Surgical oncology clinics of North America
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Surg. Oncol. Clin. N. Am. · Oct 2012
ReviewPatient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, and role of laparoscopy in diagnosis, staging, and treatment.
The indications for peritonectomy + hyperthermic intraperitoneal chemotherapy (HIPEC) are based on careful assessment of disease extent, but no imaging procedure is accurate enough to identify lesions smaller than 5 mm or extensively diffuse. Video-laparoscopy allows, with minimal surgical trauma, correct staging with a reliable prediction of expected cytoreduction index. Operative laparoscopy is indicated for palliation of neoplastic ascites with chemotherapy, offering encouraging results. Minimally invasive surgery in the treatment of minimal peritoneal carcinomatosis is not yet validated from wide international experience; the procedure is technically possible with strict indications, and combination with intraoperative hyperthermic chemotherapy is strongly recommended.
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Surg. Oncol. Clin. N. Am. · Oct 2012
ReviewCurrent status and future directions in appendiceal cancer with peritoneal dissemination.
This article focuses on the use of intraperitoneal hyperthermic chemotherapy for the treatment of peritoneal dissemination from appendiceal primary tumors. The first part of the article details patient selection criteria used at the Wake Forest University School of Medicine and the use of preoperative imaging and endoscopic evaluation in the management of this cohort of patients. The second part of the article focuses on clinical outcomes for patients undergoing hyperthermic intraperitoneal perfusion for peritoneal dissemination from appendiceal tumors. Finally, future challenges for the use of hyperthermic intraperitoneal perfusion for appendiceal primary tumors are explored.
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Surg. Oncol. Clin. N. Am. · Oct 2012
ReviewAnesthesia considerations during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
This article outlines the anesthetic management of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. This includes a discussion of preoperative evaluation, hemodynamic monitoring, fluid and electrolyte therapy, and temperature management. An understanding of the unique physiologic consequences of this procedure is essential to ensure good outcomes and avoid patient injuries.
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Surg. Oncol. Clin. N. Am. · Oct 2012
ReviewHyperthermic intraperitoneal chemotherapy: methodology and safety considerations.
Several methods of delivering hyperthermic intraperitoneal chemotherapy (HIPEC) during the course of cytoreductive surgery have been described, but no significant differences in treatment results have been found among them. HIPEC is a safe treatment for the patient and for healthcare workers involved in the procedure provided standard protective and environmental measures are used. ⋯ Also reviewed are the safety features that must be taken into consideration when performing this procedure. Recommended guidelines to prevent associated occupational hazards are provided.
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Surg. Oncol. Clin. N. Am. · Oct 2012
ReviewPharmacology of perioperative intraperitoneal and intravenous chemotherapy in patients with peritoneal surface malignancy.
Peritoneal surface malignancy is a common manifestation of intra-abdominal malignancies. Systemic chemotherapy offers no long-term survival and poor quality of life for these patients in their terminal stages of disease. ⋯ Further improvements should come from both clinical phase II/III studies and pharmacologic research. This article reviews the current pharmacologic data and controversies regarding the perioperative intraperitoneal and intravenous application of chemotherapy.