{"title":"Avoidance of Early Post-Operative Intraperitoneal Chemotherapy (EPIC) Following Peritonectomy with Heated Intraperitoneal Chemotherapy (HIPEC) Significantly Reduces Cost and Hospital Stay","authors":"R. Kirby, Jing Zhao, T. Chua, W. Liauw, D. Morris","doi":"10.2174/1876504101405010001","DOIUrl":"https://doi.org/10.2174/1876504101405010001","url":null,"abstract":"Aims: Peritoneal carcinomatosis is treated with Cytoreductive surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC) with or without Early Postoperative Intraperitoneal Chemotherapy (EPIC) depending on the pathology involved. Since 2010 heated intraperitoneal oxaliplatin has been utilised in our institution. Our aim was to determine if there was a significant cost difference between patients receiving oxaliplatin and those requiring five additional days of EPIC. Methods: We retrospectively analysed 30 patients from our database. 15 patients underwent cytoreductive surgery, heated intraperitoneal oxaliplatin (350mg/m 2 ) and 5-fluorouracil (FU) intravenously administered intraoperatively. We compared those patients with 15 patients who underwent CRS, heated intraperitoneal mitomycin C (10-25mg/m 2 ) as well as EPIC with 5-FU (600-800mg/m 2 ) on postoperative days 1 to 5. Patients were matched for age, gender, pathology and peritoneal carcinomatosis index (PCI). Results: There was no significant difference between radiology (p=0.6) and transfusion costs (p=0.4). The chemotherapy costs in the oxaliplatin group were significantly higher (p=0.001) however overall bed costs including ward, HDU and ICU were significantly lower in the oxaliplatin group (p 0.029). There was a higher percentage of patients in the EPIC group that had postoperative ileus (p 0.4), rate of infection (p 0.1), fistula formation (p 0.03), return to theatre (p 0.2) and collection formation (p 0.07) compared to the oxaliplatin group. The overall cost was significantly lower in the oxaliplatin group (p 0.038). There was no significant survival benefit between both groups (p 0.3). Conclusion: In colorectal cancer the cost and complications of EPIC following HIPEC are unjustified. We now use oxaliplatin HIPEC as our standard regimen in colorectal cancer and appendiceal adenocarcinoma.","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"40 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2014-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68144180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. W. Chan, G. Munene, J. Weaver, A. MacLean, J. Easaw, G. Kaplan, R. Parker, E. Dixon
{"title":"Cytoreductive Strategies in the Treatment of Carcinomatosis of Colorectal Origin: Results of a Transdisciplinary National Survey","authors":"A. W. Chan, G. Munene, J. Weaver, A. MacLean, J. Easaw, G. Kaplan, R. Parker, E. Dixon","doi":"10.2174/1876504120130806001","DOIUrl":"https://doi.org/10.2174/1876504120130806001","url":null,"abstract":"Background: Many patients are not referred to centers specializing in the treatment of peritoneal malignancies. This survey evaluates Canadian physician attitudes toward the role of cytoreduction in treating colorectal carcinomatosis. Methods: A discrete-choice questionnaire containing a hypothetical scenario surveyed physician preferences for the management of colorectal carcinomatosis. Results: Three mail-outs yielded a 49% response rate (217 responses). For synchronous colorectal carcinomatosis, 28.6% favoured cytoreduction with or without HIPEC plus systemic chemotherapy, and 18.9% cytoreduction with HIPEC alone. For metachronous carcinomatosis, 27.4% favoured cytoreduction with or without HIPEC plus systemic chemotherapy, and 14.9% cytoreduction with HIPEC alone. For metachronous carcinomatosis with a single liver metastasis, 24.6% favoured cytoreduction with or without HIPEC plus systemic chemotherapy, and 4.6% cytoreduction with HIPEC alone. Conclusion: Most physicians do not favor cytoreduction in the treatment of colorectal carcinomatosis. Knowledge translation strategies are needed to improve awareness regarding its utility in specific clinical scenarios.","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"4 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2013-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68144196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Multiple Abdominal Masses: Report of an Unusual Case","authors":"Vijay Ramachandran, K. Patla","doi":"10.2174/1876504101103010022","DOIUrl":"https://doi.org/10.2174/1876504101103010022","url":null,"abstract":"Patients presenting with multiple abdominal masses is quite unusual. The usual differential diagnoses entertained include Tuberculosis and Lymphoma. However, occasionally, the verdict delivered by the pathologist is a surprise. We report the successful resection of three intraabdominal masses which revealed a unique histopathological entity.","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"3 1","pages":"22-23"},"PeriodicalIF":0.0,"publicationDate":"2011-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68144113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Hegazy, W. Elnahas, O. Farouk, Mahmoud Mosbah, M. Hafez, S. Kotb, H. Sakr, Waleed Abo Zeid, S. Hendawy, T. Amer, Rifaat Hegazi
{"title":"Long Term Outcome of Preoperative Isolated Limb Infusion and External Irradiation in Management of Locally Advanced Extremity Soft TissueSarcoma","authors":"M. Hegazy, W. Elnahas, O. Farouk, Mahmoud Mosbah, M. Hafez, S. Kotb, H. Sakr, Waleed Abo Zeid, S. Hendawy, T. Amer, Rifaat Hegazi","doi":"10.2174/1876504101103010014","DOIUrl":"https://doi.org/10.2174/1876504101103010014","url":null,"abstract":"","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"3 1","pages":"14-21"},"PeriodicalIF":0.0,"publicationDate":"2011-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68144099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment of Primary Pleomorphic Soft Tissue Sarcoma of the Extremities","authors":"A. Sternheim, J. Bickels, M. Malawer","doi":"10.2174/1876504101103010007","DOIUrl":"https://doi.org/10.2174/1876504101103010007","url":null,"abstract":"Background: Pleomorphic Sarcoma is the most common histologic subtype of high grade soft tissue sarcoma involving the extremities. Methods: This retrospective study analyzed 135 patients presenting with primary Pleomorphic Sarcomas which were treated at a single referral institute between 1980 and 2006. Data was collected from an institutional database and univariate and multivariate analysis was conducted regarding significant risk factors which influence outcome. 125 (93%) patients underwent wide limb sparing resection, primary amputation was necessary in 10 (7%) patients. 52 patients (39%) received post-operative radiation therapy alone, 23 (17%) received adjuvant chemotherapy alone and 37 patients (27%) received both chemotherapy and radiation therapy. 23 patients (17%) received no adjuvant therapy. Results: The 5-year disease specific survival rate was 74%±4%, metastatic rate 29% and local recurrence rate was 22%±4%. Significant prognostic factors negatively influencing survival were a local recurrence, large size, deep tumors, close margins and proximal location. Risk factors for a local recurrence were a superficial lesion, upper extremity and extra-compartmental location. Induction chemotherapy did not show a survival or a local recurrence benefit. Chemotherapy induced tumor necrosis rates did not correlate with a survival benefit.","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"3 1","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2011-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68144052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Multimodal Treatment of Resectable Gastric Cancer with Intensive Neoadjuvant Radiation Therapy: Obninsk Radiological Center Experience","authors":"V. Skoropad, B. Berdov, L. Titova","doi":"10.2174/1876504101103010001","DOIUrl":"https://doi.org/10.2174/1876504101103010001","url":null,"abstract":"Introduction: We performed a retrospective analysis to clarify the role of neoadjuvant radiation therapy in the management of resectable gastric cancer. Methods and Methodology: All patients underwent R0 gastrectomy between 1974 and 2008 were retrospectively evaluated. Among them 597 patients underwent multimodal treatment with various schemes of intensive preoperative radiation therapy (total dose of 20-27 Gy) and 433 patients were treated with surgery alone. Results: Radiation therapy was completed in 98% of the patients without the delay of the surgery and any increase in postoperative morbidity or mortality including cases with D2 lymphadenectomy. Subgroup analysis showed that neoadjuvant radiotherapy provided statistically significant survival improvement comparing with surgery alone in pN+ cases (p=0.035); Borrmann 3 and 4 types (p=0.029); poorly differentiated, undifferentiated and signet ring cell carcinomas (p=0.005). Multivariate analysis in the latter group confirmed that neoadjuvant radiation therapy was an independent factor of the favorable prognosis (p=0.001). Conclusions: Intensive neoadjuvant radiotherapy is safe, feasible and could improve survival in selected groups of patients. Patients with poorly differentiated, undifferentiated and signet ring cell carcinomas should be considered as the target group for the multimodal treatment including radiation therapy.","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"3 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2011-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68144033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Ishizawa, N. Harada, A. Muraoka, T. Aoki, Y. Beck, K. Hasegawa, M. Ijichi, K. Kusaka, M. Shibasaki, Y. Bandai, N. Kokudo
{"title":"Scientific Basis and Clinical Application of ICG Fluorescence Imaging: Hepatobiliary Cancer~!2009-10-02~!2009-12-23~!2010-05-26~!","authors":"T. Ishizawa, N. Harada, A. Muraoka, T. Aoki, Y. Beck, K. Hasegawa, M. Ijichi, K. Kusaka, M. Shibasaki, Y. Bandai, N. Kokudo","doi":"10.2174/1876504101002020031","DOIUrl":"https://doi.org/10.2174/1876504101002020031","url":null,"abstract":"Despite recent advances in imaging modalities, the intraoperative diagnosis of small liver cancers remains unsatisfactory. Although fluorescent imaging using indocyanine green (ICG) has just been applied to hepatobiliary surgeries, this technique has the potential to delineate small liver cancers during surgery, through allowing visualization of the disordered biliary excretion of ICG in the hepatocellular carcinoma (HCC) tissues and non-cancerous liver tissues surrounding metastasis of colorectal cancer (CRC). In this technique, ICG is administered intravenously for routine liver function testing before surgery, at the dose of 0.5 mg per kg body weight. The liver surfaces prior to resection, and the cut surfaces of the resected specimen, are examined by the fluorescent imaging system. In our previous series, ICGfluorescent imaging prior to resection delineated more than 90% of liver cancers that were located within 10 mm of the liver surface. On examination of the cut surfaces of the resected specimens, this technique identified all of the microscopically confirmed HCCs and metastases of CRC. Furthermore, ICG-fluorescent imaging was useful to detect small HCCs that were not evident grossly unless visualized by this technique, as reported by Gotoh et al. These results suggest that ICG-fluorescent imaging enables the highly sensitive identification of small liver cancers in real time during liver resection and the subsequent macroscopic examination, enhancing the accuracy of surgery and operative cancer","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"2 1","pages":"31-36"},"PeriodicalIF":0.0,"publicationDate":"2010-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68143143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Azuma, M. Takikawa, Shinichirou Nakamura, Kaoru Sasaki, S. Yanagibayashi, N. Yamamoto, T. Kiyosawa, Y. Morimoto
{"title":"Indocyanine Green Fluorography in Plastic Surgery and Microvascular Surgery~!2009-10-01~!2009-12-23~!2010-05-26~!","authors":"R. Azuma, M. Takikawa, Shinichirou Nakamura, Kaoru Sasaki, S. Yanagibayashi, N. Yamamoto, T. Kiyosawa, Y. Morimoto","doi":"10.2174/1876504101002020048","DOIUrl":"https://doi.org/10.2174/1876504101002020048","url":null,"abstract":"Indocyanine green (ICG) fluorography which is used to visualize the arteries, veins, and lymphatic vessels through the skin surface has recently been developed. This article includes an overview of our clinical experiences as well as descriptions of the latest knowledge on the utilization of ICG fluorography in the fields of plastic surgery and microvascular surgery. Imaging of the Capillary Blood Flow: To predict the future survival and necrosis, ICG fluorography is useful in various situations such as to examine injured limbs, skin flaps with a poor blood flow or ischemic limbs due to arteriosclerosis obliterans. Imaging of the Arteries: Practical pictures of a subcutaneous artery can be obtained for preoperative evaluations of the nutrient vessels of a skin flap and the blood flow within a skin flap. It is particularly useful for planning the use of a perforator-based flap. Imaging of the Lymphatic Vessels: ICG lymphography makes it possible to easily detect the functional lymphatic vessels in lymphaticovenous anastomosis for lymphedema of the extremities after either a surgical lymph node dissection or radiotherapy. Imaging of the Veins: With near-infrared skin imaging after the systemic administration of ICG, a clear picture of the subcutaneous veins, approximately 1 to 2 cm from the surface, can be obtained. ICG venography has various utilizations in flap surgery and peripheral vascular surgery. A clinical application of this method in internal shunt creation is presented in this article. It is expected that various new uses and applications for ICG fluorography will therefore be developed in the future.","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"2 1","pages":"48-56"},"PeriodicalIF":0.0,"publicationDate":"2010-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68144143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Mizukami, M. Fujiwara, A. Suzuki, T. Nagata, H. Fukamizu
{"title":"Sentinel Lymph Node Detection by Indocyanine Green Fluorescence Imaging in Skin Cancer Patients: Technical Refinement~!2009-09-28~!2009-12-23~!2010-05-26~!","authors":"T. Mizukami, M. Fujiwara, A. Suzuki, T. Nagata, H. Fukamizu","doi":"10.2174/1876504101002020057","DOIUrl":"https://doi.org/10.2174/1876504101002020057","url":null,"abstract":"","PeriodicalId":89705,"journal":{"name":"Open surgical oncology journal (Online)","volume":"2 1","pages":"57-61"},"PeriodicalIF":0.0,"publicationDate":"2010-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68144153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}