Journal of Clinical Medicine

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Dr. Jorge Pedro Martins Nogueiro

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Guest Editor

Department of General Surgery, São João University Hospital Center, Porto, Portugal
Interests: bariatric surgery; peritoneal carcinomatosis; gastric cancer; colorectal cancer; abdominal surgery
Special Issues, Collections and Topics in MDPI journals

Dr. Hugo Santos-Sousa

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Guest Editor

1. Integrated Obesity Center (CRI-O) & Center of Excellence in Obesity (CED-O), São João University Hospital Center (CHUSJ), Porto, Portugal
2. Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
3. Obesity Clinic, Casa de Saúde da Boavista (CSB), Porto, Portugal
Interests: obesity; metabolic and bariatric surgery, metabolic syndrome, minimally invasive surgery; clinical and translational research
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the past, peritoneal carcinomatosis (PC) was considered a terminal disease only approached with palliative care and, despite the advent of new chemotherapies, with noticeable improvements in the survival of patients with metastatic cancers from multiple origins, PC still remains a devastating disease. With a reduced response to systemic chemotherapy compared to other metastatic sites, there is a progressively growing interest in the surgical approach to PC with CRS-HIPEC, and more recently, PIPAC, an alternative method to intra-peritoneal drug delivery with improved distribution and tissue uptake and better tolerance.

Patient selection, preoperative optimization, and postoperative care are of paramount importance, as much as the primary disease and treatment performed.

We aim to provide insight into the approach to peritoneal carcinomatosis, with emphasis on the new developments of multimodality treatment and surgical options, fast postoperative recovery programs, preoperative prognostic factors, and other data, aiming to improve the outcome of patients with PC.

Dr. Jorge Pedro Martins Nogueiro
Dr. Hugo Santos-Sousa
Guest Editors

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Keywords

peritoneal neoplasms
hyperthermic intraperitoneal chemotherapy
pressurized intraperitoneal aerosol chemotherapy
preoperative care
postoperative care

Published Papers (2 papers)

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Research

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14 pages, 1277 KiB

Open AccessArticle

Fluorescence-Guided Laparoscopy after Oral Hypericin Administration for Staging of Locally Advanced Gastric Cancer—A Pilot Study

by Can Yurttas, Philipp Horvath, Imma Fischer, Silvia Wagner, Karolin Thiel, Ruth Ladurner, Ingmar Königsrainer, Alfred Königsrainer, Matthias Schwab, Stefan Beckert and Markus W. Löffler

J. Clin. Med. 2024, 13(8), 2422; https://doi.org/10.3390/jcm13082422 - 21 Apr 2024

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Abstract

(1) Background: Laparoscopic staging is essential in gastric cancer (GC) to rule out peritoneal metastasis (PM). Hypericin, a plant-derived fluorescent compound, has been suggested to improve laparoscopic visualization of PM from GC. This prospective, single-arm, open-label clinical trial aimed to assess the feasibility and safety of oral hypericin administration as well as the suitability of fluorescence-guided laparoscopy (FGL) for improving the sensitivity and specificity of staging in GC patients (EudraCT-Number: 2015-005277-21; clinicaltrials.gov identifier: NCT-02840331). (2) Methods: GC patients received Laif^® 900, an approved hypericin-containing phytopharmaceutical, once orally two to four hours before white light and ultraviolet light laparoscopy. The peritoneal cancer index was evaluated, biopsies taken and hypericin concentrations in serum and peritoneal tissue were determined by mass spectrometry. (3) Results: Between 2017 and 2021, out of 63 patients screened for eligibility, 50 patients were enrolled and treated per protocol. The study intervention was shown to be feasible and safe in all patients. Standard laparoscopy revealed suspicious lesions in 27 patients (54%), among whom 16 (59%) were diagnosed with PM. FGL identified suspicious areas in 25 patients (50%), among whom PM was confirmed in 13 cases (52%). Although hypericin concentrations in serum reached up to 5.64 ng/mL, no hypericin was detectable in peritoneal tissue biopsies. (4) Conclusions: FGL in patients with GC was shown to be feasible but futile in this study. Sufficient levels of hypericin should be ensured in target tissue prior to reassessing FGL with hypericin. Full article

(This article belongs to the Special Issue Peritoneal Carcinomatosis: Current Treatment and Future Options)

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Review

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10 pages, 3001 KiB

Open AccessReview

It Is What the Surgeon Does Not See That Kills the Patient

by Paul H. Sugarbaker

J. Clin. Med. 2024, 13(8), 2238; https://doi.org/10.3390/jcm13082238 - 12 Apr 2024

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Abstract

Background: Patients with colon cancer may present at multiple different stages of the disease process. Many patients can be cured of colon cancer as a result of a simple surgical procedure usually performed by minimally invasive techniques. However, there are a variable number of patients, estimated at approximately 10%, who have a more advanced disease. If these patients are treated by the current conventional standard of care, the likelihood for treatment failure is extremely high. Methods: These are not patients with known disseminated disease but patients who are at high risk of recurrent disease unless special treatments are initiated preoperatively and intraoperatively. The identification of these patients is by (1) a high-quality CT scan, (2) tumor markers found preoperatively, (3) colonoscopic findings, and (4) symptoms. Results: Patients identified as being at high risk require special preoperative treatments which include neoadjuvant chemotherapy. Intraoperative chemotherapy with HIPEC should occur as part of the treatment if peritoneal metastases are documented by biopsy. In the operating room, a thorough exploration of all possible occult peritoneal spaces for metastatic disease needs to be performed. A modified cytoreductive surgical procedure along with a colon resection is performed in order to minimize sites of occult peritoneal metastases. This includes the greater omentum, ovaries, and tubes in postmenopausal women. Peritonectomy is used to create a shroud around the tumor so that all peritoneum that has been in direct contact with the tumor surface is resected and is used as a barrier against tumor cell dissemination in the process of colon cancer resection. If peritoneal metastases are visualized at any site, HIPEC should be included as part of the treatment package. Conclusions: I am convinced that patients at high risk of recurrence will have an improved outcome with proper preoperative evaluation, preoperative neoadjuvant chemotherapy, and a revised intraoperative management strategy. Full article

(This article belongs to the Special Issue Peritoneal Carcinomatosis: Current Treatment and Future Options)

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