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Highlights • The surgical removal of a primary colon cancer demands complete clearance and absolute containment of the malignant process. • Not all colon cancers are the same although the resection strategy varies little or not at all with the clinical features of the disease. • The patient may enter the operating theater with a contained malignant process and leave with disseminated disease. • Clinical and radiologic features of colon cancer indicate a high risk for cancer dissemination as a result of the resection. • The surgeon must document in the medical record preoperatively the likelihood of clearance and containment. Abstract Background The resection of a primary colon cancer has the opportunity to cure the patient of cancer by complete clearance and absolute containment of disease. Alternatively, if the cancer resection does not provide clearance and containment it will eventuate in local recurrence and peritoneal dissemination. Methods Culpability of recurrence of colorectal cancer is difficult to determine. Are the management strategies of the primary cancer evaluation and treatment at fault or is the underlying disease process is to be held responsible? The clinical and radiologic findings that could have been evaluated by a multidisciplinary team (MDT) were critically evaluated in 2 patients with right colon adenocarcinoma. Strategies to accomplish complete clearance and absolute containment of the primary malignancy as resectable for cure were suggested. Results Clinical evaluation of these 2 patients suggested that more knowledgeable preoperative evaluation by the multidisciplinary team (MDT) should have placed them in a high risk group for local recurrence and/or peritoneal dissemination. High carcinoembryonic antigen (CEA) tumor marker and by CT a large primary cancer infiltrating adjacent structures can be used to select advanced pre- and intraoperative treatment strategies. Conclusions Two patients who had an approximately 50% possibility of long-term survival with optimal preoperative evaluation and expert surgical resection techniques may have been converted to a greatly reduced survival because of tumor dissemination and positive margins of resection at the time of primary cancer resection. Neither patient was evaluated by an MDT preoperatively. It is possible that these two patients entered the operating room with a contained malignancy but as result of suboptimal pre- and intraoperative management left the operating room with disseminated intraperitoneal disease. [ABSTRACT FROM AUTHOR]

Highlights • Morbidly obese patients do get cancer and require laparotomy for resection of the malignancy. • Sleeve gastrectomy can follow a successful oncologic intervention with minimal increase in morbidity and mortality. • Doing the oncologic procedure, HIPEC, and then sleeve gastrectomy helps prevent tumor seeding at the gastric staple line. • Patient satisfaction is high with a favorable prognosis expected from a simultaneous oncologic and bariatric intervention. Abstract Introduction Morbidly obese patients may require a laparotomy to resect a malignancy. In some patients the cancer resection can be combined with the bariatric procedure to concomitantly treat both diseases. Presentation of case A morbidly obese patient with peritoneal metastases from an appendiceal mucinous neoplasm was evaluated and definitively treated with Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), at the same time the patient was treated for morbid obesity with sleeve gastrectomy and removal of a previous laparoscopic adjustable gastric banding (LAGB). Discussion The clinical features and treatments of a cancer patient who underwent a combined surgical oncologic and bariatric procedure is presented. A second-look cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) preceded a sleeve gastrectomy. At the time of surgical exploration the prognosis from an oncologic perspective was acceptable. The near total gastric resection was performed without complications. Conclusions With short term follow-up, this patient's outcome was favorable suggesting that surgical oncologic and bariatric procedures can be combined. Further, clinical investigations are indicated in this common clinical setting. [ABSTRACT FROM AUTHOR]

Use of regional chemotherapy in addition to cytoreductive surgery in patients with established gastric cancer peritoneal metastases should have limited expectations for an improved outcome. 10.1245/s10434-016-5306-0 4 Bonnot P.E., Piessen G., Kepenekian V., Decullier E., Pocard M., Meunier B., Bereder J.M., Abboud K., Marchal F., Quenet F. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): A propensity score analysis. Common knowledge would suggest that regional treatments for peritoneal metastases from gastric cancer would not be successful. [Extracted from the article]