- Email: [email protected]
Peritonectomy and hyperthermic intraperitoneal chemotherapy in HIV patient
S38 In patients with peritoneal carcinomatosis and gastric cancer, TC and CT/PET are considered necessary steps for staging. Imaging based Peritoneal Carcinomatosis Index (PCI) is routinely used to enroll patients for cytoreductive surgery. Laparoscopic PCI though permits a true assessment of the extent of disease allowing an accurate selection of patients according to the expected Completeness of Cytoreduction (CC) index and a cost/ benefit assessment in terms of disease-free, over all survival and quality of life. We performed laparoscopic procedures on 84 patients with peritoneal surface malignancy arising from gastric cancer. There were no reports of morbidity or mortality. The average time of the procedure was 30 minutes (range 15 to 45 minutes). The majority of cases (98,8%) had a PCI>18. Patients with small bowel PCI<3 (26,5%) started neoadjuvant chemotherapy and were restaged after 3 cycles of Docetaxel-Cisplatinum-Fluorouracil (DCF). Only 11 patients (13%) of the starting 84, had a down staging of peritoneal surface disease with PCI<12 and free small bowel, allowing them to be enrolled for cytoreductive surgery and HIPEC. Due to the high morbidity/mortality rates for this kind of surgery and for the poor survival associated to CC>1, current indication for cytoreductive surgery in patients with peritoneal carcinomatosis arising from gastric cancer is limited to abdominal PCI9 and small bowel PCI2. Accurate patient selection is mandatory and according to our experience laparoscopic staging is safe and allows a precise evaluation of PCI. http://dx.doi.org/10.1016/j.ejso.2013.07.015
01 e Randomized trial on peritoneal carcinosis diagnosis in mucinous colorectal cancer by laparoscopic second look at six months from a radical resection L. Montesarchio*, E. Cardone, F. Ruffolo, D. Scala, C. Sassaroli SC chirurgia oncologia colorettale Fondazione Pascale Napoli, Napoli, Italy * Corresponding author. Montesarchio L. Fondazione Pascale Napoli, Napoli, Italy. E-mail address: [email protected] (L. Montesarchio). Peritoneal tumour dissemination arising from colorectal cancer (CRC) is a sign of advanced tumour stage or disease recurrence and mostly associated with poor prognosis. Mucinous colorectal cancer is characterized by an early peritoneal spread and a worse prognosis. Radiologic diagnosis is difficult. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for isolated peritoneal surface malignancy (PC) from CRC. A recent consensus statement describes videolaparoscopy (VLS) as a staging step prior to cytoreduction. PCI obtained at VLS may prospectively assist with patient selection for this highly involved and potentially morbid procedure. Primary objective of the trial is to assess the impact on 2-year survival of an aggressive diagnostic-therapeutic strategy including a second- look laparoscopy 6 months after primary surgery. Then if appropriate, peritonectomy and HIPEC. Design Randomized phase 2 study comparing standard follow-up and laparoscopic second-look in patients disease free at radiological evaluation at 6 months after R0 resection. Inclusion criteria: Diagnosis of colorectal cancer; mucinous histology; Stage II-III ; R0 surgery of the primary tumour, CT scan negative for recurrence 6 months after primary surgery; age 18 and 65 years; ECOG performance status 1; normal liver, kidney and bone marrow function; any type of adjuvant chemotherapy may be received; written informed consent. Exclusion criteria: Residual disease after surgery; stage IV; ongoing systemic infection; chronic cardiovascular pathology not allowing laparoscopy; concomitant or previous malignancy within 5 years prior to primary surgery; pregnant or lactation; inability to comply with follow up assessments Primary outcome: Compare study arms in terms of 2-year survival rate. Secondary outcomes: describe the rate of PC diagnosed by second-look laparoscopy; evaluate sensitivity, specificity and level of correlation with
ABSTRACTS CT scan of the MRI in the diagnosis of PC in the experimental arm; compare study arms in terms of quality of life at 6 months after randomization; compare study arms in terms of survival after 5 years of follow-up; describe adverse events and toxicity in the experimental arm; describe the rate of patients with recurrent disease at CT scan 6 months after primary surgery; describe therapeutic approach and outcome in patients with recurrent disease at CT scan 6 months after primary surgery. http://dx.doi.org/10.1016/j.ejso.2013.07.016 01 e Peritonectomy and hyperthermic intraperitoneal chemotherapy in HIV patient L. Cenci*, O. Federici, M. Benedetti, G.B. Levi Sandri, F. Stefanelli, M. Valle, A. Garofalo Istituto Regina Elena, Roma, Italy * Corresponding author. Cenci L. Istituto Regina Elena, Roma, Italy. E-mail address: [email protected] (L. Cenci). An increasing number of women have been infected with human immunodeficiency virus (HIV) and now are living with the acquired immunodeficiency syndrome (AIDS) Over 40 million people worldwide are living with HIV and AIDS, and currently the prevalence of HIV is rising progressively each year. Ovarian cancer is the leading cause of death among patients with gynaecologic malignancies. We report a case of a 45 year old Caucasian women with peritoneal carcinomatosis from ovarian cancer and HIV infection. Upon admission the CD4 count was in the range. Videolaparoscopic staging was performed showing a medium-high extension of disease with a Peritoneal Cancer Index (PCI) of 22. Patient was eligible for cytoreductive surgery and hyper-thermic intraperitoneal chemotherapy (HIPEC). The surgical procedure consisted in performing a complete parietal peritonectomy, peritoneal stripping of the diaphragm and pelvis, greater and lesser omentectomy, splenectomy, anterior rectal resection and total hysterectomy with bilateral salpingo-oophorectomy. Macroscopically complete cytoreduction (CC0) was obtained. HIPEC according to open abdomen technique was performed with cisplatin 50 mg m2/l and doxorubicin 15 mg m2/l. The perfusion was carried out for 90 minutes at 42 C. Surgery was uneventful. A general decrease of blood cell counts occurred five days after surgery and was treated with bone marrow stimulation until complete normalization of the CD4 counts. Even if the value of CD4 counts as a predictor of postoperative septic complications after surgery is controversial, the incidence of complications is higher in patients with CD4 counts < 200.Although the combination of HIV infection and chemotherapy can progressively cause the failure of immune system we did not observe postoperative infections. In the best of our knowledge cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy can be performed successfully in patients with HIV. http://dx.doi.org/10.1016/j.ejso.2013.07.017
01 e Single incision laparoscopy to select patients with peritoneal carcinomatosis from colorectal carcinoma before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy B. Ulloa Severino*, D. Rega, U. Pace, C. Sassaroli SC chirurgia oncologia colorettale Fondazione Pascale, Napoli, Italy * Corresponding author. Ulloa Severino B. Fondazione Pascale Napoli, Napoli E-mail address: [email protected] (B. Ulloa Severino). Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for peritoneal surface malignancy (PC) from colorectal cancer (CRC). Videolaparoscopy
01 e Randomized trial on peritoneal carcinosis diagnosis in mucinous colorectal cancer by laparoscopic second look at six months from a radical resection L. Montesarchio*, E. Cardone, F. Ruffolo, D. Scala, C. Sassaroli SC chirurgia oncologia colorettale Fondazione Pascale Napoli, Napoli, Italy * Corresponding author. Montesarchio L. Fondazione Pascale Napoli, Napoli, Italy. E-mail address: [email protected] (L. Montesarchio). Peritoneal tumour dissemination arising from colorectal cancer (CRC) is a sign of advanced tumour stage or disease recurrence and mostly associated with poor prognosis. Mucinous colorectal cancer is characterized by an early peritoneal spread and a worse prognosis. Radiologic diagnosis is difficult. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for isolated peritoneal surface malignancy (PC) from CRC. A recent consensus statement describes videolaparoscopy (VLS) as a staging step prior to cytoreduction. PCI obtained at VLS may prospectively assist with patient selection for this highly involved and potentially morbid procedure. Primary objective of the trial is to assess the impact on 2-year survival of an aggressive diagnostic-therapeutic strategy including a second- look laparoscopy 6 months after primary surgery. Then if appropriate, peritonectomy and HIPEC. Design Randomized phase 2 study comparing standard follow-up and laparoscopic second-look in patients disease free at radiological evaluation at 6 months after R0 resection. Inclusion criteria: Diagnosis of colorectal cancer; mucinous histology; Stage II-III ; R0 surgery of the primary tumour, CT scan negative for recurrence 6 months after primary surgery; age 18 and 65 years; ECOG performance status 1; normal liver, kidney and bone marrow function; any type of adjuvant chemotherapy may be received; written informed consent. Exclusion criteria: Residual disease after surgery; stage IV; ongoing systemic infection; chronic cardiovascular pathology not allowing laparoscopy; concomitant or previous malignancy within 5 years prior to primary surgery; pregnant or lactation; inability to comply with follow up assessments Primary outcome: Compare study arms in terms of 2-year survival rate. Secondary outcomes: describe the rate of PC diagnosed by second-look laparoscopy; evaluate sensitivity, specificity and level of correlation with
ABSTRACTS CT scan of the MRI in the diagnosis of PC in the experimental arm; compare study arms in terms of quality of life at 6 months after randomization; compare study arms in terms of survival after 5 years of follow-up; describe adverse events and toxicity in the experimental arm; describe the rate of patients with recurrent disease at CT scan 6 months after primary surgery; describe therapeutic approach and outcome in patients with recurrent disease at CT scan 6 months after primary surgery. http://dx.doi.org/10.1016/j.ejso.2013.07.016 01 e Peritonectomy and hyperthermic intraperitoneal chemotherapy in HIV patient L. Cenci*, O. Federici, M. Benedetti, G.B. Levi Sandri, F. Stefanelli, M. Valle, A. Garofalo Istituto Regina Elena, Roma, Italy * Corresponding author. Cenci L. Istituto Regina Elena, Roma, Italy. E-mail address: [email protected] (L. Cenci). An increasing number of women have been infected with human immunodeficiency virus (HIV) and now are living with the acquired immunodeficiency syndrome (AIDS) Over 40 million people worldwide are living with HIV and AIDS, and currently the prevalence of HIV is rising progressively each year. Ovarian cancer is the leading cause of death among patients with gynaecologic malignancies. We report a case of a 45 year old Caucasian women with peritoneal carcinomatosis from ovarian cancer and HIV infection. Upon admission the CD4 count was in the range. Videolaparoscopic staging was performed showing a medium-high extension of disease with a Peritoneal Cancer Index (PCI) of 22. Patient was eligible for cytoreductive surgery and hyper-thermic intraperitoneal chemotherapy (HIPEC). The surgical procedure consisted in performing a complete parietal peritonectomy, peritoneal stripping of the diaphragm and pelvis, greater and lesser omentectomy, splenectomy, anterior rectal resection and total hysterectomy with bilateral salpingo-oophorectomy. Macroscopically complete cytoreduction (CC0) was obtained. HIPEC according to open abdomen technique was performed with cisplatin 50 mg m2/l and doxorubicin 15 mg m2/l. The perfusion was carried out for 90 minutes at 42 C. Surgery was uneventful. A general decrease of blood cell counts occurred five days after surgery and was treated with bone marrow stimulation until complete normalization of the CD4 counts. Even if the value of CD4 counts as a predictor of postoperative septic complications after surgery is controversial, the incidence of complications is higher in patients with CD4 counts < 200.Although the combination of HIV infection and chemotherapy can progressively cause the failure of immune system we did not observe postoperative infections. In the best of our knowledge cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy can be performed successfully in patients with HIV. http://dx.doi.org/10.1016/j.ejso.2013.07.017
01 e Single incision laparoscopy to select patients with peritoneal carcinomatosis from colorectal carcinoma before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy B. Ulloa Severino*, D. Rega, U. Pace, C. Sassaroli SC chirurgia oncologia colorettale Fondazione Pascale, Napoli, Italy * Corresponding author. Ulloa Severino B. Fondazione Pascale Napoli, Napoli E-mail address: [email protected] (B. Ulloa Severino). Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for peritoneal surface malignancy (PC) from colorectal cancer (CRC). Videolaparoscopy