Journal of Clinical Medicine

Editorial

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Open AccessEditorial

Peritoneal Metastases: Evolution from a Dark Horizon to an Encouraging Present and a Promising Future

by Manuel Diez-Alonso, Alberto San-Juan, Miguel Angel Ortega and Alberto Gutiérrez-Calvo

J. Clin. Med. 2023, 12(24), 7536; https://doi.org/10.3390/jcm12247536 - 06 Dec 2023

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Abstract

Peritoneal metastasis (PM) is the primary pattern of metastasis for primary tumours of the appendix, ovary, and peritoneal mesothelioma [...] Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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Follow-up for More than 10 Years of Patients with Peritoneal Metastases Treated with Cytoreductive Surgery + Hyperthermic Intraperitoneal Chemotherapy in a Specialized Unit

by Alba Fernández-Candela, Pedro Bretcha-Boix, Juan Carlos Ruíz Ramírez, Alejandro Paz, Paula Munoz, Miguel A. Ortega, Melchor Álvarez-Mon and José Farré-Alegre

J. Clin. Med. 2024, 13(1), 297; https://doi.org/10.3390/jcm13010297 - 04 Jan 2024

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Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have demonstrated their impact on disease-free survival (DFS) and overall survival (OS) of patients with peritoneal metastases (PM). However, prior literature lacks evidence regarding any follow-up beyond 5 years. In this study, we analyse long-term [...] Read more.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have demonstrated their impact on disease-free survival (DFS) and overall survival (OS) of patients with peritoneal metastases (PM). However, prior literature lacks evidence regarding any follow-up beyond 5 years. In this study, we analyse long-term OS and DFS (more than 10 years of follow-up) of patients undergoing CRS + HIPEC in a specialized unit. We conducted a retrospective study that included only patients who underwent CRS + HIPEC from January 2001 to May 2012. Data collection was conducted by reviewing medical records and telephone calls to patients or relatives. A total of 86 patients were included. The mean PCI was nine (range 0–39) and complete cytoreduction (CC-0) was reached in 80% of patients. Postoperative complications Clavien–Dindo III-IV occurred in 27.9% of patients and the 30-day mortality rate was 2.3%. After 10 years of actual follow-up, OS was 33.7% and DFS was 31.4%. Considering the historical context in which the standard of care for patients with PM was palliation, the results obtained show that CRS + HIPEC was a valid option, with morbimortality comparable to other major abdominal surgeries and encouraging survival results, since, after 10 years of follow-up, almost one-third of patients are still alive and disease-free. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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12 pages, 496 KiB

Open AccessArticle

Diagnostic Accuracy of Abdominal CT for Locally Advanced Colon Tumors: Can We Really Entrust Certain Decisions to the Reliability of CT?

by Yaiza García del Álamo Hernández, Óscar Cano-Valderrama, Carlos Cerdán-Santacruz, Fernando Pereira Pérez, Inés Aldrey Cao, Sandra Núñez Fernández, Eduardo Álvarez Sarrado, Rosángela Obregón Reina, Paula Dujovne Lindenbaum, María Taboada Ameneiro, David Ambrona Zafra, Silvia Pérez Farré, Marta Pascual Damieta, Ricardo Frago Montanuy, Blas Flor Lorente, Sebastiano Biondo and Collaborative Group for the Study of Metachronous Peritoneal Metastases of pT4 Colon Cancer

J. Clin. Med. 2023, 12(21), 6764; https://doi.org/10.3390/jcm12216764 - 26 Oct 2023

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Abstract

Many different options of neoadjuvant treatments for advanced colon cancer are emerging. An accurate preoperative staging is crucial to select the most appropriate treatment option. A retrospective study was carried out on a national series of operated patients with T4 tumors. Considering the [...] Read more.

Many different options of neoadjuvant treatments for advanced colon cancer are emerging. An accurate preoperative staging is crucial to select the most appropriate treatment option. A retrospective study was carried out on a national series of operated patients with T4 tumors. Considering the anatomo-pathological analysis of the surgical specimen as the gold standard, a diagnostic accuracy study was carried out on the variables T and N staging and the presence of peritoneal metastases (M1c). The parameters calculated were sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, as well as the overall accuracy. A total of 50 centers participated in the study in which 1950 patients were analyzed. The sensitivity of CT for correct staging of T4 colon tumors was 57%. Regarding N staging, the overall accuracy was 63%, with a sensitivity of 64% and a specificity of 62%; however, the positive and negative likelihood ratios were 1.7 and 0.58, respectively. For the diagnosis of peritoneal metastases, the accuracy was 94.8%, with a sensitivity of 40% and specificity of 98%; in the case of peritoneal metastases, the positive and negative likelihood ratios were 24.4 and 0.61, respectively. The diagnostic accuracy of CT in the setting of advanced colon cancer still has some shortcomings for accurate diagnosis of stage T4, correct classification of lymph nodes, and preoperative detection of peritoneal metastases. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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11 pages, 728 KiB

Open AccessArticle

Hematological Alterations after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

by Maria Consuelo Pintado, Inmaculada Lasa Unzúe, Remedios Gómez Sanz, Manuel Diez Alonso, Miguel A. Ortega, Melchor Álvarez de Mon, Emilio Nevado Losada and Alberto Gutierrez Calvo

J. Clin. Med. 2023, 12(13), 4323; https://doi.org/10.3390/jcm12134323 - 27 Jun 2023

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Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have benefits for survival in some cancers with peritoneal metastasis. Hematologic toxicity described rate is 2 to 38%. Methods: Patients admitted to an intensive care unit (ICU) after CRS and HIPEC over 78 months. [...] Read more.

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have benefits for survival in some cancers with peritoneal metastasis. Hematologic toxicity described rate is 2 to 38%. Methods: Patients admitted to an intensive care unit (ICU) after CRS and HIPEC over 78 months. The data recorded were demographic characteristics, the severity of illness, complete blood samples, the type of cancer and extension, HIPEC drug and temperature, ICU and hospital stay and mortality, bleeding, and the need for transfusion of blood products. Results: Of the 96 patients included, 77.1% presented hematological complications: 8.3% leukopenia (<4000/mm³ leucocytes), 66.7% anemia (hemoglobin < 10 mg/dL), and 22.9% coagulopathy (INR < 1.5, or/and aPTT < 45 s, or/and platelet count < 100,000/mm³, or/and <100 mg/dL of serum fibrinogen). Leukopenia was higher in ovarian cancer or those treated with doxorubicin. Females with anemia, ovarian cancer, and those treated with cisplatin or doxorubicin had longer ICU stays. Bleeding complications were low-corrected in a conservative manner. The median ICU stay was 5 (4.0–5.0) days. The ICU mortality rate was 1.0%. Conclusions: In our study, 77.1% of patients treated with CRS and HIPEC developed hematological complications during the postoperative period; the majority of them were not severe and resolved spontaneously, without an effect on mortality or hospital stay. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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10 pages, 1817 KiB

Open AccessArticle

Under the Hood: Understanding the Features of Mucin in Pseudomyxoma Peritonei

by Pedro Villarejo-Campos, Mariano García-Arranz, Siyuan Qian, Santos Jiménez de los Galanes, Víctor Domínguez-Prieto, Juan Felipe Vélez-Pinto, Ismael Guijo Castellano, Montiel Jiménez-Fuertes, Héctor Guadalajara and Damián García-Olmo

J. Clin. Med. 2023, 12(12), 4007; https://doi.org/10.3390/jcm12124007 - 12 Jun 2023

Cited by 2 | Viewed by 1041

Abstract

Pseudomyxoma peritonei (PMP) is a rare malignant growth characterized by the production of mucin and the potential for peritoneal relapse. This study aimed to investigate the immunohistochemical and biological characteristics of mucin in patients with cellular and acellular PMP. We prospectively analyzed mucin [...] Read more.

Pseudomyxoma peritonei (PMP) is a rare malignant growth characterized by the production of mucin and the potential for peritoneal relapse. This study aimed to investigate the immunohistochemical and biological characteristics of mucin in patients with cellular and acellular PMP. We prospectively analyzed mucin specimens obtained from our patient cohort and described the composition and type of mucin present in each sample. A metagenomic analysis of the samples was performed to investigate the bacterial composition of the PMP microbiome. Secreted mucins 2 and 5AC and membrane-associated mucin-1 were the primary components of mucin in both cellular and acellular tumor specimens. The metagenomic study revealed a predominance of the phylum Proteobacteria and the genus Pseudomonas. Notably, Pseudomonas plecoglossicida, a species not previously reported in the human microbiome, was found to be the most abundant organism in the mucin of pseudomyxoma peritonei. Our findings suggest that the presence of MUC-2 and mucin colonization by Pseudomonas are characteristic features of both cellular and acellular disease. These results may have significant implications for the diagnosis and treatment of this rare entity. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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13 pages, 1135 KiB

Open AccessArticle

Simultaneous Surgical Approach with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Concurrent Peritoneal and Liver Metastases of Colon Cancer Origin

by Rafael Morales-Soriano, Cristina Pineño-Flores, José Miguel Morón-Canis, Francisco Javier Molina-Romero, José Carlos Rodriguez-Pino, Julia Loyola-Miró, Francisco Xavier Gonzalez-Argente, Elías Palma-Zamora, Mónica Guillot-Morales, Sandra Giménez, Melchor Alvarez-Mon, Miguel A. Ortega and Juan José Segura-Sampedro

J. Clin. Med. 2023, 12(11), 3860; https://doi.org/10.3390/jcm12113860 - 05 Jun 2023

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Abstract

Background: Simultaneous liver resection and peritoneal cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial today. The aim of the study was to analyze the postoperative outcomes and survival of patients with advanced metastatic colon cancer (peritoneal and/or liver metastases). Methods: Retrospective observational [...] Read more.

Background: Simultaneous liver resection and peritoneal cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial today. The aim of the study was to analyze the postoperative outcomes and survival of patients with advanced metastatic colon cancer (peritoneal and/or liver metastases). Methods: Retrospective observational study from a prospective maintained data base. Patients who underwent a simultaneous peritoneal cytoreduction and liver resection plus HIPEC were studied. Postoperative outcomes and overall and disease free survival were analyzed. Univariate and multivariate analyses were performed. Results: From January 2010 to October 2022, 22 patients operated with peritoneal and liver metastasis (LR+) were compared with 87 patients operated with peritoneal metastasis alone (LR−). LR+ group presented higher serious morbidity (36.4 vs. 14.9%; p: 0.034). Postoperative mortality did not reach statistical difference. Median overall and disease free survival was similar. Peritoneal carcinomatosis index was the only predictive factor of survival. Conclusions: Simultaneous peritoneal and liver resection is associated with increased postoperative morbidity and hospital stay, but with similar postoperative mortality and OS and disease free survival. These results reflect the evolution of these patients, considered inoperable until recently, and justify the trend to incorporate this surgical strategy within a multimodal therapeutic plan in highly selected patients. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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13 pages, 1146 KiB

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Treatment of Peritoneal Surface Malignancies by Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Spain: Results of the National Registry of the Spanish Group of Peritoneal Oncologic Surgery (REGECOP)

by Israel Manzanedo, Fernando Pereira, Pedro Cascales-Campos, Cristobal Muñoz-Casares, Enrique Asensio, Juan Torres-Melero, Arancha Prada-Villaverde, Ibán Caravaca-García, Alberto Gutiérrez-Calvo, Javier Vaqué, Gloria Ortega, Alberto Titos-García, Laura González-Sánchez, Estíbalitz Pérez-Viejo, Ángel Serrano, Beatriz Martínez-Torres and REGECOP Group

J. Clin. Med. 2023, 12(11), 3774; https://doi.org/10.3390/jcm12113774 - 31 May 2023

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Abstract

Introduction: Treatment of Peritoneal Surface Malignancies (PSM) with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved results never seen before in these patients, which classically have a poor prognosis. The possibility of conducting clinical trials in these diseases is complicated, since [...] Read more.

Introduction: Treatment of Peritoneal Surface Malignancies (PSM) with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved results never seen before in these patients, which classically have a poor prognosis. The possibility of conducting clinical trials in these diseases is complicated, since some of them are rare, so the analysis of large databases provides very valuable scientific information. The aim of this study is to analyze the global results of the National Registry of the Spanish Group of Peritoneal Oncologic Surgery (REGECOP), whose objective is to register all patients scheduled for HIPEC nationwide. Methods: This is a retrospective analysis of the data recorded in the REGECOP from 36 Spanish hospitals from 2001 to 2021. There were 4159 surgical interventions in 3980 patients. Results: 66% are women and 34% are men with a median age of 59 years (range 17–86). 41.5% of the patients were treated for Peritoneal Metastases (PM) of colorectal cancer (CRC); 32.4% were women with ovarian cancer (OC) with PM; 12.8% were treated for pseudomyxoma peritonei (PMP); 6.2% had PM from gastric cancer (GC); 4.9% had PM of non-conventional origin; and, finally, 2.1% of cases were patients diagnosed with peritoneal mesothelioma. The median Peritoneal Cancer Index (PCI) was 9 (0–39), and complete cytoreduction was achieved in 81.7% of the procedures. Severe morbidity (Dindo–Clavien grade III–IV) was observed in 17.7% of surgeries, with 2.1% mortality. Median hospital stay was 11 days (0–259). Median overall survival (OS) was 41 months for CRC patients, 55 months for women with OC, was not reached in PMP patients, was 14 months for GC patients, and 66 months in mesothelioma patients. Conclusions: large databases provide extremely useful data. CRS with HIPEC in referral centers is a safe treatment with encouraging oncologic results in PSM. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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10 pages, 812 KiB

Open AccessArticle

Peritoneal Mesothelioma in a High Volume Peritoneal Surface Malignancies Unit

by Fernando Pereira, Mónica Pereira, Israel Manzanedo, Ángel Serrano and Estibalitz Pérez-Viejo

J. Clin. Med. 2023, 12(6), 2288; https://doi.org/10.3390/jcm12062288 - 15 Mar 2023

Cited by 1 | Viewed by 1619

Abstract

Diffuse malignant peritoneal mesothelioma (PM) is a rare neoplasm, traditionally associated with a poor prognosis. There are other varieties of PM that are even less frequent and of uncertain malignancy. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved prolonged survival in [...] Read more.

Diffuse malignant peritoneal mesothelioma (PM) is a rare neoplasm, traditionally associated with a poor prognosis. There are other varieties of PM that are even less frequent and of uncertain malignancy. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved prolonged survival in selected patients. The aim of this study is to analyze the patients with PM assessed in our center. Clinicopathological characteristics, diagnostic procedures and survival results from patients with PM appraised at our unit, according to the applied treatment, were analyzed. Seventeen patients were assessed between 2007 and 2019. Three cases had multicystic PM that were treated with complete CRS + HIPEC; all patients are alive and free of disease after a long follow-up. Three other cases had biphasic PM; a curative treatment could be performed in none of them, and their survival was minimal (<6 moths). Lastly, 11 cases with epithelioid PM were treated. Two cases were considered unresectable at laparoscopy (PCI 39); one of them had a long survival (67 months) with three iterative laparoscopic palliatives HIPECs for refractory ascites. The other nine cases were treated with curative CRS + HIPEC, with a median PCI of 14 (range 4–25), and a median overall survival (OS) of 58 months, with a 5-year OS of 47.4%. In conclusion, CRS + HIPEC, when possible, appears to be the optimal treatment for patients with PM. Knowledge of this therapeutic option is crucial, both to offer it to patients and to avoid delays in their referral to appropriate centers for treatment. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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Hyperthermic Intraperitoneal Chemotherapy and Recirculation with CO₂: A Safe Technique

by Remedios Gómez-Sanz, Enrique Ovejero-Merino, Inmaculada Lasa-Unzúe, Adela López-García, Ruth Marcos-Hernández, Javier Mínguez-García, Francisca García-Moreno Nisa, Fernando Mendoza-Moreno, Manuel Díez-Alonso, Miguel A Ortega, Melchor Álvarez-Mon, Alberto Gutiérrez-Calvo and the Spanish PRS Collaborating Group

J. Clin. Med. 2022, 11(20), 6152; https://doi.org/10.3390/jcm11206152 - 19 Oct 2022

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Abstract

Introduction: Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) has evolved as a treatment for peritoneal carcinomatosis in various tumors after a careful and complete cytoreductive surgery, and it demonstrated much better and longer survival than more traditional therapeutic schemas. Our objective has been to examine the [...] Read more.

Introduction: Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) has evolved as a treatment for peritoneal carcinomatosis in various tumors after a careful and complete cytoreductive surgery, and it demonstrated much better and longer survival than more traditional therapeutic schemas. Our objective has been to examine the safety, efficacy and survival achieved with closed technique with CO₂-agitation system Combat PRS^® (Peritoneal Recirculation System: PRS). To achieve this, we compared the appearance of adverse events, mortality and survival with the described using classic techniques (open, closed without CO₂-agitation) for the treatment of selected patients with peritoneal carcinomatosis; Materials and methods: We studied overall survival, disease-free survival and safety (morbidity and mortality) of the administration of HIPEC through a closed method technique with CO₂ recirculation (Combat PRS^®) in 482 patients from 11 Spanish hospitals; Results: The mortality of our technique (1.66%) was similar to other published techniques (open, closed). Morbidity exhibited a 9.96% rate of Clavien-Dindo (CD) III/IV complications in 482 patients, which was lower than in other series. Survival (overall survival (OS) and disease-free survival (DFS)) was similar to previously published results: 86% 1y-OS, 54% 3y-OS, 77% 1y-DFS and 31% 3y-DFS; Conclusion: The procedure with closed PRS with CO₂ agitation is as safe as standard open and closed procedures for the administration of HIPEC after complete cytoreductive surgery, with similar and very low mortality (1.66%) and lower morbidity (9.96% CD III and IV in our series vs range of 20–40% in the majority of different series); only Kusamura had similar results, with 12% in 205 patients, using the closed technique without CO₂ agitation). Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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14 pages, 970 KiB

Open AccessArticle

The Role of Intraperitoneal Intraoperative Chemotherapy with Paclitaxel in the Surgical Treatment of Peritoneal Carcinomatosis from Ovarian Cancer—Hyperthermia versus Normothermia: A Randomized Controlled Trial

by Angela Casado-Adam, Lidia Rodriguez-Ortiz, Sebastian Rufian-Peña, Cristobal Muñoz-Casares, Teresa Caro-Cuenca, Rosa Ortega-Salas, Maria Auxiliadora Fernandez-Peralbo, Maria Dolores Luque-de-Castro, Juan M. Sanchez-Hidalgo, Cesar Hervas-Martinez, Antonio Romero-Ruiz, Javier Briceño and Álvaro Arjona-Sánchez

J. Clin. Med. 2022, 11(19), 5785; https://doi.org/10.3390/jcm11195785 - 29 Sep 2022

Cited by 2 | Viewed by 1430

Abstract

Background: The treatment of ovarian carcinomatosis with cytoreductive surgery and HIPEC is still controversial. The effect and pharmacokinetics of the chemotherapeutics used (especially taxanes) are currently under consideration. Methods: A phase II, simple blind and randomized controlled trial (NTC02739698) was performed. The trial [...] Read more.

Background: The treatment of ovarian carcinomatosis with cytoreductive surgery and HIPEC is still controversial. The effect and pharmacokinetics of the chemotherapeutics used (especially taxanes) are currently under consideration. Methods: A phase II, simple blind and randomized controlled trial (NTC02739698) was performed. The trial included 32 patients with primary or recurrent ovarian carcinomatosis undergoing cytoreductive surgery (CRS) and intraoperative intraperitoneal chemotherapy with paclitaxel (PTX): 16 in hyperthermic (42–43 °C) and 16 in normothermic (37 °C) conditions. Tissue, serum and plasma samples were taken in every patient before and after intraperitoneal chemotherapy to measure the concentration of PTX. To analyze the immunohistochemical profile of p53, p27, p21, ki67, PCNA and caspase-3 and the pathological response, a scale of intensity and percentage of expression and a grouped Miller and Payne system were used, respectively. Perioperative characteristics and morbi-mortality were also analyzed. Results: The main characteristics of patients, surgical morbidity, hemotoxicity and nephrotoxicity were similar in both groups. The concentration of paclitaxel in the tissue was higher than that observed in plasma and serum, although no statistically significant differences were found between the two groups. No statistically significant association regarding pathological response and apoptosis (caspase-3) between both groups was proved. There were no statistically significant differences between the normothermic and the hyperthermic group for pathological response and apoptosis. Conclusions: The use of intraperitoneal PTX has proven adequate pharmacokinetics with reduction of cell cycle and proliferation markers globally without finding statistically significant differences between its administration under hyperthermia versus normothermia conditions. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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9 pages, 687 KiB

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Initial Experience of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Baltic Country Center

by Rokas Račkauskas, Augustinas Baušys, Jonas Jurgaitis, Marius Paškonis and Kęstutis Strupas

J. Clin. Med. 2022, 11(19), 5554; https://doi.org/10.3390/jcm11195554 - 22 Sep 2022

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Background: Peritoneal surface malignancies (PSMs) are a heterogenous group of primary and metastatic cancers affecting the peritoneum. They are associated with poor long-term outcomes. Many centers around the world adopt cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in routine clinical practice [...] Read more.

Background: Peritoneal surface malignancies (PSMs) are a heterogenous group of primary and metastatic cancers affecting the peritoneum. They are associated with poor long-term outcomes. Many centers around the world adopt cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in routine clinical practice for these otherwise condemned patients despite a lack of high-level evidence from randomized control trials. This study aimed to investigate and present our 10-year experience with this controversial method, CRS and HIPEC, for PSM in a single tertiary center in a Baltic country. Methods: Patients who underwent CRS and HIPEC at Vilnius University Hospital Santaros Klinikos between 2011 and 2021 were included in this retrospective study. Overall survival was the primary study outcome. Secondary outcomes included postoperative morbidity and mortality, and local or systemic recurrence rates. Results: Sixty-nine patients who underwent CRS and HIPEC were included in the study. Most patients underwent treatment for peritoneal metastases from colorectal, ovarian, and appendiceal cancers. Six (8.7%) patients received CRS and HIPEC for primary peritoneal neoplasm—pseudomyxoma peritonei. The mean peritoneal carcinomatosis index score was 12 ± 7. Complete cytoreduction was achieved in 62 (89.9%) patients. The mean OS was 39 ± 29 months. The mean survival of patients with PSMs of different origin was as follows: 39 ± 25 (95% CI: 28–50) months for colorectal cancer, 44 ± 31 (95% CI: 30–58) months for ovarian cancer, 32 ± 21 (95% CI: 21–43) months for appendiceal cancer, 422 ± 1 (95% CI: 12–97) months for pseudomyxoma peritonei, and 7 months for gastric cancer. Conclusions: The current study demonstrated the results of the CRS and HIPEC program in a single Baltic country tertiary center. Patients who underwent CRS and HIPEC for PSMs achieved moderate survival rates with acceptable postoperative morbidity and mortality risk. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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14 pages, 1470 KiB

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Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer

by Fernando Mendoza-Moreno, Manuel Diez-Alonso, Belén Matías-García, Enrique Ovejero-Merino, Remedios Gómez-Sanz, Alma Blázquez-Martín, Ana Quiroga-Valcárcel, Cristina Vera-Mansilla, Raquel Molina, Alberto San-Juan, Silvestra Barrena-Blázquez, Miguel A. Ortega, Melchor Alvarez-Mon and Alberto Gutiérrez-Calvo

J. Clin. Med. 2022, 11(16), 4922; https://doi.org/10.3390/jcm11164922 - 22 Aug 2022

Cited by 6 | Viewed by 1564

Abstract

Objectives: The aim of this study was to analyze the prognostic factors of survival in patients with peritoneal metastasis (PM) from colorectal cancer (CRC). The type of relationship between survival and the PM time of detection was used to determine whether it was [...] Read more.

Objectives: The aim of this study was to analyze the prognostic factors of survival in patients with peritoneal metastasis (PM) from colorectal cancer (CRC). The type of relationship between survival and the PM time of detection was used to determine whether it was synchronous with the primary tumor or metachronous. Patients and Methods: Retrospective observational study. It included patients treated for colorectal adenocarcinoma diagnosed between January 2005 and December 2019 who presented PM at the time of diagnosis or during follow-up. Variables, such as sex, age, differentiation grade, positive adenopathy (pN+), tumor size (pT), tumor location, mucinous component, peritoneal carcinomatosis index (PCI), and KRAS mutational status, were analyzed. Results: During the study period, 1882 patients were surgically treated for CRC in our hospital. Of these, 240 patients (12.8%) were included in the study after evidence of PM. The mean age was 67 ± 12 years (range: 32–92 years), and 114 patients were female (47.5%). The mean follow-up was 20 ± 13 months (median 12 months). The Kaplan–Meier survival at 36 months was higher in patients with metachronous PM (24% vs. 8%; p = 0.002), WT-KRAS tumors (31% vs. 15%; p < 0.001), N0 stage (30% vs. 19%; p < 0.001), T3 stage tumors (18% vs. 19% in T4A and 3% in T4B; p > 0.001), and tumors with classic adenocarcinoma histology (18% vs. 8%; p = 0.011). Patients with a PCI of 1–10 showed a likelihood of survival at 36 months of 56%, which was longer than that found in patients with a PCI of 11–20 (8%) or a PCI of >20 (0%) (p < 0.001). In the multiple regression analysis, the factors with an independent prognostic value were: poor grade of differentiation (HR 1.995; 95% CI: 1.294–3.077), KRAS mutation (HR 1.751; 95% CI: 1.188–2.581), PCI 11–20 (HR: 9.935; 95% CI: 5.204–18.966) and PCI > 20 (HR: 4.011; 95% CI: 2.291–7.023). Conclusions: PCI should continue as the as the most useful prognostic indicator in order to assess prognostic estimations as well as therapeutic and surgical decisions, but tumor grade and KRAS mutational status may help in the treatment decision process by providing complementary information. The time of PM detection did not achieve statistical significance in the multiple regression analysis. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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17 pages, 1360 KiB

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Development of the Peritoneal Metastasis: A Review of Back-Grounds, Mechanisms, Treatments and Prospects

by Kaijie Ren, Xin Xie, Tianhao Min, Tuanhe Sun, Haonan Wang, Yong Zhang, Chengxue Dang and Hao Zhang

J. Clin. Med. 2023, 12(1), 103; https://doi.org/10.3390/jcm12010103 - 23 Dec 2022

Cited by 10 | Viewed by 2355

Abstract

Peritoneal metastasis is a malignant disease which originated from several gastrointestinal and gynecological carcinomas and has been leading to a suffering condition in patients for decades. Currently, as people have gradually become more aware of the severity of peritoneal carcinomatosis, new molecular mechanisms [...] Read more.

Peritoneal metastasis is a malignant disease which originated from several gastrointestinal and gynecological carcinomas and has been leading to a suffering condition in patients for decades. Currently, as people have gradually become more aware of the severity of peritoneal carcinomatosis, new molecular mechanisms for targeting and new treatments have been proposed. However, due to the uncertainty of influencing factors involved and a lack of a standardized procedure for this treatment, as well as a need for more clinical data for specific evaluation, more research is needed, both for preventing and treating. We aim to summarize backgrounds, mechanisms and treatments in this area and conclude limitations or new aspects for treatments. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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