11 results on '"Di Giorgio, Andrea"'
Search Results
2. Efficacy of Cytoreductive Surgery (CRS) + HIPEC in Gastric Cancer with Peritoneal Metastasis: Systematic Review and Meta-Analysis.
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Langellotti, Lodovica, Fiorillo, Claudio, D'Annibale, Giorgio, Panza, Edoardo, Pacelli, Fabio, Alfieri, Sergio, Di Giorgio, Andrea, and Santullo, Francesco
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STOMACH tumors ,PERITONEUM ,THERMOTHERAPY ,CYTOREDUCTIVE surgery ,TREATMENT effectiveness ,META-analysis ,DESCRIPTIVE statistics ,METASTASIS ,ADJUVANT chemotherapy ,SYSTEMATIC reviews ,MEDLINE ,DRUG efficacy ,ONLINE information services ,COMPARATIVE studies - Abstract
Simple Summary: Peritoneal disease in gastric cancer has a poor prognosis, with a median survival of 3–6 months and a 5-year survival rate of 0%. Despite multiple advancements in therapeutics, the National Comprehensive Cancer Network (NCCN) guidelines recommend systemic chemotherapy or best supportive care for GC with peritoneal dissemination. According to several studies, CRS + HIPEC could provide survival advantages in gastric cancer peritoneal metastasis compared to pSC. Background: Peritoneal carcinomatosis is one of deadliest metastatic patterns of gastric cancer, being associated with a median overall survival (OS) of 4 months. Up to now, palliative systemic chemotherapy (pSC) has been the only recommended treatment. The aim of this study is to evaluate a potential survival benefit after CRS + HIPEC compared to pSC. Methods: A systematic review was conducted according to the PRISMA guidelines in March 2024. Manuscripts reporting patients with peritoneal carcinomatosis from gastric cancer treated with CRS + HIPEC were included. A meta-analysis was performed, comparing the survival results between the CRS + HIPEC and pSC groups, and the primary outcome was the comparison in terms of OS. We performed random-effects meta-analysis of odds ratios (ORs). We assessed heterogeneity using the Q2 statistic. Results: Out of the 24 papers included, 1369 patients underwent CRS + HIPEC, with a median OS range of 9.8–28.2 months; and 103 patients underwent pSC, with a median OS range of 4.9–8 months. CRS + HIPEC was associated with significantly increased survival compared to palliative systemic chemotherapy (−1.8954 (95% CI: −2.5761 to −1.2146; p < 0.001). Conclusions: CRS + HIPEC could provide survival advantages in gastric cancer peritoneal metastasis compared to pSC. [ABSTRACT FROM AUTHOR]
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- 2024
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3. A novel HIPEC technique using hybrid CO2 recirculation system: intra-abdominal diffusion test in a porcine model
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Cianci, Stefano, Vizzielli, Giuseppe, Fagotti, Anna, Pacelli, Fabio, Di Giorgio, Andrea, Tropea, Alessandro, Biondi, Antonio, and Scambia, Giovanni
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- 2018
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4. Diagnostic and Therapeutic Algorithm for Appendiceal Tumors and Pseudomyxoma Peritonei: A Consensus of the Peritoneal Malignancies Oncoteam of the Italian Society of Surgical Oncology (SICO).
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Vaira, Marco, Robella, Manuela, Guaglio, Marcello, Berchialla, Paola, Sommariva, Antonio, Valle, Mario, Pasqual, Enrico Maria, Roviello, Franco, Framarini, Massimo, Fiorentini, Giammaria, Sammartino, Paolo, Ilari Civit, Alba, Di Giorgio, Andrea, Ansaloni, Luca, and Deraco, Marcello
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TUMOR classification ,CONSENSUS (Social sciences) ,PREOPERATIVE care ,ADJUVANT chemotherapy ,THERMOTHERAPY ,PERITONEUM tumors ,MEDICAL referrals ,RESEARCH funding ,ONCOLOGIC surgery ,CYTOREDUCTIVE surgery ,PATIENT safety - Abstract
Simple Summary: Pseudomyxoma peritonei (PMP) is an uncommon pathology, and its rarity causes a lack of scientific evidence, precluding the design of a prospective trial. A diagnostic and therapeutic algorithm (DTA) is necessary in order to standardize disease treatment while balancing optimal patient management and the correct use of resources. The Consensus of the Italian Society of Surgical Oncology (SICO) Oncoteam aims at defining a diagnostic and therapeutic pathway for PMP and appendiceal primary tumors applicable in Italian healthcare. Aim: Pseudomyxoma peritonei (PMP) is an uncommon pathology, and its rarity causes a lack of scientific evidence, precluding the design of a prospective trial. A diagnostic and therapeutic algorithm (DTA) is necessary in order to standardize the disease treatment while balancing optimal patient management and the correct use of resources. The Consensus of the Italian Society of Surgical Oncology (SICO) Oncoteam aims at defining a diagnostic and therapeutic pathway for PMP and appendiceal primary tumors applicable in Italian healthcare. Method: The consensus panel included 10 delegated representatives of oncological referral centers for Peritoneal Surface Malignancies (PSM) affiliated to the SICO PSM Oncoteam. A list of statements regarding the DTA of patients with PMP was prepared according to recommendations based on the review of the literature and expert opinion. Results: A consensus was obtained on 33 of the 34 statements linked to the DTA; two flowcharts regarding the management of primary appendiceal cancer and peritoneal disease were approved. Conclusion: Currently, consensus has been reached on pathological classification, preoperative evaluation, cytoreductive surgery technical detail, and systemic treatment; some controversies still exist regarding the exclusion criteria for HIPEC treatment. A shared Italian model of DTA is an essential tool to ensure the appropriateness and equity of treatment for these patients. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Enhanced Recovery after Surgery (ERAS) Program for Patients with Peritoneal Surface Malignancies Undergoing Cytoreductive Surgery with or without HIPEC: A Systematic Review and a Meta-Analysis.
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Robella, Manuela, Tonello, Marco, Berchialla, Paola, Sciannameo, Veronica, Ilari Civit, Alba Maria, Sommariva, Antonio, Sassaroli, Cinzia, Di Giorgio, Andrea, Gelmini, Roberta, Ghirardi, Valentina, Roviello, Franco, Carboni, Fabio, Lippolis, Piero Vincenzo, Kusamura, Shigeki, and Vaira, Marco
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ADJUVANT chemotherapy ,LENGTH of stay in hospitals ,ONLINE information services ,MEDICAL databases ,THERMOTHERAPY ,META-analysis ,MEDICAL information storage & retrieval systems ,PERITONEAL cancer ,SYSTEMATIC reviews ,SURGICAL complications ,PATIENT readmissions ,DISEASES ,REOPERATION ,ENHANCED recovery after surgery protocol ,CYTOREDUCTIVE surgery ,MEDLINE ,LONGITUDINAL method - Abstract
Simple Summary: Cytoreductive surgery and Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) represent a promising treatment strategy for the management of selected cases of peritoneal cancer, but it's still burdened by significant morbidity and prolonged hospital stay. Herein, the review of the impact of ERAS program on length of stay, postoperative complications and readmission rate in patients undergoing cytoreductive surgery with or without HIPEC for peritoneal surface malignancies. Enhanced recovery after surgery (ERAS) program refers to a multimodal intervention to reduce the length of stay and postoperative complications; it has been effective in different kinds of major surgery including colorectal, gynaecologic and gastric cancer surgery. Its impact in terms of safety and efficacy in the treatment of peritoneal surface malignancies is still unclear. A systematic review and a meta-analysis were conducted to evaluate the effect of ERAS after cytoreductive surgery with or without HIPEC for peritoneal metastases. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane Database were searched from January 2010 and December 2021. Single and double-cohort studies about ERAS application in the treatment of peritoneal cancer were considered. Outcomes included the postoperative length of stay (LOS), postoperative morbidity and mortality rates and the early readmission rate. Twenty-four studies involving 5131 patients were considered, 7 about ERAS in cytoreductive surgery (CRS) + HIPEC and 17 about cytoreductive alone; the case histories of two Italian referral centers in the management of peritoneal cancer were included. ERAS adoption reduced the LOS (−3.17, 95% CrI −4.68 to −1.69 in CRS + HIPEC and −1.65, 95% CrI −2.32 to –1.06 in CRS alone in the meta-analysis including 6 and 17 studies respectively. Non negligible lower postoperative morbidity was also in the meta-analysis including the case histories of two Italian referral centers. Implementation of an ERAS protocol may reduce LOS, postoperative complications after CRS with or without HIPEC compared to conventional recovery. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Laparoscopic Cytoreduction Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Peritoneal Surface Malignancies (PSM): Italian PSM Oncoteam Evidence and Literature Review.
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Sommariva, Antonio, Valle, Mario, Gelmini, Roberta, Tonello, Marco, Carboni, Fabio, De Manzoni, Giovanni, Sorrentino, Lorena, Pasqual, Enrico Maria, Bacchetti, Stefano, Sassaroli, Cinzia, Di Giorgio, Andrea, Framarini, Massimo, Marrelli, Daniele, Casella, Francesco, and Federici, Orietta
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ADJUVANT chemotherapy ,ONLINE information services ,THERMOTHERAPY ,MEDICAL information storage & retrieval systems ,SYSTEMATIC reviews ,PATIENT selection ,LAPAROSCOPIC surgery ,METASTASIS ,SURGICAL complications ,PERITONEUM tumors ,TREATMENT effectiveness ,SURVIVAL rate ,DESCRIPTIVE statistics ,REOPERATION ,CYTOREDUCTIVE surgery ,MEDLINE ,ELECTRONIC health records - Abstract
Simple Summary: Mini-invasive surgery represents an interesting yet challenging technical evolution for treating peritoneal metastases. This retrospective study aims to present the experience of the Italian Peritoneal Surface Malignancies Oncoteam with laparoscopic cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), including a detailed description of the technique and a systematic review of the literature. The study shows the feasibility and safety of laparoscopic CRS-HIPEC and its association with favorable outcomes in properly selected patients. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained increasing acceptance in clinical practice. Performing CRS and HIPEC laparoscopically represents a challenging and intriguing technical evolution. However, the experiences are limited, and the evidence is low. This retrospective analysis was performed on patients treated with laparoscopic CRS-HIPEC within the Italian Peritoneal Surface Malignancies Oncoteam. Clinical, perioperative, and follow-up data were extracted and collected on prospectively maintained databases. We added a systematic review according to the PRISMA method for English-language articles through April 2022 using the keywords laparoscopic, hyperthermic, HIPEC, and chemotherapy. From 2016 to 2022, fourteen patients were treated with Lap-CRS-HIPEC with curative intent within the Italian centers. No conversion to open was observed. The median duration of surgery was 487.5 min. The median Peritoneal Cancer Index (PCI) was 3, and complete cytoreduction was achieved in all patients. Two patients (14.3%) had major postoperative complications, one requiring reintervention. After a median follow-up of 16.9 months, eleven patients were alive without disease (78.6%), two patients developed recurrence (14.3%), and one patient died for unrelated causes (7.1%). The literature review confirmed these results. In conclusion, current evidence shows that Lap-CRS-HIPEC is feasible, safe, and associated with a favorable outcome in selected patients. An accurate patient selection will continue to be paramount in choosing this treatment. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Complications and Mortality Rate of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: Italian Peritoneal Surface Malignancies Oncoteam Results Analysis.
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Carboni, Fabio, Valle, Mario, Vaira, Marco, Sammartino, Paolo, Federici, Orietta, Robella, Manuela, Deraco, Marcello, Framarini, Massimo, Macrì, Antonio, Sassaroli, Cinzia, Lippolis, Piero Vincenzo, Di Giorgio, Andrea, Biacchi, Daniele, Martin-Roman, Lorena, Sperduti, Isabella, and Baratti, Dario
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SURGICAL complication risk factors ,ADJUVANT chemotherapy ,THERMOTHERAPY ,OVARIAN tumors ,PERITONEAL cancer ,MULTIPLE regression analysis ,AGE distribution ,RETROSPECTIVE studies ,ACQUISITION of data ,SURGERY ,PATIENTS ,RISK assessment ,CANCER patients ,COLORECTAL cancer ,MEDICAL records ,REOPERATION ,DESCRIPTIVE statistics ,CYTOREDUCTIVE surgery ,BODY mass index ,PROPORTIONAL hazards models - Abstract
Simple Summary: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has been introduced in order to improve outcomes for selected patients with peritoneal surface malignancies. Although survival benefits have been widely reported in the literature, this treatment is still not accepted worldwide because of the potential high incidence of postoperative complications. The aim of this study was to record the morbidity and mortality rates and to evaluate the associated risk factors. In our experience, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy appeared as a safe and feasible procedure with good postoperative outcomes if performed in specialized centers. Further improvement of results could be achieved with better selection of patients. Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy may significantly improve survival for selected patients with peritoneal surface malignancies, but it has always been criticized due to the high incidence of postoperative morbidity and mortality. Methods: Data were collected from nine Italian centers with peritoneal surface malignancies expertise within a collaborative group of the Italian Society of Surgical Oncology. Complications and mortality rates were recorded, and multivariate Cox analysis was used to identify risk factors. Results: The study included 2576 patients. The procedure was mostly performed for ovarian (27.4%) and colon cancer (22.4%). The median peritoneal cancer index was 13. Overall postoperative morbidity and mortality rates were 34% and 1.6%. A total of 232 (9%) patients required surgical reoperation. Multivariate regression logistic analysis identified the type of perfusion (p ≤ 0.0001), body mass index (p ≤ 0.0001), number of resections (p ≤ 0.0001) and colorectal resections (p ≤ 0.0001) as the strongest predictors of complications, whereas the number of resections (p ≤ 0.0001) and age (p = 0.01) were the strongest predictors of mortality. Conclusions: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is a valuable option of treatment for selected patients with peritoneal carcinomatosis providing low postoperative morbidity and mortality rates, if performed in high-volume specialized centers. [ABSTRACT FROM AUTHOR]
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- 2022
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8. The prognostic value of skeletal muscle index on clinical and survival outcomes after cytoreduction and HIPEC for peritoneal metastases from colorectal cancer: A systematic review and meta-analysis.
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Di Giorgio, Andrea, Rotolo, Stefano, Cintoni, Marco, Rinninella, Emanuele, Pulcini, Gabriele, Schena, Carlo Alberto, Ferracci, Federica, Grassi, Futura, Raoul, Pauline, Moroni, Rossana, Pacelli, Fabio, Gasbarrini, Antonio, and Mele, Maria Cristina
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PERITONEAL cancer ,HYPERTHERMIC intraperitoneal chemotherapy ,PROGNOSIS ,SURVIVAL rate ,SKELETAL muscle ,COLORECTAL cancer ,TREATMENT effectiveness - Abstract
Cytoreductive surgery (CRS) and hypertermic intraperitoneal chemotherapy (HIPEC) represent the most effective strategy to manage peritoneal metastases (PM). This systematic review and meta-analysis aimed to assess the impact of body composition on clinical outcomes in patients with PM. A systematic literature search was performed using Medline, Web of Science and EMBASE databases from inception to the 20
st August 2020. Data were independently extracted by 3 authors. Newcastle-Ottawa Scale was used to assess quality and risk of bias of studies. Pooled analyses were performed using Mantel-Haenszel method to estimate overall effect size with mean differences or odd ratios (ORs) and 95% confidence interval (CI). The primary outcome was postoperative complication (POC) rate, while secondary outcomes were severe POC and postoperative mortality. A total of 4 studies were included in the systematic review and meta-analysis, including 582 patients. A significant association between low skeletal muscle mass and POC was found (OR 1.45, 95% CI 1.04 to 2.03; p = 0.03), while no differences were found in terms operative time, estimated blood loss, length of hospital stay, and postoperative mortality (p > 0.05). Low skeletal muscle mass at diagnosis is a valid prognostic factor for POC development in colorectal and PM patients undergoing CRS. Prospective and larger studies are needed to better investigate the role of CT scan derived body composition and to understand how to implement this tool in clinical practice. [ABSTRACT FROM AUTHOR]- Published
- 2022
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9. Cytoreductive surgery and mitomycin C hyperthermic intraperitoneal chemotherapy with CO2 recirculation (HIPEC-CO2) for colorectal cancer peritoneal metastases: analysis of short-term outcomes.
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Rotolo, Stefano, Di Giorgio, Andrea, Santullo, Francesco, Attalla El Halabieh, Miriam, Lodoli, Claudio, Abatini, Carlo, and Pacelli, Fabio
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Peritoneal dissemination from colorectal cancer (CRC) has long been associated with unfavorable prognosis. However, in the last decades, the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was able to obtain up to 30% 5-year survival rate in selected centers. Despite the wide diffusion of CRS and HIPEC, until now, there are no clear recommendations on the drug of choice for HIPEC nor its technique, and safety and efficacy data of HIPEC regimens and techniques are lacking. We performed a retrospective analysis of a prospectively maintained database of 26 CRS and mitomycin C HIPEC with CO
2 recirculation (HIPEC-CO2 ) for CRC peritoneal metastasis (PM) performed at our center. The main endpoints were morbidity, mortality, the temperature of perfusate during HIPEC and metabolic changes throughout the procedure. Morbidity was assessed by analysis of postoperative adverse events according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.0). Continuous variables of Arterial Blood Gas (ABG) analysis at three time-points were compared by the Student t test. There were no postoperative deaths. The overall grade 3–4 CTCAE complications rate at 30 days was 38.4%, with ten severe adverse events occurring to six (23.0%) patients. The temperature within HIPEC perfusion maintained between 41 and 42 °C in all cases and we experienced no HIPEC-related intraoperative complications. We observed a significant difference between all baseline and pre-HIPEC ABG parameters evaluated but no statistically significant differences between pre- and post-HIPEC ABG outcomes. This study shows that mitomycin C HIPEC-CO2 is feasible and has a safety profile comparable to that of other HIPEC techniques reported in the literature. Further research is needed to validate prospectively the safety and efficacy of this technique. [ABSTRACT FROM AUTHOR]- Published
- 2021
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10. Diagnostic and therapeutic algorithm for colorectal peritoneal metastases. A consensus of the peritoneal surface malignancies onco-team of the Italian society of surgical oncology.
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Sommariva, Antonio, Ansaloni, Luca, Baiocchi, Gian Luca, Cascinu, Stefano, Cirocchi, Roberto, Coccolini, Federico, Deraco, Marcello, Fiorentini, Gianmaria, Gelmini, Roberta, Di Giorgio, Andrea, Lippolis, Piero Vincenzo, Pasqual, Enrico Maria, Sassaroli, Cinzia, Macrì, Antonio, Sammartino, Paolo, Scaringi, Stefano, Valle, Mario, and Vaira, Marco
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ONCOLOGIC surgery ,METASTASIS ,ALGORITHMS ,COLON cancer ,MEDICAL personnel ,CYTOREDUCTIVE surgery - Abstract
the surgical workup for colorectal cancer peritoneal metastases (CRCPM) is complex and should be managed in specialized centers. Diagnostic and therapeutic algorithms (DTA) have been proposed to balance optimal patients management and correct use of resources. Aim of this study was to establish a consensus on DTA for CRCPM patients in Italy. a panel of 18 delegated members of centers afferent to Peritoneal Surface Malignancies Onco-team of the Italian Society of Surgical Oncology was established. A list of statements regarding the DTA of patients with CRCPM was prepared according to different activities and decision-making nodes with a defined entry and exit point. Consensus was obtained through RAND UCLA methodology. two different DTA were defined and approved according to the modality of presentation of CRCPM (synchronous and metachronous). A consensus was also obtained on 17 of the 19 statements related to DTA. a shared model of DTA is now available for healthcare providers to monitor appropriateness in diagnosis and treatment of patients with isolated peritoneal metastases from CRC. [ABSTRACT FROM AUTHOR]
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- 2021
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11. A novel HIPEC technique using hybrid CO2 recirculation system: intra-abdominal diffusion test in a porcine model.
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Cianci, Stefano, Vizzielli, Giuseppe, Fagotti, Anna, Pacelli, Fabio, Di Giorgio, Andrea, Tropea, Alessandro, Biondi, Antonio, and Scambia, Giovanni
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The role of loco-regional treatment of peritoneal carcinomatosis using intraperitoneal chemotherapy is still investigated. Actually, new technologies are suitable for these procedures, especially a new hybrid system using CO
2 called Peritoneal Recirculation System (PRS-1.0 Combat). A HIPEC procedure in a porcine model using the PRS system was conducted. The objective of experimentation was to assess the distribution of liquid inside the abdomen, by using methylene blue instead of chemotherapy. Moreover, we positioned six different thermal probes in different abdominal regions inside the abdomen to measure the temperature during procedure. During the procedure, all thermal probes recorded an average temperature of 41.5°. At the end of infusion, the abdomen was emptied and then opened; the tracer distribution was recorded. No technical problems were recorded during the procedure. Good distribution of tracer was recorded. More studies are needed to investigate better this new technology. [ABSTRACT FROM AUTHOR]- Published
- 2018
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