgical Oncology Service, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Silvia Schmied
- Anesthesia Service, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Daniella Rigo-Righi
- Anesthesia Service, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Jean M Butte
- Gastrointestinal Surgical Oncology Service, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
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28
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Ogawa S, Kubo H, Murayama Y, Kubota T, Yubakami M, Matsumoto T, Ohashi T, Okamoto K, Kuriki Y, Hanaoka K, Urano Y, Otsuji E. Matrix metalloprotease-14 is a target enzyme for detecting peritoneal metastasis in gastric cancer. Photodiagnosis Photodyn Ther 2021; 35:102420. [PMID: 34242818 DOI: 10.1016/j.pdpdt.2021.102420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Accurate diagnosis of peritoneal metastasis in gastric cancer (GC) is important to determine the appropriate treatment. This study aimed to examine whether matrix metalloprotease-14 (MMP-14) was a candidate enzyme in fluorescence imaging for the diagnosis of peritoneal metastasis in GC. METHODS GC and normal peritoneal (NP) tissues from 96 and 20 patients, respectively were evaluated for MMP-14 expression. Live cell imaging of GC cell lines (NUGC4, MKN45, MKN74, HGC-27, and Kato-III) was performed using the MMP-14-activatable fluorescence probe; BODIPY-MMP. Furthermore, the overall survival (OS) was calculated in all patients (n = 96). RESULTS MMP-14 expression was significantly higher in GC tissues (median: 3.57 ng/mg protein; range:0.64-24.4 ng/mg protein) than in NP tissues (median: 1.34 ng/mg protein; median: 0.53-3.09 ng/mg protein) (P < 0.01). Receiver operating characteristic curves showed that the area under the curve, sensitivity, and specificity were 0.907, 84.4%, and 90.0%, respectively. In live cell imaging using the BODIPY-MMP, fluorescence was observed in five GC cell lines. In the analysis of OS, the high expression of the MMP-14 group had a significantly poorer OS rate than the low expression of the MMP-14 group (P = 0.02). In the multivariate analyses, MMP-14 expression was an independent risk factor for OS (hazard ratio: 2.33; 95 % confidence interval: 1.05-5.45; P = 0.04). CONCLUSION MMP-14 is a promising enzyme in intraoperative fluorescence imaging for peritoneal metastasis in GC, especially in patients with poor prognosis.
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Affiliation(s)
- Soichiro Ogawa
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Hidemasa Kubo
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Yasutoshi Murayama
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Masayuki Yubakami
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Tatsuya Matsumoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Takuma Ohashi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Yugo Kuriki
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Kenjiro Hanaoka
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30, Shibakoen, Minato-ku, Tokyo 105-8512, Japan.
| | - Yasuteru Urano
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; CREST (Japan) Agency for Medical Research and Development (AMED), 1-7-1 Otemachi, Chiyoda-ku, Tokyo 100-0004, Japan.
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
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Fernández-Candela A, Calero A, Sánchez-Guillén L, Escrig-Sos J, Barreras JA, López-Rodríguez-Arias F, Armañanzas L, Murcia A, Arroyo A, Lacueva FJ. Effect of Preoperative Immunonutrition on Postoperative Major Morbidity after Cytoreductive Surgery and HIPEC in Patients with Peritoneal Metastasis. Nutrients 2021; 13:2147. [PMID: 34201458 PMCID: PMC8308234 DOI: 10.3390/nu13072147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022] Open
Abstract
The effect of preoperative immunonutrition intake on postoperative major complications in patients following cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) was assessed. The accuracy of C-Reactive Protein (CRP) for detecting postoperative complications was also analyzed. Patients treated within a peritoneal carcinomatosis program in which a complete or optimal cytoreduction was achieved were retrospectively analyzed. They were divided into two groups based on whether preoperative immunonutrition (IMN) or not (non-IMN) were administered. Clinical and surgical variables and postoperative complications were gathered. Predictive values of major morbidity of CRP during the first 3 postoperative days (POD) were also evaluated. A total of 107 patients were included, 48 belonging to the IMN group and 59 to the non-IMN group. In multivariate analysis immunonutrition (OR 0.247; 95%CI 0.071-0.859; p = 0.028), and the number of visceral resections (OR 1.947; 95%CI 1.086-3.488; p = 0.025) emerged as independent factors associated with postoperative major morbidity. CRP values above 103 mg/L yielded a negative predictive value of 84%. Preoperative intake of immunonutrition was associated with a decrease of postoperative major morbidity and might be recommended to patients with peritoneal carcinomatosis following CRS. Measuring CRP levels during the 3 first postoperative days is useful to rule out major morbidity.
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Affiliation(s)
- Alba Fernández-Candela
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Alicia Calero
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Luís Sánchez-Guillén
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Javier Escrig-Sos
- Department of Medicine, University Jaume I (UJI), 12004 Valencia, Spain;
| | - José A. Barreras
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Francisco López-Rodríguez-Arias
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
| | - Laura Armañanzas
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
- Pathology and Surgery Department, Universidad Miguel Hernandez, 03202 Elche, Spain
| | - Ana Murcia
- Pharmacy Department, Elche University General Hospital, 03202 Elche, Spain;
| | - Antonio Arroyo
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
- Pathology and Surgery Department, Universidad Miguel Hernandez, 03202 Elche, Spain
| | - Francisco Javier Lacueva
- Peritoneal Carcinomatosis Unit, General Surgery Department, Elche University General Hospital, 03202 Elche, Spain; (A.F.-C.); (L.S.-G.); (J.A.B.); (F.L.-R.-A.); (L.A.); (A.A.); (F.J.L.)
- Pathology and Surgery Department, Universidad Miguel Hernandez, 03202 Elche, Spain
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Morgan R, Tun S, Eng OS. Hyperthermic Intraperitoneal Chemotherapy: An Overview #412. J Palliat Med 2021; 24:621-622. [PMID: 33797986 DOI: 10.1089/jpm.2020.0758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Intraperitoneal Glucose Transport to Micrometastasis: A Multimodal In Vivo Imaging Investigation in a Mouse Lymphoma Model. Int J Mol Sci 2021; 22:ijms22094431. [PMID: 33922728 PMCID: PMC8123046 DOI: 10.3390/ijms22094431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
Bc-DLFL.1 is a novel spontaneous, high-grade transplantable mouse B-cell lymphoma model for selective serosal propagation. These cells attach to the omentum and mesentery and show dissemination in mesenteric lymph nodes. We aimed to investigate its early stage spread at one day post-intraperitoneal inoculation of lymphoma cells (n = 18 mice), and its advanced stage at seven days post-inoculation with in vivo [18F]FDG-PET and [18F]PET/MRI, and ex vivo by autoradiography and Cherenkov luminescence imaging (CLI). Of the early stage group, nine animals received intraperitoneal injections, and nine received intravenous [18F]FDG injections. The advanced stage group (n = 3) received intravenous FDG injections. In the early stage, using autoradiography we observed a marked accumulation in the mesentery after intraperitoneal FDG injection. Using other imaging methods and autoradiography, following the intravenous injection of FDG no accumulations were detected. At the advanced stage, tracer accumulation was clearly detected in mesenteric lymph nodes and in the peritoneum after intravenous administration using PET. We confirmed the results with immunohistochemistry. Our results in this model highlight the importance of local FDG administration during diagnostic imaging to precisely assess early peritoneal manifestations of other malignancies (colon, stomach, ovary). These findings also support the importance of applying topical therapies, in addition to systemic treatments in peritoneal cancer spread.
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Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy Experience in Peritoneal Carcinomatosis: Single-Center Analysis of 180 Cases. Int J Surg Oncol 2021; 2021:8851751. [PMID: 33976936 PMCID: PMC8087469 DOI: 10.1155/2021/8851751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/27/2022] Open
Abstract
Background In peritoneal carcinomatosis (PC), increased life span and disease-free survival times are shown in patients with hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) following cytoreductive surgery (SRC). In this study, our main objective was to present our experience of performing SRC and perioperative intraperitoneal chemotherapy (HIPEC and EPIC) on patients with PC, in light of the literature. Methods Demographic data, follow-up results, peritoneal carcinomatosis index (PCI), completeness of cytoreduction (CCR) score, and morbidity and mortality rates of 180 patients treated with SRC + HIPEC + EPIC for PC at the Department of Surgical Oncology at Sivas Cumhuriyet University between January 2008 and July 2020 were analyzed retrospectively. Results Distribution of 180 PC cases according to primary organs included 53 ovarian, 39 colorectal, 33 stomach, 25 primary peritoneum, 10 uterus, 10 tuba, five soft tissue, and five appendix originated carcinoma. The average PCI of the cases detected preoperatively was 21 (5-30). Completeness of cytoreduction scores of CCR-0 in 102 cases, CCR-1 in 67 cases, CCR-2 in eight cases, and CCR-3 in three cases was obtained. Median operation time was 300 (200-540) minutes. Perioperative morbidity rate was 47.0%, and perioperative mortality rate was 13.5%. Conclusion The peritonectomy procedure is a difficult, long-lasting, troublesome intervention, but it is the most important treatment option with acceptable morbidity and mortality rates in patients selected for PC treatment in experienced centers.
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Ji ZH, Zhang Y, Li Y. Intra-operative hyperthermic intraperitoneal chemotherapy for prevention and treatment of peritoneal metastases from gastric cancer: a narrative review. J Gastrointest Oncol 2021; 12:S70-S78. [PMID: 33968427 DOI: 10.21037/jgo-20-262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Peritoneal metastasis (PM) from gastric cancer (GC) has long been regarded as the terminal disease, lacking of effective treatments. In recent 40 years, cytoreductive surgery (CRS) plus perioperative intraperitoneal chemotherapy, including hyperthermic intraperitoneal chemotherapy (HIPEC), neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), and early post-operative intraperitoneal chemotherapy (EPIC), has been recommended as a preferred treatment option for some selected patients with GCPM. Intraperitoneal free cancer cells were recognized as the pathological cause of PM and the primary target for intraperitoneal chemotherapy. There were a lot of evidence demonstrating that HIPEC could effectively eradiate intraperitoneal free cancer cells and prolong overall survival in GCPM. However, there are still no standard HIPEC protocols. This review summarized the current HIPEC regimens used in GCPM from a literature search, trying to conclude the optimal HIPEC in GCPM, and indicate the future direction of HIPEC study. Moreover, the new data on the exploration of HIPEC in GCPM at Shijitan Hospital, Capital Medical University was shared. In conclusion, there was not enough evidence from publications and our own experience to conclude a recommended HIPEC regimen for GCPM. There is urgent need for standardizing HIPEC protocols worldwide. Accordingly, more international collaborations focusing on pharmacology and HIPEC-related parameters to generate high level evidence are essential.
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Affiliation(s)
- Zhong-He Ji
- Department of Peritoneal Cancer Surgery, Cancer Center of Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Pathology, Cancer Center of Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Cancer Center of Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Pathology, Cancer Center of Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Violette C, Kim T, Shandley L, Lee R, Staley C, Winer J, Maithel S, Hipp H, Kawwass J, Russell M. Fertility after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A call to action. J Surg Oncol 2021; 123:1045-1049. [PMID: 33497472 DOI: 10.1002/jso.26387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the best therapeutic option in primary and some secondary peritoneal malignancies. The ramifications of this procedure on fertility are unknown. The aim of this study was to assess the current association of CRS/HIPEC with fertility following surgery. METHODS A review of patients who underwent CRS/HIPEC between 2009 and 2018 was performed. Female patients were included if they were between ages 18-50 at the time of surgery. Gynecologic and obstetric history before and following CRS/HIPEC was collected by phone interview. RESULTS Of 48 eligible participants, 21 completed the survey. Sixty-five percent of women underwent a total abdominal hysterectomy before or during CRS. Twenty-nine percent of these women recall fertility counseling before CRS/HIPEC, while 14.3% saw a fertility specialist for consultation, and only one patient proceeded with oocyte cryopreservation before treatment. There were no pregnancies reported following treatment with CRS/HIPEC. CONCLUSION Few patients after CRS/HIPEC retain child-bearing potential, partly due to the high rate of hysterectomy and oophorectomy at time of surgery. Efforts towards improved preoperative counseling, increased oocyte cryopreservation, and evaluating the safety of preserving reproductive organs at the time of surgery are needed.
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Affiliation(s)
- Caroline Violette
- Department of Obstetrics and Gynecology, University of Southern California/LAC+USC, Los Angeles, California, USA
| | - Tesia Kim
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lisa Shandley
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rachel Lee
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charles Staley
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joshua Winer
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shishir Maithel
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Heather Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maria Russell
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Cho WC, Kim M, Park JW, Jeong SY, Ku JL. Exosomal miR-193a and let-7g accelerate cancer progression on primary colorectal cancer and paired peritoneal metastatic cancer. Transl Oncol 2020; 14:101000. [PMID: 33352502 PMCID: PMC7758376 DOI: 10.1016/j.tranon.2020.101000] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 02/08/2023] Open
Abstract
A metastasis of colorectal cancer is difficult to diagnose, and has a poor prognosis. Therefore, we tried to elucidate the possibility of a diagnostic and prognostic marker. Exosomal miR-193a and let-7g were sorted by miRNA microarray. The expression of miR-193a in the PTM group was lower than that of the primary CRC group, and the expression of let-7g was higher than that of the primary CRC. MMP16 and CDKN1A expression was confirmed respectively for target genes of two miRNAs. When the mimics of these miRNAs were treated with cell lines, both MMP16 and CDKN1A decreased intracellular expression. Cell invasiveness and proliferation were decreased by miR-193a and increased by let-7g. The differences in expression of exosomal miR-193a and let-7g extracted from the plasma of patients were classified as cancer progression indicators. Furthermore, the survival rate decreased in the group with low miR-193a expression and high let-7g expression. Our study confirmed the possibility of using this as a diagnostic and prognostic marker for colorectal cancer by measuring the expression levels of exosomal miR-193a and let-7g in blood.
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Affiliation(s)
- Woo-Cheol Cho
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea; Laboratory of Cell Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea; Cancer Research Institute, Seoul National University, Seoul 03080, Republic of Korea
| | - Minjung Kim
- Cancer Research Institute, Seoul National University, Seoul 03080, Republic of Korea; Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Korea; Division of Colorectal Surgery, Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Ji Won Park
- Cancer Research Institute, Seoul National University, Seoul 03080, Republic of Korea; Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Korea; Division of Colorectal Surgery, Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Seung-Yong Jeong
- Cancer Research Institute, Seoul National University, Seoul 03080, Republic of Korea; Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Korea; Division of Colorectal Surgery, Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea.
| | - Ja-Lok Ku
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea; Laboratory of Cell Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea; Cancer Research Institute, Seoul National University, Seoul 03080, Republic of Korea.
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Seretis C, Gill J, Malik A, Elhassan AM, Shariff U, Youssef H. Low Preoperative Serum Albumin Levels Are Associated With Impaired Outcome After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies. J Clin Med Res 2020; 12:773-779. [PMID: 33447310 PMCID: PMC7781284 DOI: 10.14740/jocmr4362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/09/2020] [Indexed: 12/03/2022] Open
Abstract
Preoperative hypoalbuminemia is known to be associated with postoperative morbidity and mortality, as well as with poor survival after gastrointestinal cancer surgery. However, limited data exist regarding the prognostic significance of hypoalbuminemia in patients with peritoneal metastases undergoing cytoreductive surgery, combined with perioperative intraperitoneal chemotherapy. We performed a systematic literature review of the previously published studies addressing the potential association between preoperative albumin levels and overall surgical outcomes after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancies. Our research yielded a total of nine retrospective studies which met our inclusion criteria, and despite their heterogeneity; and we can conclude that preoperatively low albumin levels are associated with greater likelihood of overall and major morbidity, as well as less favorable oncological outcome after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy.
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Affiliation(s)
| | - Jagjit Gill
- George Eliot Hospital NHS Trust, Warwickshire, UK
| | - Adnan Malik
- George Eliot Hospital NHS Trust, Warwickshire, UK
| | | | - Umar Shariff
- General Surgery Department, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Haney Youssef
- General Surgery Department, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
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Rossi SM, Murray T, McDonough L, Kelly H. Loco-regional drug delivery in oncology: current clinical applications and future translational opportunities. Expert Opin Drug Deliv 2020; 18:607-623. [PMID: 33253052 DOI: 10.1080/17425247.2021.1856074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Drug-based treatment regimens for cancer are often associated with off-target toxic side effects and low penetration of the drug at the tumor site leading to patient morbidity and limited efficacy. Loco-regional drug delivery has the potential to increase efficacy while concomitantly reducing toxicity.Areas covered: Clinical applications using loco-regional delivery include intra-arterial drug delivery in retinoblastoma, direct intra-tumoral (IT) injection of ethanol for ablation in hepatocellular carcinoma (HCC) and the use of HIPEC in peritoneal carcinomas. In recent years, there has been a significant increase in both approved products and clinical trials, with a particular emphasis on drug delivery platforms such as drug-eluting beads for HCC and hydrogel platforms for intravesical delivery in bladder cancer.Expert opinion: Development of loco-regional drug-delivery systems has been slow, limited by weak clinical data for early applications and challenges relating to dosing, delivery and retention of drugs at the site of action. However, there is increasing focus on the potential of loco-regional drug delivery when combined with bespoke drug-delivery platforms. With the growth in immunotherapies, the use of IT delivery to drive priming of the anti-tumor response has opened up a new field of opportunity for loco-regional drug delivery.
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Affiliation(s)
- Seona M Rossi
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Timothy Murray
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liam McDonough
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Helena Kelly
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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Shyu S, Choudry H, Hall L, Pingpank J, Holtzman M, Bartlett D, Pai RK. Clinicopathological analysis of appendiceal goblet cell adenocarcinoma with peritoneal metastasis: World Health Organization grade predicts survival following cytoreductive surgery with intraperitoneal chemotherapy. Histopathology 2020; 77:798-809. [PMID: 32557796 DOI: 10.1111/his.14189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/27/2020] [Accepted: 06/13/2020] [Indexed: 12/26/2022]
Abstract
AIMS Peritoneal spread is the most common route of metastasis in appendiceal goblet cell adenocarcinoma. The aim of this study was to assess the prognostic significance of the World Health Organization (WHO) 5th edition grading criteria in peritoneal metastases of goblet cell adenocarcinoma. METHODS AND RESULTS We evaluated the clinicopathological features and survival of 63 patients with peritoneal metastasis of goblet cell adenocarcinoma who underwent cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC), stratified according to the WHO 5th edition and the Tang et al. grading schemes. The patients were also compared with 120 patients with peritoneal metastasis of appendiceal mucinous neoplasia. Most (73%) peritoneal metastases of goblet cell adenocarcinoma were WHO Grade 3 (G3), there being fewer cases of Grade 2 (G2) (16%) and Grade 1 (G1) (11%) disease. No significant differences in overall survival were observed between WHO G1 and G2 tumours or between the three Tang grades. In the multivariable model of survival, WHO G3 [hazard ratio (HR) 2.81, 95% confidence interval (CI) 1.02-7.70] and the presence of >50% extracellular mucin (HR 2.30, 95% CI 1.09-4.88) were associated with reduced overall survival for patients with goblet cell adenocarcinoma. As compared with patients with peritoneal metastasis of mucinous neoplasia, patients with goblet cell adenocarcinoma had significantly reduced survival (median overall survival of 37 months versus 102 months, P < 0.001), which was attributed to the reduced survival of patients with G1/G2 goblet cell adenocarcinoma as compared with patients with G1 mucinous neoplasia (median survival of 98 months versus 204 months, P < 0.001). CONCLUSIONS Grade of peritoneal goblet cell adenocarcinoma determined according to the WHO 5th edition criteria is a clinically relevant measure that independently predicts survival in patients treated with CRS-HIPEC.
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Affiliation(s)
- Susan Shyu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Haroon Choudry
- Department of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lauren Hall
- Department of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James Pingpank
- Department of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew Holtzman
- Department of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Bartlett
- Department of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Rouche A, Hübner M, Grass F, Pache B, Demartines N, Blanc C. Anaesthesia in a Toxic Environment: Pressurised Intraperitoneal Aerosol Chemotherapy: A Retrospective Analysis. Turk J Anaesthesiol Reanim 2020; 48:273-279. [PMID: 32864641 PMCID: PMC7434348 DOI: 10.5152/tjar.2019.15493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a new type of intraperitoneal chemotherapy for peritoneal carcinosis via minimally invasive surgery. This technique's specificity is the remote application of the therapy because of the potential risk of exposure to toxic products. The present paper summarises the important aspects of PIPAC and analyses the anaesthetic outcomes. METHODS This retrospective study included all patients undergoing PIPAC treatment between January 2015 and February 2018. Data on protocol adherence and perioperative anaesthetic complications and postoperative nausea and vomiting (PONV) and pain levels (visual analogue scale 0-10) from recovery room to 72 h were analysed. RESULTS The overall analysis included 193 PIPAC procedures on 87 patients. Protocol adherence was high as regards the use of propofol (100%), rocuronium (98%), antiemetic prophylaxis (99%) and lidocaine intravenous (i.v.) (87%). No accidental exposure to chemotherapy occurred during the study period. Of the 87 patients, 6.3% suffered delayed recovery, 58% due to hypothermia and 42% due to excessive sedation or curarisation. In the recovery room, 16% of patients suffered moderate to severe pain, requiring >8 mg of morphine i.v., with average doses of 13.7 mg. Median postoperative pain scores were 1 and 3 at 12 h and 0 and 0 at 72 h at rest and mobilisation, respectively. PONV was observed in <10% of patients during the first 12 h, but in 40% at 72 h. CONCLUSION A dedicated anaesthetic protocol and intraoperative safety checklist facilitates safe, well-tolerated anaesthesia for PIPAC treatments.
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Affiliation(s)
- Amir Rouche
- Department of Anaesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Basile Pache
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Catherine Blanc
- Department of Anaesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Ye J, Chen L, Zuo J, Peng J, Chen C, Cai S, Song W, He Y, Yuan Y. A precise temperature control during hyperthermic intraperitoneal chemotherapy promises an early return of bowel function. Cancer Biol Ther 2020; 21:726-732. [PMID: 32644887 PMCID: PMC7515524 DOI: 10.1080/15384047.2020.1775444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction The hyperthermic intraperitoneal chemotherapy (HIPEC) has been widely applied in clinical practice for peritoneal carcinomatosis (PC). The temperature is one of the important elements affecting the efficacy of HIPEC, and it can become fluctuant by several factors. This study is aimed to explore the role of a stable perfusion temperature in promoting bowel recovery of PC patients due to gastrointestinal malignancies. Methods Between January 2012 and July 2013, 59 PC patients undergoing cytoreductive surgery and three-cycle HIPEC were included. Patients having stable perfusion temperature for all cycles were assigned into the study group, with the rest having unstable temperature into the control group. Time of flatus and defecation passage and initiation time of enteral nutrition were compared between both groups to detect the significance in bowel function recovery, with visual analogue scale (VAS) pain intensity and overall survival (OS) compared meanwhile. Results In sum, 33 (55.9%) patients obtained stable temperature during HIPEC, and the rest of 26 (44.1%) developed fluctuant perfusion temperature. Average time of flatus (2.3 ± 1.2 vs 3.9 ± 2.2 days, P =.002), defecation passage (5.2 ± 2.1 vs 7.1 ± 2.9 days, P =.004) and enteral nutrition initiation (4.3 ± 1.5 vs 6.7 ± 2.3 days, P <.001) were much shorter in the study group than the control group. Additionally, the VAS score (4.5 ± 2.3 vs 6.3 ± 1.3, P <.001) and 5-year OS rate (17.8% vs 11.1%, P=.135) were both improved, with significance observed in postoperative pain control. Conclusions During HIPEC, a precise temperature control could promise an early recovery of bowel function and reduce postoperative pain, without survival significance found based on the current cohort.
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Affiliation(s)
- Jinning Ye
- Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R.China.,Center of Gastric Cancer, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
| | - Liuhua Chen
- Department of Biliary-Pancreatic Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
| | - Jidong Zuo
- Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R.China.,Center of Gastric Cancer, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
| | - Jianjun Peng
- Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R.China.,Center of Gastric Cancer, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
| | - Chuangqi Chen
- Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R.China.,Center of Gastric Cancer, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
| | - Shirong Cai
- Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R.China.,Center of Gastric Cancer, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
| | - Wu Song
- Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R.China.,Center of Gastric Cancer, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
| | - Yulong He
- Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R.China.,Center of Gastric Cancer, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
| | - Yujie Yuan
- Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R.China.,Center of Gastric Cancer, the First Affiliated Hospital, Sun Yat-Sen University , Guangzhou, P.R. China
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Guo X, Mei J, Jing Y, Wang S. Curcumin-Loaded Nanoparticles with Low-Intensity Focused Ultrasound-Induced Phase Transformation as Tumor-Targeted and pH-Sensitive Theranostic Nanoplatform of Ovarian Cancer. NANOSCALE RESEARCH LETTERS 2020; 15:73. [PMID: 32266591 PMCID: PMC7138896 DOI: 10.1186/s11671-020-03302-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
We have developed a simple and versatile nanoplatform using pH-sensitive ferritin nanocages co-loaded with the anticancer drug curcumin (Cur) and liquid fluorocarbon perfluorohexane (PFH) inside the core and conjugated tumor-targeting molecule FA outside the shell referred to as FA-FCP. The synthesized FA-FCP has an average particle diameter of 47 nm, with stable and favorable physicochemical properties in different media, and high biocompatibility and biosafety in vivo and in vitro. Under the conditions of low-intensity focused ultrasound (LIFU) and at pH = 5.0, FA-FCP released a large amount of drugs (53.2%) in 24 h. After 4 min of LIFU (7 W) treatment, FA-FCP provided contrast-enhanced ultrasound imaging capabilities at pH = 5.0. Due to FA receptor-mediated endocytosis, FA-FCP could efficiently enter the cells and further relocate to lysosomes. Eighteen hours after injection of FA-FCP, the tumor was stimulated by LIFU, resulting in a contrast-enhanced ultrasound image. In vivo and in vitro experiments showed that the combined use of FA-FCP and LIFU had significant tumor treatment effects. Based on the results, it was concluded that FA-FCP combined with the external LIFU and the endogenic acidic environment can have powerful theranostic functions and provide a novel type of non-invasive and integrated tumor theranostic option.
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Affiliation(s)
- Xiaoxia Guo
- Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, 610041 Sichuan China
| | - Jie Mei
- Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, 610041 Sichuan China
| | - Yong Jing
- Department of Imaging, Eastern Hospital of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, No. 585 Honghe North Road, Longquanyi District, Chengdu, 610000 Sichuan China
| | - Shiguang Wang
- Department of Imaging, Eastern Hospital of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, No. 585 Honghe North Road, Longquanyi District, Chengdu, 610000 Sichuan China
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Narasimhan V, Ooi G, Michael M, Ramsay R, Lynch C, Heriot A. Colorectal peritoneal metastases: pathogenesis, diagnosis and treatment options - an evidence-based update. ANZ J Surg 2020; 90:1592-1597. [PMID: 32129577 DOI: 10.1111/ans.15796] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022]
Abstract
Peritoneal metastases confer the worst survival among all sites in patients with metastatic colorectal cancer. They develop largely through transcoelomic spread, with a sequence of events that allow cells to first detach from primary tumours, survive in the peritoneal environment, attach to the peritoneal surface of organs and migrate into the submesothelial space to create a microenvironment conducive to metastatic growth. Diagnostic challenges have previously hindered early identification of peritoneal metastases. While advances in diagnostic modalities have improved our ability to identify peritoneal metastases, lesions under 0.5 cm remain challenging to detect. The advent of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) can offer selected patients with colorectal peritoneal metastases a favourable long-term survival. Recent trials, however, have cast doubts on the efficacy of HIPEC, with the recent PRODIGE 7 trial showing no benefit from oxaliplatin based HIPEC in addition to good quality cytoreductive surgery in resectable disease. While peritoneal recurrence can be reliably predicted from high-risk features in primary tumours such as a perforated cancer, ovarian metastases or T4a cancers, the use of prophylactic second look surgery with HIPEC or adjuvant HIPEC failed to demonstrate any survival benefit in high-risk cases in recent clinical trials, raising further questions about the efficacy of HIPEC. With high failure rates from systemic chemotherapy in unresectable disease, novel surgical techniques such as pressurized intraperitoneal aerolized chemotherapy are being investigated in clinical trials worldwide. Further collaborative research is needed to explore newer avenues of treatment for this poor prognostic cohort.
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Affiliation(s)
- Vignesh Narasimhan
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Geraldine Ooi
- Department of General Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Michael Michael
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Robert Ramsay
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Craig Lynch
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Novel Chimeric Immuno-Oncolytic Virus CF33-hNIS-antiPDL1 for the Treatment of Pancreatic Cancer. J Am Coll Surg 2020; 230:709-717. [PMID: 32032721 DOI: 10.1016/j.jamcollsurg.2019.12.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Peritoneal carcinomatosis (PC) from pancreatic ductal adenocarcinoma (PDAC) is fatal. Our preclinical study presents an effective treatment against PDAC PC using a novel oncolytic viral agent, CF33-hNIS-antiPDL1. STUDY DESIGN CF33-hNIS-antiPDL1 is a genetically engineered chimeric orthopoxvirus, CF33, armed with the human Sodium Iodide Symporter (hNIS) and anti-PD-L1 antibody (anti-PD-L1). The in vitro cytotoxic ability of this virus against 5 PDAC cell lines was tested at various doses (multiplicity of infection [MOI] = 0.01, 0.1, 1, 10). Production and blockade function of virus-encoded anti-PD-L1 antibody were verified using immunoblot, immunoprecipitation, and PD-1/PD-L1 bioassay. In vivo mouse models of PC, with or without subcutaneous (SC) tumors, created by injecting AsPC-1-ffluc cells into nude mice, were treated with PBS or a single dose (1×105 plaque-forming units) of either intraperitoneal (IP) or IV injection of CF33-hNIS-antiPDL1. Mice with PC tumors were treated on days 0, 2, or 14 after tumor implantation. RESULTS CF33-hNIS-antiPDL1 killed PDAC cells in a dose-dependent manner, achieving >90% cell killing by day 8. Cells infected with CF33-hNIS-antiPDL1 produced bioactive anti-PD-L1 antibody, which blocked PD-1/PD-L1 interaction. In vivo, a single dose of virus reduced tumor burden and prolonged survival of treated mice. It was observed that IP administration of CF33-hNIS-antiPDL1 was more effective than IV administration. CONCLUSIONS CF33-hNIS-antiPDL1 virus is effective in infecting and killing human PDACs and producing functional anti-PD-L1 antibody. Intraperitoneal delivery of CF33-hNIS-antiPDL1 effectively reduces peritoneal tumor burden and improves survival after only 1 dose and is superior to IV delivery.
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Ellebæk SB, Graversen M, Detlefsen S, Lundell L, Fristrup CW, Pfeiffer P, Mortensen MB. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) of peritoneal metastasis from gastric cancer: a descriptive cohort study. Clin Exp Metastasis 2020; 37:325-332. [PMID: 32002724 DOI: 10.1007/s10585-020-10023-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/23/2020] [Indexed: 12/23/2022]
Abstract
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) represents a novel approach to deliver intraperitoneal chemotherapy. We report our experience with PIPAC in patients with peritoneal metastasis (PM) from gastric cancer (GC). Data from GC patients (n = 20) included in the prospective PIPAC-OPC1 and PIPAC-OPC2 studies are reported. All patients had received prior systemic chemotherapy. The mean peritoneal cancer index (PCI) was 10.5 (range 0-39) and nine patients had diffuse GC. PIPAC with cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2 were administered at 4-6-week intervals. Outcome criteria were objective tumour response, survival and adverse events. Twenty patients had 52 PIPAC procedures with a median follow-up of 10.4 months (3.3-26.5). Median survival from the time of PM diagnosis and after the first PIPAC procedure was 11.5 months and 4.7 months, respectively. Fourteen patients had repeated PIPAC (> 2), and the objective tumour response according to the histological peritoneal regression grading score (PRGS) was observed in 36%, whereas 36% had stable disease. Ten patients completed the three prescheduled sessions (per protocol group) and 40% of those displayed an objective tumour response, while 20% had stable disease. Only minor postoperative complications were noted, and none were considered causally related to the PIPAC treatment. PIPAC with low-dose cisplatin and doxorubicin can induce a quantifiable objective tumour response in selected patients with PM from GC. Survival data are encouraging and warrant further clinical studies.
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Affiliation(s)
- S Bremholm Ellebæk
- Odense PIPAC Center, Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark. .,Department of Surgery, Upper GI and HPB Section, Odense University Hospital, Odense, Denmark.
| | - M Graversen
- Odense PIPAC Center, Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark.,Department of Surgery, Upper GI and HPB Section, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient Data Explorative Network, Odense, Denmark
| | - S Detlefsen
- Odense PIPAC Center, Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Pathology, Odense University Hospital, Odense, Denmark
| | - L Lundell
- Odense PIPAC Center, Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark.,Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - C W Fristrup
- Odense PIPAC Center, Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark.,Department of Surgery, Upper GI and HPB Section, Odense University Hospital, Odense, Denmark
| | - P Pfeiffer
- Odense PIPAC Center, Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - M B Mortensen
- Odense PIPAC Center, Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark.,Department of Surgery, Upper GI and HPB Section, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient Data Explorative Network, Odense, Denmark
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Wong JSM, Tan GHC, Chia CS, Ong J, Ng WY, Teo MCC. The importance of synchronicity in the management of colorectal peritoneal metastases with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Surg Oncol 2020; 18:10. [PMID: 31931817 PMCID: PMC6958608 DOI: 10.1186/s12957-020-1784-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background Colorectal peritoneal metastases (CPM) occur in up to 13% of patients with colorectal cancer, presenting either synchronously or metachronously. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) have been increasingly utilised for selected CPM patients with favourable outcomes, though its benefits may differ for synchronous (s-CPM) and metachronous CPM (m-CPM). Methods A retrospective analysis of CPM patients treated with CRS and HIPEC at the National Cancer Centre Singapore over 15 years was performed. In the s-CPM group, CPM was diagnosed at primary presentation with CRS and HIPEC performed at the time of or within 6 months from primary surgery. In the m-CPM group, patients developed CPM > 6 months after primary curative surgery. Results One hundred two patients with CPM were treated with CRS and HIPEC. Twenty (19.6%) patients had s-CPM and 82 (80.4%) had m-CPM. Recurrences occurred in 45% of s-CPM and in 54% of m-CPM (p = 0.619). Median overall survival was significantly prolonged in patients with m-CPM (45.2 versus 26.9 months, p = 0.025). In a subset of m-CPM patients with limited PCI in whom ICU stay was not required, a survival advantage was seen (p = 0.031). Conclusion A survival advantage was seen a subset of m-CPM patients, possibly representing differences in disease biology.
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Affiliation(s)
- Jolene Si Min Wong
- Division of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169610, Singapore
| | - Grace Hwei Ching Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169610, Singapore.
| | - Claramae Shulyn Chia
- Division of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169610, Singapore
| | - Johnny Ong
- Division of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169610, Singapore
| | - Wai Yee Ng
- Division of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169610, Singapore
| | - Melissa Ching Ching Teo
- Division of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169610, Singapore
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Chen CY, Chang HY, Lu CH, Chen MC, Huang TH, Lee LW, Liao YS, Chen VCH, Huang WS, Ou YC, Lung FC, Wang TY. Risk factors of acute renal impairment after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int J Hyperthermia 2020; 37:1279-1286. [PMID: 33198563 DOI: 10.1080/02656736.2020.1846793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Acute renal impairment (ARI) is a major complication after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for cancer patients with peritoneal metastases. This study aimed to investigate the incidence and identify the risk factors of post-HIPEC creatinine increased. METHODS From April 2015 to December 2019, demographic and perioperative data of 169 patients undergoing CRS/HIPEC with a preoperative creatinine level <1.5 mg/dL were retrospectively reviewed. Renal impairment was defined according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0. The risk factors of creatinine increased were analyzed using univariate and multiple logistic regression analyses. RESULTS Among the 169 enrolled patients, 21 (12.4%) had postoperative creatinine increased (ARI group) and 148 (87.6%) did not (non-ARI group). Significantly more of the ARI group received a cisplatin HIPEC regimen than the non-ARI group (71.4 vs. 37.8%, p = 0.004). Multiple logistic regression analysis revealed that the patients who received a cisplatin HIPEC regimen (adjusted odds ratio [AOR] = 11.38, p < 0.001) and peritoneal dialysis solution as HIPEC perfusate (AOR = 7.07, p = 0.002) were more likely to develop post-HIPEC creatinine increased. CONCLUSIONS Identifying the risk factors of post-HIPEC creatinine increased can help to improve patient selection, a dose of HIPEC regimens modification and perioperative care. We also identified the detrimental renal effect of peritoneal dialysis solution as HIPEC perfusate. More prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Chao-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Hung-Yu Chang
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chang-Hsien Lu
- Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Min-Chi Chen
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Biostatistics Consulting Centre and Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Hao Huang
- Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Wen Lee
- Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yu-San Liao
- Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital and Chang Gung University, Chiayi, Taiwan
| | - Wen-Shih Huang
- Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chi Lung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Ting-Yao Wang
- Peritoneal Malignancy Program of Cancer Center, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Zhang F, Huang X, Song Y, Gao P, Zhou C, Guo Z, Shi J, Wu Z, Wang Z. Conversion Surgery for Stage IV Gastric Cancer. Front Oncol 2019; 9:1158. [PMID: 31788445 PMCID: PMC6854003 DOI: 10.3389/fonc.2019.01158] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/17/2019] [Indexed: 12/24/2022] Open
Abstract
The prognosis of stage IV gastric cancer (GC) is poor, with palliative chemotherapy remaining the main therapeutic option. Studies increasingly indicate that patients with unresectable stage IV GC, who undergo gastrectomy with radical intention after responding to several regimens of combined chemotherapy, can achieve good survival outcomes. Thus, surgery aiming at radical resection for unresectable stage IV GC after combined chemotherapy has received increasing attention in recent years. This novel therapeutic strategy was defined as conversion surgery in patients with unresectable stage IV GC and it can associate with significant improved survival when R0 resection can be achieved. Despite the recent advances in conversion surgery for patients with unresectable stage IV GC, selection criteria for combination chemotherapy regimens, indications for conversion surgery, optimal timing to surgery, and postoperative chemotherapy all remain controversial. This article reviews the current state of conversion surgery for unresectable stage IV GC.
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Affiliation(s)
- Fei Zhang
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xuanzhang Huang
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yongxi Song
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Peng Gao
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Cen Zhou
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhexu Guo
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jinxin Shi
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhonghua Wu
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhenning Wang
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
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Zhao L, Li J, Bai C, Nie Y, Lin G. Multi-Modality Treatment for Patients With Metastatic Gastric Cancer: A Real-World Study in China. Front Oncol 2019; 9:1155. [PMID: 31737573 PMCID: PMC6839024 DOI: 10.3389/fonc.2019.01155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/16/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction: People with metastatic gastric cancer (GC) have a poor prognosis. The study aims to investigate the efficacy of multi-modality treatment for patients with metastatic GC. Methods: We retrospectively identified 267 patients with stage IV gastric cancer who were treated with systemic chemotherapy: 114 received multi-modality treatments, 153 received systematic chemotherapy alone. The survival of these two groups was compared by log rank test, the independent prognostic factors were investigated using univariate and multivariate analyses. Results: The median survival of metastatic GC patients who received multi-modality treatment was significantly longer than those who received systematic chemotherapy alone (18.4 vs. 11.4 months, P < 0.001). Multivariate analysis identified tumor histologic differentiation, CA19–9 level, previous curative resection, palliative gastrectomy, and metastasectomy as independent prognostic factors for overall survival. In the multimodality treatment group, patients who received palliative gastrectomy or metastasectomy had a longer survival than those who only received intraperitoneal chemotherapy or radiotherapy (21.6 vs. 15.2 months, P = 0.014). Conclusion: Multi-modality treatments offer a survival benefit for patients with metastatic GC. Future prospective studies are needed to confirm the result.
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Affiliation(s)
- Lin Zhao
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiarui Li
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongdu Nie
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guole Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part I: Introduction and Indications. AORN J 2019; 110:479-499. [DOI: 10.1002/aorn.12842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Owusu-Agyemang P, Cata JP, Kapoor R, Speer BB, Bellard B, Feng L, Gottumukkala V. Patterns and predictors of outpatient opioid use after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Int J Hyperthermia 2019; 36:1058-1064. [PMID: 31646916 DOI: 10.1080/02656736.2019.1675912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Long-term opioid use is a well-known complication after surgery. In this retrospective study of adults who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), we sought to determine the rates and factors associated with outpatient opioid use within the sixth and twelfth postoperative months. Methods: Records of 288 opioid-naïve patients were included. Logistic regression models were used to determine factors prognostic of outpatient opioid use. Results: The median patient age was 54 years, and 63% were female. Rates of outpatient opioid use within the sixth and twelfth postoperative months were 21 and 13%, respectively. In the multivariate analysis, every doubling in the amount of in-hospital postoperative opioid consumption was associated with a 44% increase in odds of opioid use within the sixth postoperative month (OR 1.44, 95% CI 1.11-1.87, p = .006) and a 70% increase within the twelfth postoperative month (OR 1.70, 95% CI 1.70-2.37, p = .001). Other factors associated with opioid use within the sixth postoperative month included physical status (OR 5.26, 95% CI 1.08-25.55, p = .039) and recent additional surgery (OR 23.02, 95% CI 2.03-261.30, p = .011). Age (OR 4.39, 95% CI 1.77-10.89, p = .001) and tumor grade (OR 3.31, 95% CI 1.31-8.41, p = .012) were associated with opioid use within the twelfth postoperative month. Conclusion: In this study, the amount of in-hospital postoperative opioid consumption was an important contributory factor to outpatient opioid use in the sixth and twelfth postoperative months. Synopsis In this study of adults who had undergone CRS-HIPEC, higher postoperative opioid consumption during hospitalization was associated with higher odds of opioid use within the sixth and twelfth postoperative months.
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Affiliation(s)
- Pascal Owusu-Agyemang
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,Anesthesiology and Surgical Oncology Research Group , Houston , TX , USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,Anesthesiology and Surgical Oncology Research Group , Houston , TX , USA
| | - Ravish Kapoor
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Barbra B Speer
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Bobby Bellard
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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