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Peritoneal Carcinomatosis: Current Treatment and Future Options

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (30 December 2024) | Viewed by 10960

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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

E-Mail Website
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

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Research

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13 pages, 628 KiB

Open AccessArticle

Morbidity and Mortality after Cytoreductive Surgery and HIPEC in a National Reference Center: A Six-Year Experience under Independent Evaluation

by Miguel Enrique Alberto Vilchez, Sebastian Halskov, Axel Winter, Johann Pratschke, Beate Rau and Safak Gül

J. Clin. Med. 2024, 13(17), 5182; https://doi.org/10.3390/jcm13175182 - 31 Aug 2024

Cited by 1 | Viewed by 1786

Abstract

Introduction: Cytoreductive surgery (CRS) coupled with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative approach to peritoneal disease (PD) and corresponds to the needs of patients with dire survival rates. However, the oncological community remains cautious toward this procedure because of its significant morbidity and mortality rates. This evolving evidence around CRS and HIPEC and its impact suggests a need for more standardized procedures in existing centers. Because of its complexity and potential for high morbidity and mortality, critical observation of our center’s complication rates using complication management documentation tools were crucial to further develop our standard operating procedures (SOP) and maximize patient safety. Methods: Our prospectively maintained institutional database was queried to identify all patients who underwent CRS and HIPEC and had a filled-out quality management (QM) and complication management documentation tool at discharge at the surgical department of the Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany, between January 2018 and December 2023. Results: A total of 155 patients had a surgical and/or medical complication recorded. In total, 305 surgeries were surveyed. Some patients had more than one postoperative complication; hence, 344 events in 50 categories were recorded, of which 267 were graded 3a or higher in 92 patients. The most common medical complications were of pulmonary and renal origin. On the surgical side, surgical site infections (SSI) were most common. The incidence of anastomotic leakage (AL) was 5% (n = 8), with no events between 2021 and the present. Patients with longer surgery duration times were at higher risk for developing postoperative complications. Conclusions: Major abdominal surgeries like CRS and HIPEC are associated with significant patient morbidity despite achieving optimal oncological outcomes. Postoperative complications are managed through strict surveillance and transparency, particularly in our large reference centers, to minimize patient risk. Quality management programs in our department have successfully maintained high standards of care without compromising patient safety. Full article

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

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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

Cited by 1 | Viewed by 1297

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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24 pages, 4305 KiB

Open AccessSystematic Review

Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis

by Cristián Grillo-Marín, Cristina Antón-Rodríguez, Lola Prieto, Gloria Ortega-Pérez and Santiago González-Moreno

J. Clin. Med. 2024, 13(13), 3793; https://doi.org/10.3390/jcm13133793 - 28 Jun 2024

Cited by 3 | Viewed by 1829

Abstract

Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6–25%, range of true effects 3–59%). For chronic kidney disease, it was 7% (95% CI: 3–15.3%, range of true effects 1–53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management. Full article

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

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20 pages, 4284 KiB

Open AccessSystematic Review

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Gastric Cancer: Feasibility, Efficacy and Safety—A Systematic Review and Meta-Analysis

by Francisca Ramalho-Vasconcelos, Raquel Gomes, Raquel Bouça-Machado, Marisa Aral, Jorge Nogueiro, Tiago Bouça-Machado, Bernardo Sousa-Pinto and Hugo Santos-Sousa

J. Clin. Med. 2024, 13(11), 3320; https://doi.org/10.3390/jcm13113320 - 4 Jun 2024

Cited by 5 | Viewed by 3520

Abstract

Background: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is an emerging technique for delivering chemotherapy directly to the peritoneum via a pressurized aerosol. Its growing attention stems from its effectiveness in treating peritoneal carcinomatosis (PC) originating from various primary tumors, with gastric cancer (GC) being among the most prevalent. This study aimed to systematically investigate PIPAC’s therapeutic role in gastric cancer peritoneal metastasis (GCPM). Methods: The systematic review and meta-analysis followed the PRISMA 2020 guidelines, searching Pubmed, Web of Science, and SCOPUS databases. The meta-analysis of relative risks and mean differences compared patients undergoing one or two PIPAC sessions with those completing three or more, assessing various outcomes. Results: Eighteen studies underwent qualitative analysis, and four underwent quantitative analysis. Patients with three or more PIPAC procedures had shorter hospital stays (MD = −1.2; 95%CI (−1.9; −0.5); p < 0.001), higher rates of histopathological response (RR = 1.77, 95%CI 1.08; 2.90; p = 0.023), and significantly improved overall survival (MD = 6.0; 95%CI 4.2; 7.8; p < 0.001). Other outcomes showed no significant differences. Conclusions: PIPAC demonstrated efficacy in carefully selected patients, enhancing histopathologic response rates and overall survival without prolonging hospital stays. This study underscores the necessity for randomized controlled trials and precise selection criteria to refine PIPAC’s implementation in clinical practice. Full article

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

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