Search

Gastric cancer (GC) with peritoneal carcinomatosis (PC) is traditionally considered a terminal stage of the disease. The use of a multimodal treatment, including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), can benefit these patients. Our goal was to evaluate the morbidity and survival outcomes of these patients. This is a retrospective, multicenter study from a prospective national database of patients diagnosed with PC secondary to GC treated with CRS and HIPEC from June 2006 to October 2017. Eighty-eight patients from seven specialized Spanish institutions were treated with CRS and HIPEC, with median age of 53 years; 51% were women. Median Peritoneal Cancer Index (PCI) was 6, and complete cytoreduction was achieved in 80 patients (90.9%). HIPEC was administered in 85 cases with 4 different regimens (Cisplatin + Doxorubicin, Mitomycin-C + Cisplatin, Mitomycin-C and Oxaliplatin). Twenty-seven cases (31%) had severe morbidity (grade III–IV) and 3 patients died in the postoperative period (3.4%). Median follow-up was 32 months. Median overall survival (OS) was 21.2 months, with 1-year OS of 79.9% and 3-year OS of 30.9%. Median disease-free survival (DFS) was 11.6 months, with 1-year DFS of 46.1% and 3-year DFS of 21.7%. After multivariate analysis, the extent of peritoneal disease (PCI ≥ 7) was identified as the only independent factor that influenced OS (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.26–4.46, p = 0.007). The multimodal treatment, including CRS and HIPEC, for GC with PC can improve the survival results in selected patients (PCI

Resumen La necesidad de cooperacion sanitaria en paises de bajo desarrollo es conocida y se implementa dia a dia. Sin embargo, la asistencia sanitaria quirurgica en estos paises, en el siglo XXI, es mas discutida, y se encuentra por debajo de niveles deseables y con soluciones mas complejas. Por otra parte, el numero de cirujanos que buscan implicarse aumenta progresivamente. Se analizan las causas que originan estos bajos niveles de asistencia, como la falta de personal cualificado, fuga de profesionales, coste de la asistencia o la falta de cuantificacion de las necesidades. Las oportunidades de mejora, como el hermanamiento institucional, las misiones quirurgicas de corta duracion o la realizacion de acciones dirigidas a la educacion, evaluacion, evidencia y formacion son algunas de las posibilidades propuestas.

The need for healthcare cooperation in low- and middle-income countries is known and is implemented day by day. However, the surgical sanitary assistance in these countries in the 21st century is very controversial, as it is still below desirable levels and entails complex solutions. On the other hand, the number of surgeons seeking to get involved is increasing progressively. We analyze the causes of the low levels of medical assistance, such as the lack of qualified personnel, the brain drain of surgeons, healthcare costs or the lack of quantified needs. Opportunities for improvement, such as institutional twinning, short-term surgical missions or activities aimed at education, evaluation, evidence and training, are some of the possibilities proposed.

Resumen Introduccion La cirugia citorreductora seguida de quimioterapia intraperitoneal hipertermica (HIPEC) se asocia frecuentemente a alteraciones de la hemostasia y a elevados requerimientos transfusionales perioperatorios. El proposito de este estudio fue analizar los trastornos hemostaticos asociados a cada una de las fases de este procedimiento terapeutico mediante tromboelastometria rotacional (ROTEM), niveles de fibrinogeno y recuento plaquetario, asi como su posible relacion con las necesidades transfusionales. Metodos Se efectuo un estudio prospectivo longitudinal. Se registraron niveles de hemoglobina, recuento plaquetario, niveles de fibrinogeno y parametros tromboelastometricos: tiempo de coagulacion (CT), tiempo de formacion del coagulo (CFT), firmeza maxima del coagulo (MCF), y angulo α (EXTEM, INTEM, FIBTEM). Las mencionadas determinaciones se realizaron: antes del inicio de la cirugia; al finalizar la cirugia citorreductora y al concluir la HIPEC. Se utilizaron los test estadisticos apropiados. Los valores de p Resultados Se incluyo en el estudio a 41 mujeres con una mediana de edad de 54 anos (rango: 34-76). Tras la cirugia citorreductora se observo una caida de la tasa de hemoglobina desde 11,4 ± 1,5 a 10,6 ± 1,6 g/dl; un descenso del fibrinogeno serico desde 269 ± 69 hasta 230 ± 48 mg/dl (p Conclusiones Las alteraciones hemostaticas observadas aparecen tras la cirugia citorreductora, probablemente a consecuencia de la hemorragia quirurgica. Se requieren mas estudios para confirmar una correlacion entre las necesidades transfusionales y las pruebas de coagulacion postoperatorias.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is frequently associated with coagulation impairment and perioperative blood transfusion. Our aim was to investigate the impact of each procedure step on hemostasis, as measured by rotational thromboelastometry™ (ROTEM), fibrinogen level and platelet count as a primary outcome, along with its relationship with transfusion needs.A prospective longitudinal study was performed. Hemoglobin level, fibrinogen level, platelet count and ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), α-angle (EXTEM, INTEM, FIBTEM) were measured before the procedure, at the end of cytoreductive surgery and after HIPEC. Appropriate statistical tests were used for comparison. A P.05 was considered as significant.Forty-one women, with median age 54 (range 34-76) were recruited. Cytoreductive surgery was followed by a reduction of hemoglobin level from 11,4±1,5g/dl to 10,6±1,6g/dl, a reduction of serum fibrinogen level from 269±69mg/dl to 230±48mg/dl (P.01) and MCF decline from 20±10 to 16±8mm (P.01), in the FIBTEM test. HIPEC was followed by no hemostatic impairment. The number of packed red blood cells administered during patients stay kept a mild significant relationship with both fibrinogen level (ρ = -0.5, P=.002), and MCF EXTEM values (ρ= -0.43, P=0.006), recorded after HIPEC.The mild observed hemostatic impairment appeared after cytoreductive surgery instead of HIPEC, involving surgical hemorrhage as the most likely responsible factor. Further studies are required to confirm a correlation between transfusion needs and postoperative hemostatic tests.

Hepatoid carcinoma of the ovary (HCO) was first reported in 1987 in 5 cases of malignant ovarian tumors which were similar to hepatocarcinoma in the histological analysis. We report the first case in the literature of a patient diagnosed with HCO treated using HIPEC after extensive cytoreductive surgery, and we discuss the value of this therapeutical option in patients with HCO.