Pseudomyxoma Peritonei Surgery and Treatment
PMP Cancer Treatment Surgery
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Suggestions for Selecting a Surgeon
Questions to Ask Before Scheduling Surgery
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Questions to Ask Your Surgeon for PMP Cancer Surgery
by Pal Patient, Gabriella
The PMP Pals’ Network suggests that patients prepare a personal list of questions prior to meeting with a surgeon for a pre op evaluation.
Here are a few questions for your consideration. Refer to the PMP Pals’ Handbooks, Preparing for a Consultation with a Specialist and Preparing for Surgery for detailed lists of questions to ask your physician.
Treatment
Is my diagnosis aggressive? Does it require treatment?
What are my treatment options for my particular diagnosis?
If you were me, which option would you choose and why?
What is my prognosis with the treatment you recommend?
What is my prognosis without treatment?
What does “watch and wait” mean?
Surgery
Will any organs be removed?
If so, what, if any, are the ramifications of losing those organs?
Will I have an ostomy? If so, which type? Ileostomy? Colostomy? Urostomy?
If I have an ostomy, can it be “reversed?” If so, when?
Will I have the HIPEC treatment? Is HIPEC optional?
How will my pain be controlled after surgery?
What, if any, are the risks/complications from this surgery? From HIPEC?
Will the HIPEC treatment and your fees as my attending surgeon covered by my insurance?
Post Op (After Surgery)
Will my family caregiver be able to visit me in the ICU?
How often will you visit me during my hospitalization?
Who will oversee my post op recuperation? You (my attending surgeon) or the Fellows or Residents?
How long will I be hospitalized?
When will I be able to return to work?
When will I be able to return to work?
Surgeon’s Experience
How many patients with my diagnosis do you treat each year?
How many surgeries have you performed on patients with conditions like mine?
How often do you treat patients with the HIPEC procedure?
How experienced is your surgical team and post op nursing staff in treating patients with my condition?
Refer to the PMP Pals’ Handbooks, Preparing for a Consultation with a Specialist and Preparing for Surgery for detailed lists of questions to ask your physician.
Articles posted in PMP Pals and on www.pmppals.org are written from the perspectives of patients and their families and are not intended to substitute for licensed, professional legal or medical advice. Each patient is unique and should seek specific counsel from their own licensed healthcare professional. Copyright © 2012 by the PMP Pals’ Network. All rights reserved.
The PMP Pals’ Network suggests that patients prepare a personal list of questions prior to meeting with a surgeon for a pre op evaluation.
Here are a few questions for your consideration. Refer to the PMP Pals’ Handbooks, Preparing for a Consultation with a Specialist and Preparing for Surgery for detailed lists of questions to ask your physician.
Treatment
Is my diagnosis aggressive? Does it require treatment?
What are my treatment options for my particular diagnosis?
If you were me, which option would you choose and why?
What is my prognosis with the treatment you recommend?
What is my prognosis without treatment?
What does “watch and wait” mean?
Surgery
Will any organs be removed?
If so, what, if any, are the ramifications of losing those organs?
Will I have an ostomy? If so, which type? Ileostomy? Colostomy? Urostomy?
If I have an ostomy, can it be “reversed?” If so, when?
Will I have the HIPEC treatment? Is HIPEC optional?
How will my pain be controlled after surgery?
What, if any, are the risks/complications from this surgery? From HIPEC?
Will the HIPEC treatment and your fees as my attending surgeon covered by my insurance?
Post Op (After Surgery)
Will my family caregiver be able to visit me in the ICU?
How often will you visit me during my hospitalization?
Who will oversee my post op recuperation? You (my attending surgeon) or the Fellows or Residents?
How long will I be hospitalized?
When will I be able to return to work?
When will I be able to return to work?
Surgeon’s Experience
How many patients with my diagnosis do you treat each year?
How many surgeries have you performed on patients with conditions like mine?
How often do you treat patients with the HIPEC procedure?
How experienced is your surgical team and post op nursing staff in treating patients with my condition?
Refer to the PMP Pals’ Handbooks, Preparing for a Consultation with a Specialist and Preparing for Surgery for detailed lists of questions to ask your physician.
Articles posted in PMP Pals and on www.pmppals.org are written from the perspectives of patients and their families and are not intended to substitute for licensed, professional legal or medical advice. Each patient is unique and should seek specific counsel from their own licensed healthcare professional. Copyright © 2012 by the PMP Pals’ Network. All rights reserved.
How to Select a PMP Surgeon, Part III
How to Select a Surgeon, Part III: Meet the “Charge Nurse”
by Pal Patient, Gabriella
While most patients take the time to interview their surgeon prior to scheduling CRS and HIPEC, few take the time to tour the floor of the hospital where recuperation will take place following surgery.
Typically, Pals spend 24 to 48 hours in ICU, immediately following surgery, before being released to the surgery recovery floor for the duration of their hospitalized recuperation.
The “charge nurse” is responsible for supervising the floor/unit where you will recuperate. S/he assigns nurses to specific patients, and monitors the unit to be staffed adequately to meet the needs of the patients. Charge nurses may also provide direct patient care when needed and may serve as liaisons between patients and the nursing staff. Charge nurses may be rotated throughout the week, therefore, the charge nurse may change from day to day. In some hospitals, charge nurses maintain that position for longer periods of time.
On the day you interview your surgeon, request to meet with the “charge nurse” of the floor where you will recuperate. Ask the charge nurse to give you a tour of the ward. You and your family caregiver will want to see an example of the room where you will recuperate, as well as any amenities the floor or hospital may have to offer, e.g. a lounge for patients and caregivers, cafeteria, access to Wi-Fi, etc.
Prior to meeting with the charge nurse, prepare your list of questions for him/her, just as you prepare your questions for the surgeon. Among the questions to consider asking are the following:
What is the "nurse to patient" ratio on this floor? (How many patients are assigned to each nurse?)
Will the majority of your hands on nursing care be provided by RNs, LVNs, or licensed aides?
How many HIPEC patients are cared for on this floor each week? (How experienced is the nursing staff in taking care of HIPEC patients?)
These are just a few of the important questions patients must consider when selecting a surgeon/specialist. It's important to pay attention to these details regarding the hospital itself because after you are released from the ICU, you will spend the remainder of your hospitalized recuperation on the floor (unit or ward) supervised by the charge nurse.
As a proactive cancer patient and consumer, interview all potential healthcare providers whenever possible. Your health and your future are deserving of your time and attention to investigating your healthcare treatment plan thoroughly, prior to scheduling your surgery.
These are just a few of the important considerations that one must examine prior to selecting a surgeon/specialist. A more detailed and comprehensive list of questions is included in the PMP Pals’ Network Handbook: Preparing for Surgery. This handbook is provided to all new members of the PMP Pals’ Network.
Articles posted in PMP Pals and on www.pmppals.org are written from the perspectives of patients and their families and are not intended to substitute for licensed, professional legal or medical advice. Each patient is unique and should seek specific counsel from their own licensed healthcare professional. Copyright © 2012 by the PMP Pals’ Network. All rights reserved.
Frequently Asked Questions About Pseudomyxoma Peritonei Surgery
Why Doesn't My Surgeon Specialist Visit Me Daily?
by Pal Patient, Gabriella
Most PMP Pal members choose to schedule their surgeries at university hospitals. The majority of our surgeon specialists are professors; the young physicians who do visit you daily (more commonly twice a day) are their students, who carefully report on your daily condition, under the supervision of your surgeon specialist.
Due to the detailed nature of our surgeries, it is not uncommon for our operations to last eight to fourteen hours, sometimes even longer. The time surgeons spend in the operating room does not include prep time to evaluate and plan the treatment of your individual case; this requires additional time.
The long hours in the operating room, combined with hours devoted to consulting with newly diagnosed patients in the clinic, time devoted to research studies, time scheduled for coordination and preparation of symposiums and conferences, etc, leaves little time for daily bedside visits with patients in the hospital. Therefore, frequent monitoring of the patient’s recuperation, as conducted by the nursing staff and physicians in residence/training, provides the surgeon specialist with the opportunity to supervise your recuperation without daily visits.
When your surgeon does visit you, don’t be surprised if s/he pops in very early in the morning (on the way to surgery) or very late at night (after surgery has been completed.)
Copyright © 2012 by PMP Pals’ Network. All rights reserved. Articles published by the PMP Pals’ Network and posted on www.pmppals.org are not intended as a substitute for professional medical or legal care. Individuals should seek the counsel of licensed healthcare professionals regarding their own specific needs. Visit us on the web at www.pmppals.org
Why Do Patients Have an NG Tube After Surgery?
What is the NG Tube?
Kerry from the USA asks the PMP Pals’ Network:
“I am scheduled for CRS and HIPEC. My surgeon says I will wake up from surgery with an NG tube. What can I expect to experience with the NG tube?”
PMP Pals responds:
“The Nasogastric tube, or “NG tube” is plastic tubing inserted through the nose, down the throat and into the stomach. In the case of CRS and HIPEC patients, it is inserted while the patient is “asleep” under anesthesia.
In the case of CRS and HIPEC patients the NG tube is used for aspiration to suck out the patient’s stomach contents, including secretions and swallowed air from the stomach. The NG tube is attached to a drainage bag or bottle alongside the patient’s bed, for the collection of drainage contents. When used for aspiration the patient is not allowed to eat or drink anything by mouth, including popsicles, broth or gelatin. In order to prevent vomiting, it’s important for the patient to refrain from eating or drinking anything while the NG tube is in place.
For CRS and HIPEC patients, the NG tube is typically left in place for several days to a few weeks, depending on how much time is need for peristalsis to resume. The nose and throat may become irritated the longer the NG tube has been left in place. For this reason, and due to oral dryness, some patients prefer to limit speaking at length (limit the length of their conversations.)
To combat oral dryness, refer to our article “Dental Care for Cancer Patients” offering solutions to combatting the oral discomfort that may accompany use of the NG tube. Although the patient is neither eating nor drinking while the NG tube is inserted, it’s very important to maintain dental hygiene during this period in order to prevent future dental decay.
During the time the NG tube is in place, the patient’s abdomen will be checked several times a day for signs (sounds) of peristalsis. Peristalsis typically slows or ceases during the initial days following CRS and HIPEC, especially when narcotics are being administered for pain relief.
When signs (sounds) of peristalsis return, the NG tube is typically removed within a day or so. As tempting it may be for the patient to remove the NG tube prematurely, a conservative approach to removing the NG tube is suggested, as should the NG tube need to be reinserted, it will most likely be done so without the use of general anesthesia. Most patients prefer to avoid re insertion, if at all possible.
After the NG tube has been removed, clear fluids are gradually introduced to the patient’s diet. Once again, it is suggested that patient’s progress conservatively in re introducing clear, followed by soft, and eventually solid foods back into the diet, in order to avoid vomiting.
Each patient should consult with his/her personal surgeon for detailed information about the use of the NG tube for the patient’s specific case.”
Articles posted in PMP Pals and on www.pmppals.org are written from the perspectives of patients and their families and are not intended to substitute for licensed, professional legal or medical advice. Each patient is unique and should seek specific counsel from their own licensed healthcare professional. Copyright © 2012 by Gabriella Graham. All rights reserved.
How Long Does it Really Take to Recover from PMP Surgery?
PMP Pal Patient, Fred, Suggests a Frank Discussion About Post Op Recovery!
By “Pal” member, Fred, from the USA
“A frequent concern that arises among patients who are planning to, or have had CRS and HIPEC, is the length of time required to recover. A corollary to recovery time is what “recovery” actually means. Before addressing these issues, I should emphasize that each patient’s experience will differ depending on a host of factors (e.g., age, general health, extent of tumors, type of cancer, invasiveness of surgery, etc.). There is no simple rule of thumb to determine an expected recovery time.
What is recovery? How do patients and surgeons define “recovery?”
This question is one that never occurred to me in my initial discussions with my surgeon; as a result there was a misunderstanding. He did not mince words regarding the seriousness of my condition and the necessary surgery. However, he indicated that I should be back to “normal” in a few months. The problem was his idea of “normal” and mine were different. I viewed “normal” as my state of health prior to developing the disease. His notion was apparently being able to return to work and everyday activities free of the disease.
In brief, my post operation weight dropped from about 150 to 109 before recovering to 118, which is my new “normal” (permanent weight loss is a common result of the surgery) and the necessary removal of various organs and sections of organs has had a major impact on my digestive system, which in turn has affected my quality of life in certain ways. As I’ve often joked, I’ve developed a close personal relationship with my bathroom and have become much more aware of the locations of public facilities. Thus, in one sense I’ve never “recovered” from the surgery; I have not returned to my prior state of health.
However, I did return to work, returned to my nature photography, and took up competitive table tennis after a 30 year hiatus. I am physically able to do most things I did pre surgery, including working out at a fitness center several times a week, but am acutely aware of the limits due to the digestive issues.
Time frame for recovery
My particular surgery was about 10 hours. I spent almost a month in the hospital before being released, then another few days a week later due to dehydration.
At home, I began walking around the neighborhood gradually lengthening the time and distance as I felt stronger I was able to return to my desk job on a part time basis 3 months after surgery and on a full time basis a couple of months later.
I began doing my nature photography carrying very limited equipment about 4 months after surgery and a full backpack about a year after surgery.
Recovery, the “new normal”, and Senior Olympics!
I retired 14 months after the surgery and began playing table tennis at a local club soon after, winning two bronze medals and a silver medal in the local senior Olympics and a bronze medal for my talent level at the 2011 U.S. nationals this past December.
Looking back, I’d say full recovery for me, which I’d define as reaching my new “normal,” took about 9-12 months. As noted above, and as a former economist, I again emphasize that I represent just one data point. Recovery time will vary considerably across individuals.”
Articles posted in “PMP Pals” and on www.pmppals.org are written from the perspective of patients and their family caregivers and are not intended to substitute for licensed professional legal or medical care. Each patient is unique and should seek the counsel of a licensed professional for their own specific case. Copyright © 2012 by PMP Pals’ Network/All rights reserved. Visit us on the web at www.pmppals.org
Doctors and Nurses in Training for your Surgery
Gabriella answers questions from Pals!
Doctors and Nurses in Training
by Jim, Pal member, and Gabriella, Patient
Most Appendix Cancer/Pseudomyxoma Peritonei patients select to have their surgeries at teaching hospitals associated with universities. Unlike smaller community hospitals, patients at university teaching hospitals are often attended to by medical students, interns, residents, fellows, and nursing students who will take a special interest in your case and in your care. Throughout your hospitalization, your care will be supervised by your specialist surgeon (even if you don’t see him or her daily.) After surgery, the majority of our fellow PMP Pals do not see their surgeon specialist more than once or twice a week; nevertheless, your specialist will be monitoring your case closely.
The physicians and nurses in training may ask you many questions and may examine you thoroughly during your recuperation. This level of care is seen as an advantage to many patients who would otherwise not receive such close attention at a community hospital.
Keep in mind that Pseudomyxoma Peritonei is very rare and that any aspects of treatment that student physicians and nurses learn from talking with and treating you, will help their knowledge base to grow and thus will help our fellow patients in the future.
Copyright © 2012 by PMP Pals’ Network. All rights reserved.
Articles published by the PMP Pals’ Network and posted on www.pmppals.org are not intended as a substitute for professional medical or legal care. Individuals should seek the counsel of licensed healthcare professionals regarding their own specific needs. Visit us on the web at www.pmppals.org
by Jim, Pal member, and Gabriella, Patient
Most Appendix Cancer/Pseudomyxoma Peritonei patients select to have their surgeries at teaching hospitals associated with universities. Unlike smaller community hospitals, patients at university teaching hospitals are often attended to by medical students, interns, residents, fellows, and nursing students who will take a special interest in your case and in your care. Throughout your hospitalization, your care will be supervised by your specialist surgeon (even if you don’t see him or her daily.) After surgery, the majority of our fellow PMP Pals do not see their surgeon specialist more than once or twice a week; nevertheless, your specialist will be monitoring your case closely.
The physicians and nurses in training may ask you many questions and may examine you thoroughly during your recuperation. This level of care is seen as an advantage to many patients who would otherwise not receive such close attention at a community hospital.
Keep in mind that Pseudomyxoma Peritonei is very rare and that any aspects of treatment that student physicians and nurses learn from talking with and treating you, will help their knowledge base to grow and thus will help our fellow patients in the future.
Copyright © 2012 by PMP Pals’ Network. All rights reserved.
Articles published by the PMP Pals’ Network and posted on www.pmppals.org are not intended as a substitute for professional medical or legal care. Individuals should seek the counsel of licensed healthcare professionals regarding their own specific needs. Visit us on the web at www.pmppals.org
Tips for Returning to Work After Surgery
By PMP Pal member, Adele
Our Pal Patient, Elizabeth, has recuperated from CRS with HIPEC and is returning to her job soon.
Today she asked her fellow Pals for helpful suggestions for returning to the office
Pal Mentor, Adele, came forward to offer the following suggestions:
“Be realistic about what you can accomplish during the day.
Ask your supervisor for flexibility in your work schedule while you transition back into your working life.
Bring hand sanitizer and Lysol to work with you and use them.
Avoid anyone who has a cold or a cough!
Bring nutritious, high protein, small meals and snacks so that you can eat a little throughout the day.
For women, consider carrying a smaller, lighter handbag!
Dress comfortably. When selecting shoes, choose safety and comfort over style.
Be careful about lifting anything heavy.
Your surgeon will advise you of weight limitations. Ask for assistance in opening heavy doors
Be realistic about what you can accomplish during the day.
If you find yourself becoming tired over what were previously routine tasks, like walking from the parking lot or from one building to another, pace yourself, remember that your body is still healing, and allow yourself extra time for routine tasks, if needed.
Ask your supervisor for flexibility in your work schedule while you transition back into your working life.
Your colleagues and coworkers will be happy to see you back on the job and will likely want to assist you in any way they can…let them!”
Articles posted in PMP Pals and on www.pmppals.org are written from the perspective of patients and family caregivers and are not intended to substitute for licensed, professional legal or medical advice. Each patient’s case is unique; therefore consult with a licensed professional regarding your specific needs. Copyright © 2013 by PMP Pals’ Network. All rights reserved. Todos derechos reservados.
Visit us on the web at www.pmppals.org
We have HOPE for YOU!
Our Pal Patient, Elizabeth, has recuperated from CRS with HIPEC and is returning to her job soon.
Today she asked her fellow Pals for helpful suggestions for returning to the office
Pal Mentor, Adele, came forward to offer the following suggestions:
“Be realistic about what you can accomplish during the day.
Ask your supervisor for flexibility in your work schedule while you transition back into your working life.
Bring hand sanitizer and Lysol to work with you and use them.
Avoid anyone who has a cold or a cough!
Bring nutritious, high protein, small meals and snacks so that you can eat a little throughout the day.
For women, consider carrying a smaller, lighter handbag!
Dress comfortably. When selecting shoes, choose safety and comfort over style.
Be careful about lifting anything heavy.
Your surgeon will advise you of weight limitations. Ask for assistance in opening heavy doors
Be realistic about what you can accomplish during the day.
If you find yourself becoming tired over what were previously routine tasks, like walking from the parking lot or from one building to another, pace yourself, remember that your body is still healing, and allow yourself extra time for routine tasks, if needed.
Ask your supervisor for flexibility in your work schedule while you transition back into your working life.
Your colleagues and coworkers will be happy to see you back on the job and will likely want to assist you in any way they can…let them!”
Articles posted in PMP Pals and on www.pmppals.org are written from the perspective of patients and family caregivers and are not intended to substitute for licensed, professional legal or medical advice. Each patient’s case is unique; therefore consult with a licensed professional regarding your specific needs. Copyright © 2013 by PMP Pals’ Network. All rights reserved. Todos derechos reservados.
Visit us on the web at www.pmppals.org
We have HOPE for YOU!
Q & A for Pseudomyxoma Peritonei Surgery and Treatment
We're "veterans" of pseudomyxoma peritonei surgery and we'll support you!
How is PMP treated?
What are the treatment options for Pseudomyxoma Peritonei?
Is surgery required for Pseudomyxoma Peritonei treatment?
What treatment therapy is standard care for Pseudomyxoma Peritonei syndrome treatment?
What are CRS surgery and HIPEC therapy?
Are you or a loved one preparing for surgery for the treatment of Pseudomyxoma Peritonei syndrome?
The PMP Pals' Network provides a wide variety of services to assist you in preparing for, and recuperating from, surgery as quickly as possible!
Our Preparing for Surgery Handbook and Newsletters provide step by step instructions to assist you with preparing for and recuperating from treatment.
Our Pal Mentors will personally communicate with you via telephone, email, personal visits, SKYPE or web cam to help you, or your loved one prepare for surgery and/or HIPEC. We will share helpful resources and positive information to guide you through your recuperation!
We are here to assist you in returning to your full and active life, as soon as possible!
View photos and profiles of successful surgery survivors!
Pseudomyxoma Peritonei Surgery, HIPEC and Chemotherapy Overview
Citoredducion con HIPEC
Your surgical oncologist will explain and review all treatment options for Pseudomyxoma Peritonei. Your treatment plan will depend on your overall health, the type of tumor (pathology), the quantity (mass) size and location of the tumor, and whether the cancer has metastasized.
Treatment for the Pseudomyxoma Peritonei syndrome generally includes CRS or cytoreductive surgery with or without systemic chemotherapy and HIPEC.
The purpose of debulking surgery is to remove as much tumor as possible. Debulking surgery often includes the removal of the omentum and the right colon. Additionally, for women, debulking will likely include a hysterectomy, if this was not perfomed previously. Adhesions become more troublesome with any additional debulking surgeries.
Cytoreductive surgery is a detailed, lengthy procedure often requiring ten or more hours.
Tumors are removed and destroyed using a variety of surgical techniques including argon beam coagulator, electro-evaporation, laser, and ultrasonic dissection.
CRS (cytoreductive surgery) consists of the removal of as much mucin and visible tumor as possible, from the abdominal cavity. CRS surgery, refers to the removal of all visible tumors present throughout the peritoneal cavity. Cytoreductive Surgery includes thorough removal or destruction of all visible tumors throughout the surfaces of the peritoneum. Surgery may include the removal or resection of segments of small and large bowel, gall bladder, liver, omentum, ovaries, pancreas, spleen, stomach and uterus, and may require removing the lining of the peritoneum.
The aim of cytoreductive surgery is to eliminate all tumor and metastatic tissues from the abdominal cavity, in order to effectively deliver intra-peritoneal heated chemotherapy (HIPEC).
Cytoreductive Surgery or Cytoreduction (CRS) is performed under general anesthesia. CRS time averages eight to ten hours.
A longitudinal incision is made in the abdomen. The abdomen, pelvis and organs therein are carefully inspected, during which time all operable visible and palpable tumors and tumor deposits are removed. The peritoneum is stripped.
Following surgery patients are admitted to the intensive care unit (ICU) for 24 hours or longer, depending on the individual patient. Patients are then transferred to regular hospitalization for an average of two weeks. This time period will vary depending on the individual.
Join the PMP Pals' Network and ask a Pal Mentor to assist you in preparing for surgery!
Hemicolectomy is a surgical procedure involving the removal of a portion of the colon next to the appendix. This procedure may also include the removal of nearby blood vessels and lymph nodes at the same time.
Peritonectomy refers to stripping the parietal peritoneum and resecting structures at the sites that contain adenomucinosis. A combination of surgical techniques are utilized including organ resection, when necessary and tumor destruction via electro-evaporation and argon beam coagulation.
CRS surgery for Appendix Cancer and Pseudomyxoma Peritonei may include the following:
Removal of the omentum, spleen and gall bladder,
Right hemicolectomy, colectomy, removal of the rectum and sigmoid,
Stripping tumor from the surface of the liver,
Resection of the pancreas,
Gastrectomy (partial or total removal of the stomach)
Stripping the peritoneum from left and right hemidiaphragm;
Pelvic peritonectomy,
Ileostomy,colostomy or urostomy
HIPEC may be included at the conclusion of the cytoreductive surgery for the treatment of pseudomyxoma peritonei and appendix cancer if substantial tumor debulking is accomplished through CRS. HIPEC may be administered when complete removal of visible tumor (or debulking) is achieved through cytoreductive surgery; it involves perfusion of the peritoneal cavity with chemotherapy heated to approximately 40 degrees Celsius.
HIPEC is administered with the infusion of heated chemotherapy during the last 90 minutes of the CRS procedure. Through HIPEC the surgeon(s) intend to destroy any residual tumor cells that may not have been surgically removed during the actual CRS surgery process.
Although this procedure may initially sound drastic to the newly diagnosed patient, rarely is resection and/or removal of all of these organs is required.
Each patient's case is unique and most patients live productive and healthy lives following surgery!
Learn about HIPEC
Q&A: How are patients selected for surgery?
This question is frequently asked by newly diagnosed patients and “veteran” patients experiencing a “recurrence of disease.”
Why are some patients accepted for CRS or CRS/HIPEC while others are not?
Is there any truth to the rumors that surgeons “cherry pick” their patients?
Why isn’t every patient a candidate for surgery?
Surgeons refer to the process of evaluating a surgical candidate as “patient selection.”
Many factors are taken into consideration for patient selection.
The success of CRS and HIPEC may be dependent on the:
patient’s overall general health,
complete removal of all tumor tissue,
location of tumor site(s) and
type of tumor (histology and differentiation.)
The following is a very general explanation of how patients are selected as surgical candidates:
1. Preliminary disease criteria
Patients with metastasis to the peritoneum, aka Peritoneal Carcinomatosis.
Patients with disease contained within the abdomen (without metastasis outside the abdomen)
2. Preliminary general health criteria for patient selection
Good overall heath lacking any major co-morbid conditions*.
Age (some surgeons limit the ages of patients they will accept into surgery)
Mental health (coherence, ability to understand instructions, evidence of chemical dependencies, etc.)
Ability to pay for surgery (adequate health insurance coverage or ability to pay out-of-pocket for medical care)
3. Preliminary review of patient medical history
Medical history including surgical history, if applicable, co-morbid conditions* (ie diabetes, lung or heart disease) current medications (prescribed and OTC) allergies and family history
History of present illness including summary of symptoms
Operative reports of previous surgeries
Pathology reports
Record of previous chemotherapy and radiotherapy treatments, if applicable, including dates and protocols
4. Extent of disease
Evaluation of CT scans to determine PCI (Peritoneal Cancer Index.)
The PCI helps the surgeon to determine the extent, volume and locations of the disease.
Evaluation of tumor block samples from original surgery(ies) if applicable.
Laparoscopy optional
Biopsy optional
Evaluation of tumor markers and associated lab tests
Physical examination of the patient
Learn how to prepare for surgery
Order the PMP Pals' Network Handbook: Preparing for Surgery.*
Slideshow "Getting Ready for Surgery" provides generic surgery information
Presented by WB MD, August 2010
Ostomies
Request a Pal Mentor to help you prepare for and recuperate from surgery!
Our Pal Mentors are "veterans" of surgery with Drs. Ahrendt, Bartlett, Esquivel, Goodman, Holtzman,Levine, Loggie, Lowy, Mansfield, Moran, Morris, Pingpank, Temple, Sardi, Shen, Stewart, Sugarbaker, Selby and Zeh!
Learn more about systemic Chemotherapy
CRS (Cytoreductive Surgery) in conjunction with HIPEC: Articles and Abstracts
This week's featured articles:
Upfront Compared to Delayed Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei Is Associated With Considerably Lower Perioperative Morbidity and Recurrence Rate.Chua TC, Liauw W, Zhao J, Morris DL.
*UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, Australia. †Department of Medical Oncology, Cancer Care Centre, St George Hospital, Kogarah, Sydney, Australia.
Abstract
BACKGROUND: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) is a recognized management strategy for pseudomyxoma peritonei. We seek to evaluate the outcomes of patients treated upfront with CRS PIC compared to patients undergoing delayed CRS PIC as salvage or treatment for recurrences after initial debulking surgery.
METHODS: Retrospective analysis of patients with low-grade pseudomyxoma peritonei treated within our institution were stratified according to upfront versus delayed CRS PIC after intial debulking surgery. Survival was analyzed using the Kaplan-Meier method and compared using the log-rank test.
RESULTS: Of 83 patients treated, 35 patients (42%) underwent upfront and 48 patients (58%) underwent delayed CRS PIC. The peritoneal cancer index (P = 0.048), amount of blood transfusion intraoperatively (P = 0.003) and duration of operation (P = 0.007) was lesser in the upfront compared to delayed group. Upfront treatment confers 5-year recurrence-free survival benefit (77% vs 37%; P = 0.011) and 10-year overall survival benefit (67% vs 35%; P = 0.054) over delayed treatment.
CONCLUSION: Upfront CRS PIC seems to confer beneficial perioperative outcomes and lower recurrence rates over delayed CRS PIC. Early referral to centralized treatment centers would seem to be a reasonable strategy to improve outcomes.
Source: Annals of Surgical Oncology, Jan 13, 2011
Laparoscopic Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Limited Peritoneal Surface Malignancies: Feasibility, Morbidity and Outcome in an Early Experience.
Laparoscopic CRS and HIPEC in Patients with Limited PSMs
Source: Esquivel J, Averbach A, Chua TC St. Agnes Hospital, Baltimore, Maryland.
Ann Surg. 2011 Jan 6. [Epub ahead of print]
Abstract
INTRODUCTION: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are being widely used in the treatment of patients with peritoneal surface malignancies. The open procedure has been associated with high grade III and IV morbidity and prolonged hospitalization.
METHODS: Patients with peritoneal surface malignancies and no gross evidence of carcinomatosis on the computed tomographic scan were enrolled to undergo laparoscopic CRS and HIPEC. We aimed to assess the feasibility, safety, and outcome of this procedure. Postoperative complications were reported according to the National Cancer Institute Common Toxicity Criteria.
RESULTS: From October 2008 to January 2010, 14 patients were enrolled into the protocol. Amongst these 14 patients, one patient was found with extensive carcinomatosis at the time of laparoscopy and had no surgical procedure. Thirteen patients had a complete cytoreduction and HIPEC, 10 (77%) laparoscopically and 3 (23%) were converted to an open procedure. There was one grade 3 morbidity (10%) and one patient (10%) in the laparoscopy group experienced a grade 4 complication, needing a reoperation for an internal hernia. Mean length of hospital stay was 6 days for those completed laparoscopically, 8 days for those converted to an open procedure and 8 days for a matched cohort of patients with an upfront open procedure.
CONCLUSIONS: This initial investigative stage demonstrates the feasibility and safety of cytoreductive surgery and HIPEC via the laparoscopic route in selected patients with low-tumor volume and no small bowel involvement mainly from appendiceal malignancies. Longer follow-up and additional studies are required to evaluate its long-term efficacy.
PMID: 21217512 [PubMed - as supplied by publisher] January 2011
Study of 300+ Patients Treated with CRS and PIC
Abstract of a study of 300+ Pseudomyxoma Peritonei patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Describes "gold standard " of treatment.
Source: Elias D, Gilly F, Quenet F, Bereder JM, Sidéris L, Mansvelt B, Lorimier G, Glehen O; the Association Française de Chirurgie.
Department of Oncologic Surgery, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif Cédex, France March 2010
Radiofrequency Ablation for Treatment of Unresectable Colorectal Pulmonary Metastes
Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases. Radiofrequency ablation for colorectal pulmonary metastases represents a step forward towards a nonsurgical option of combining systemic and local treatment for metastatic disease and is a safe treatment with a low risk profile.
Terence C. Chua, BScMed (Hons), MBBS 1, Kelly Thornbury, BMed 1, Akshat Saxena, BMedSc 1, Winston Liauw, MBBS, M Med Sci 2, Derek Glenn, MBBS 3, Jing Zhao, MD 1, David L. Morris, MD, PhD 1 *
1Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
2Cancer Care Center, St George Hospital, Sydney, Australia
3Department of Radiology, St George Hospital, Sydney, Australia
Source: AMC Feb 2010
Treatment of Peritoneal Malignancies, including Pseudomyxoma Peritonei with CRS and HIPEC
CONCLUSION: It is important to recognize the role of and indications for CRS and HIPEC. Biologic factors of the disease and completeness of resection are important prognostic factors. Cytoreductive surgery, combined with intraperitoneal chemotherapy, can improve survival in selected patients with peritoneal-based malignancies.
Source:Department of Surgical Oncology, National Cancer Centre of Singapore, Singapore 2010
Study of 523 Colorectal Peritoneal Carcinomatosis Cases: CRS and IPC
Source: Journal of Clinical Oncology,2010
12 Year Study of CRS and HIPEC for Pseudomyxoma Peritonei Treatment
Source: In Vivo, 2009
Morbidity and Mortality: Study of HIPEC and CRS for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgery, Feb 2009, Dr David Morris, Dr Tristan Yan
CRS with HIPEC have improved quality and quantity of life for patients
Source:Dr Brian Loggie, 2007
HIPEC: Complexity
Source: Dr David L Bartlett,Journal of Surgical Oncology
Twelve year study of Pseudomyxoma Peritonei Treatment with CRS and HIPEC
Source: San Giuseppe Hospital, June 2009
Pleural Pseudomyxoma Peritonei Treatment with Thoracic CRS and HIPEC
Source: University of New South Wales, Australia, 2009
Pseudomyxoma Peritonei Treatment with CRS and HIPEC
Source: Universite de Montreal, Canada, 2009
HIPEC Treatment provided at St Agnes
Source: Dr Jesus Esquivel
Pseudomyxoma Peritonei Treatment with Cytoreductive Surgery and HIPEC
Source: British Journal of Surgery, Aug 2008
Tailgut Cyst: An Unusual Case of Pseudomyxoma Peritonei
Source: Tumori, Dr Paul H Sugarbaker, 2009
Pseudomyxoma Peritonei Treatment with Chemo Hyperthermic Perfusion(CHPP)
Source: Pub Med 2009
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Annuals of Surgical Oncology, 2008
International Consensus of PSMG for CRS and HIPEC
Source: Springerlink, Oct 2006
Recommended Reading:
Questions Patients Need to Ask by Dr David Shulkin
Source: Amazon.com, Barnes and Noble, Ebay
Read ratings for physicians across the USA
Alpha Index of Surgery Articles by "PMP" Cancer Specialists
International listing of research articles and abstracts
See our SURGEONS & SPECIALISTS link for additional information about these physicians.
We provide the following abstracts and articles, published by, and/or written about the world's most experienced specialists in the treatment and research of Pseudomyxoma Peritonei, and Appendix Cancer. The full titles of some abstracts have been abbreviated due to space limitations.
Articles by Dr SA Ahrendt, USA
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis in Colorectal Cancer Patient with Liver Metastasis: Study of 57 Patients
Source: Journal of Clinical Oncology 2008
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgical Oncology, 2008
CRS and HIPEC for Treatment of Colorectal Carcinomatosis
Source: Annals of Surgial Oncology, Nov 2008
Articles by Dr Fernando Arias, Colombia
Sleeve Gastrectomy
Source: Fundacion Santa Fe de Bogota
Abstracts by Dr Mario Baratti, Italy
Pseudomyxoma Peritonei Biological Features Are the Dominant Prognostic Determinants After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy
Source: Annals of Surgery, Dr Marcello Deraco, Dr Baratti, 2009
Articles by Dr David L Bartlett, USA
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis in Colorectal Cancer Patient with Liver Metastasis: Study of 57 Patients
Source: Journal of Clinical Oncology 2008
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Anuals of Surgical Oncology, 2008
HIPEC: The Complexity of Clinical Trials
Source: Dr David L Bartlett, UPMC, Society of Surgical Oncology 2008
Dr David L Bartlett, Dr James Pingpank, Dr Steven Ahrendt
Source: Koch Cancer Treatment Center, UPMC
Profile for Dr David L Bartlett
Source: UPMC
Dr David L Bartlett: Koch Cancer Center
Source: UPMC
Dr David L Bartlett: Treatment of Liver Cancer
Source: UPMC Koch Cancer Center
Articles by Dr Jean Bereder, France
Study of 300+ Patients Treated with CRS and PIC
Abstract of a study of 300+ Pseudomyxoma Peritonei patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Describes "gold standard " of treatment.
Source: Elias D, Gilly F, Quenet F, Bereder JM, Sidéris L, Mansvelt B, Lorimier G, Glehen O; the Association Française de Chirurgie. Department of Oncologic Surgery, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif Cédex, France March 2010
Study of 523 Colorectal Peritoneal Carcinomatosis Cases: CRS and IPC
Source: Journal of Clinical Oncology,2010
Articles by Dr Wim Ceelen, Belgium
Dr Wim P Ceelen treats Pseudomyxoma Peritonei with HIPEC www.surgery.ugent.be
Articles by Dr Marcello Deraco, Italy
Pseudomyxoma PeritoneiBiological Features Are the Dominant Prognostic Determinants After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy
Source: Annals of Surgery, Dr Marcello Deraco, Dr Baratti, 2009
HIPEC Treatment: Dott. Marcello Deraco: Pseudomyxoma Peritonei and Appendix Cancer
Source: Dott. Marcello Deraco
Articles by Dr D Elias, France
Study of 523 Colorectal Peritoneal Carcinomatosis Cases: CRS and IPC
Source: Journal of Clinical Oncology,2010
Articles by Dr Jesus Esquivel, USA
Learning Curve for CRS and HIPEC
Source: Journal of Surgical Oncology, August 2009
Laparoscopic CRS and HIPEC Treatment for Peritoneal Mesothelioma
Source: Dr Jesus Esquivel, 2009
HIPEC Treatment available at St Agnes Hospital
Source: Dr Jesus Esquivel
Pros and Cons of HIPEC: Dr Jesus Esquivel
Source: Oncology Times, Jan 2007
Physician Profile for Dr Jesus Esquivel
Source: St Agnes Hospital
Dr Jesus Esquivel:St Agnes Hospital
Source: St Agnes Hospital
Articles by Dr Jan Franko, USA
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis in Colorectal Cancer Patient with Liver Metastasis: Study of 57 Patients
Source: Journal of Clinical Oncology 2008
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgical Oncology, 2008
CRS and HIPEC for Treatment of Colorectal Carcinomatosis
Source: Annals of Surgial Oncology, Nov 2008
Click here to read Dr Jan Franko's profile
Source: Mercy Medical Center
Articles by Dr Gilly, France
Study of 300+ Patients Treated with CRS and PIC :
Abstract of a study of 300+ Pseudomyxoma Peritonei patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Describes "gold standard " of treatment.
Source: Elias D, Gilly F, Quenet F, Bereder JM, Sidéris L, Mansvelt B, Lorimier G, Glehen O; the Association Française de Chirurgie.
Department of Oncologic Surgery, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif Cédex, France March 2010
Study of 523 Colorectal Peritoneal Carcinomatosis Cases: CRS and IPC
Source: Journal of Clinical Oncology,2010
Articles by Dr Matthew Holtzman, USA
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis in Colorectal Cancer Patient with Liver Metastasis: Study of 57 Patients Source: Journal of Clinical Oncology 2008
Articles by Dr Joachim Jahne, Germany
CRS:Stategies to Reduce Post Op Morbidity and Complications
Source: Dr Joachim Jahne, April 2009
Articles by Dr Santiago Gonzalez-Moreno, Spain
Patient Selection for CRS and HIPEC
Source: Journal of Surgical Oncology 2009
Articles by Dr Martin Goodman, USA
Dr Martin Goodman at Tufts University provides HIPEC
Source: Tufts University, Boston
Articles by Dr Matthew Holtzman, USA
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgical Oncology, 2008
CRS and HIPEC for Treatment of Colorectal Carcinomatosis
Source: Annals of Surgial Oncology, Nov 2008
Articles by Dr Laura Lambert, USA
CRS and Perioperative Intraperitoneal Chemotherapy for Colorectal Carcinomatosis:
Source: Annals of Surgical Oncology. 2007, Lambert, Laura A. and Paul F. Mansfield.
See: http://www.annalssurgicaloncology.org/cgi/content/full/14/11/3037
Articles by Dr Edward Levine, USA
CRS and HIPEC for the Treatment of Peritoneal Dissemination of Appendiceal and Colorectal Neoplasms
Source: Dr Edward Levine, ASCO 2008
“Appendiceal Carcinoma with Peritoneal Dissemination: Outcomes for the Best of the Best.”
Source: Annals of Surgical Oncology,2007, Dr Edward Levine, WFU
Survival Study for Pseudomyxoma Peritonei: DPAM, PMCA, PMCA 1
Source: Dr Edward Levine, American Journal of Surgical Pathology, May 2006
DPAM and HIPEC Treatment
Source: Wake Forest University
Articles by Dr Brian W Loggie, USA
CRS with HIPEC have improved quality and quantity of life for patients
Source:Dr Brian Loggie, 2007
Cox II expression in patients with Pseudomyxoma Peritonei and Disseminated Peritoneal Adenomucinosis
Source: Dr Brian Loggie
Articles referring to Dr Brian Loggie's patients
Source: PMP Pals' Network
Articles by Dr Andrew Lowy, USA
Minimally Invasive Laparoscopic Treatment of Pseudomyxoma Peritonei
Source: UCSD, Dr Andrew Lowy, 2009
Dr Andrew Lowy:Moores Cancer Center
Source: UCSD
Treatment of Pancreatic Cancer
Source: Dr Andrew Lowy UCSD
Articles by Dr Paul Mansfield, USA
Profile for Dr Paul Mansfield
Source: MD Anderson
CRS and HIPEC for the Treatment of Peritoneal Dissemination of Appendiceal and Colorectal Neoplasms
Source: Dr Paul Mansfield, ASCO 2008
CRS and Perioperative Intraperitoneal Chemotherapy for Colorectal Carcinomatosis:
Source: Annals of Surgical Oncology. 2007, Lambert, Laura A. and Paul F. Mansfield.
See: http://www.annalssurgicaloncology.org/cgi/content/full/14/11/3037
Laparoscopic Staging for Gastric Cancer
Source: Dr Paul Mansfield, MDACC, Annals of Surgical Oncology, 2001
Laparoscopy for Surgical Oncology
Source: MDACC
Articles by Dr Brendan J Moran, United Kingdom
CRS and HIPEC for the Treatment of Patients age 30-77 years
Source: North Hampshire Hospital, Basingstoke UK, 2007
Articles by Prof David L Morris, Australia
Radiofrequency Ablation for Treatment of Unresectable Colorectal Pulmonary Metastes
Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases. Radiofrequency ablation for colorectal pulmonary metastases represents a step forward towards a nonsurgical option of combining systemic and local treatment for metastatic disease and is a safe treatment with a low risk profile.
Source: David L. Morris, MD, PhD 2009
Morbidity and Mortality: Study of HIPEC and CRS for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgery, Feb 2009, Dr David Morris, Dr Tristan Yan
DPAM: Peritonectomy Improves Survival
Source Prof David L Morris, 2009
Assessment of risk factors following CRS and chemotherapy
Source: Dr David L Morris, Dr Tristan Yan, 2009Cost effectiveness of treatment with CRS and HIPEC
Source: Dr David L Morris, Dr Tristan Yan, Dec 2009
Pseudomyxoma Peritonei Long Term Survival (10 year study)
Source: Annals of Surgical Oncology, 2009, Prof David L Morris, St George Hospital,Univ of New South Wales, Sydney, NSW, AU
Long-term survival in patients with pseudomyxoma peritonei treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy: 10 years of experience.
This report demonstrates long-term survival outcomes, acceptable perioperative outcomes, and a learning curve associated with the treatment of patients with pseudomyxoma peritonei.
In vivo model for Pseudomyxoma Peritonei research
Source: Prof David L Morris, Sydney Australia, 2009
Articles by Dr Stefaan Mulier, Belgium
Dr Stefaan Mulier provides HIPEC treatment for Pseudomyxoma Peritonei and Peritoneal Carcinomatosis
Source: Leopold Park Clinic in Brussels
Articles by Dr Herwart Mueller, German
CRS for Senior Patients
Source: Dr Herwart Mueller, Germany
Articles by Dr Garrett M Nash USA
Laparoscopic Surgery for the Treatment of Peritoneal Surface Malignancies including Pseudomyxoma Peritonei
Source: Memorial Sloan Kettering, NY
Articles by Dr Haydee Ojeda-Fournier, USA
Diagnostic Imaging of Pancreatic Cancer
Source: Dr Haydee Ojeda-Fournier, UCSD
Articles by Dr Gloria Ortega-Perez, Spain
Patient Selection for CRS and HIPEC
Source: Journal of Surgical Oncology 2009
Articles by Dr James Pingpank, USA
Peritoneal Carcinomatois Clinical Trials Study
Source: NIH, Dr James Pingpank, Feb 2009
Articles by Prof Pompiliu Piso, Germany
Peritoneal Carcinomatosis Treatment (Study) with Tumor Honing Peptides
Source: Dept of Radiology, Germany 2009
Peritoneal Carcinomatosis Prognosis following treatment with surgery and HIPEC
Source: Prof P Piso, 2009
CRS and HIPEC for the Treatment of Peritoneal Carcinomatosis
Source: Prof Pompiliu Piso, 3rd Annual Symposium, 2008
HIPEC Study with laboratory rats
Source: Deutscher Krebskongress, 2004
Articles by Dr B Ronnett, USA
CRS and HIPEC for the Treatment of Peritoneal Dissemination of Appendiceal and Colorectal Neoplasms
Source: Dr Edward Levine, ASCO 2008
DPAM Long Term Survival
Source: Dr BM Ronnett, Dr Paul H Sugarbaker, 2009
Articles by Dr Armando Sardi, USA
CRS and HIPEC offer longterm survival for Peritoneal Carcinomatosis of disseminated Appendiceal tumor origin
Source: Dr Armando Sardi, Mercy Med Center, Journal of American College of Surgeons, Sept 2009
Published abstracts by Dr Armando Sardi
Source: Mercy Medical Center
Steps to Prepare for SurgerySource: Mercy Medical Center
Curriculum Vitae for Dr Armando Sardi
Source: Mercy Medical Center
Profile for Dr Armando Sardi
Source: Mercy Medical Center
Articles by Dr Perry Shen, USA
Dr Perry Shen at WFU provides HIPEC
Source: Wake Forest University
Articles by Dr Paul H Sugarbaker, USA
Mesenteric Cyst resulting in Pseudomyxoma Peritonei
Source: Dr Paul H Sugarbaker, 2010
Tailgut Cyst: An Unusual Case of Pseudomyxoma Peritonei
Source: Tumori, Dr Paul H Sugarbaker, 2009
Epithelial appendiceal neoplasms (abstract with availability to purchase article in full)
Source: The Cancer Journal, 2009
Epithelial appendiceal neoplasms: report reviews 900 cases treated at the Washington Hospital Center
Source: Dr Paul H Sugarbaker, Cancer Journal, May 2009
DPAM Long Term Survival
Source: Dr BM Ronnett, Dr Paul H Sugarbaker, 2009
Management of mucinous urachal neoplasm presenting as Pseudomyxoma Peritonei
Source: Dr Paul H Sugarbaker, 2008
Failure Analysis of Recurrent Disease Following CRS and IPC for Colorectal Cancer with Peritoneal Carcinomatosis
Source: Dr Paul H Sugarbaker, Dr Tristan Yan, 2007
Treatment of Peritoneal Surface Malignancy
Source: Dr Paul H Sugarbaker, Dr Tristan Yan, Journal of Transistional Medicine, 2006
Cytoreductive Surgery (includes graphic illustrations) Source: Dr Paul H Sugarbaker
Indications for use of CRS and HIPEC
Source: Dr Paul H Sugarbaker
Appendix Cancer Prognosis
Source: Dr Paul H Sugarbaker, Washington Hospital Center
Prognostic indicators for Peritoneal Carcinomatosis originating with gastrointestinal adenocarcinoma
Source: Dr Paul H Sugarbaker, 2005
Atlas of Appendix Cancer(includes graphic illustrations)
Source: Dr Paul H Sugarbaker
Articles referring to Dr Paul Sugarbaker and his patients
Source: PMP Pals' Network
Articles by Dr V J Verwaal,Holland
Population Based Study of Appendiceal Neoplasms and Pseudomyxoma Peritonei
Source: ESJO, 2008
Cytoreduction and HIPEC Treatment for Appendix Cancer and Pseudomyxoma Peritonei (pdf)
Source: Netherlands Cancer Institute, Prof VJ Verwaal, 2006
Articles by Dr Tristan Yan, Australia
Cost effectiveness of treatment with CRS and HIPEC
Source: Dr David L Morris, Dr Tristan Yan, Dec 2009
Morbidity and Mortality: Study of HIPEC and CRS for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgery, Feb 2009, Dr David Morris, Dr Tristan Yan
Assessment of risk factors following CRS and chemotherapy
Source: Dr David L Morris, Dr Tristan Yan, 2009
Failure Analysis of Recurrent Disease Following CRS and IPC for Colorectal Cancer with Peritoneal Carcinomatosis
Source: Dr Paul H Sugarbaker, Dr Tristan Yan, 2007
Treatment of Peritoneal Surface Malignancy
Source: Dr Paul H Sugarbaker, Dr Tristan Yan, Journal of Transistional Medicine, 2006
Articles by Dr H Zeh, USA
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis in Colorectal Cancer Patient with Liver Metastasis: Study of 57 Patients
Source: Journal of Clinical Oncology 2008
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgical Oncology, 2008
CRS and HIPEC for Treatment of Colorectal Carcinomatosis
Source: Annals of Surgial Oncology, Nov 2008
Articles by Dr F Zoetmulder, Holland
Population Based Study of Appendiceal Neoplasms and Pseudomyxoma Peritonei
Source: ESJO, 2008
Purdue Uses New Technology Used in Cancer Treatment
Purdue University studies efficacy of fluorescence imaging for cancer treatment
Source: Purdue University 09.18.11
Fluorescence guided surgery
Dr Phillip Low, Purdue University
Can Fluorescence-guided surgery be effective for Pseudomyxoma Peritonei?
Already used in Europe and the USA for the detection and treatment of ovarian cancer, can Fluorescence guided surgery be utilized during CRS for the treatment of PMP cancer?
Purdue University describes the procedure as follows:
“The technique attaches a fluorescent imaging agent to a modified form of the vitamin folic acid, which acts as a "homing device" to seek out and attach to ovarian cancer cells. Patients are injected with the combination two hours prior to surgery and a special camera system, called a multispectral fluorescence camera, then illuminates the cancer cells and displays their location on a flat-screen monitor next to the patient during surgery.”
Read additional details about technique under investigation >>
Already used in Europe and the USA for the detection and treatment of ovarian cancer, can Fluorescence guided surgery be utilized during CRS for the treatment of PMP cancer?
Purdue University describes the procedure as follows:
“The technique attaches a fluorescent imaging agent to a modified form of the vitamin folic acid, which acts as a "homing device" to seek out and attach to ovarian cancer cells. Patients are injected with the combination two hours prior to surgery and a special camera system, called a multispectral fluorescence camera, then illuminates the cancer cells and displays their location on a flat-screen monitor next to the patient during surgery.”
Read additional details about technique under investigation >>
Aggressive PMP Treated with CRS and HIPEC: Outcome
Outcome of Patients with Aggressive Pseudomyxoma Peritonei Treated by Cytoreductive Surgery and Intraperitoneal Chemotherapy.
Arjona-Sanchez A, Muñoz-Casares FC, Casado-Adam A, Sánchez-Hidalgo JM, Ayllon Teran MD, Orti-Rodriguez R, Padial-Aguado AC, Medina-Fernández J,Ortega-Salas R, Pulido-Cortijo G, Gómez-España A, Rufián-Peña S.
Source
Department of Surgery, H.U. Reina Sofia, Cordoba, Spain, alvaroarjona@hotmail.com.
Abstract
BACKGROUND:
Pseudomyxoma peritonei (PMP) is a rare disease with an incidence rate of approximately 1 per million a year. During the past few years, there has been a survival benefit for these patients treated by complete cytoreduction and perioperative chemotherapy. Better survival rates were found in the adenomucinosis group than the carcinomatosis group.
The purpose of our study was to analyze the outcome and the prognosis factors of only high-grade PMP.
METHODS:
We selected 38 patients from a prospective database of 59 with high-grade PMP from appendiceal origin who were treated by cytoreduction surgery and HIPEC at the Hospital University Reina Sofia (Cordoba, Spain) between 1998 and July 2012.
Clinical, surgical, analytical, radiological, and histological data were obtained prospectively. Survival curves were calculated using the Kaplan-Meier method, a univariate analysis was performed and the log rank-test was used to analyze the effects of several clinical and pathologic factors on overall survival (OS) and disease-free survival (DFS).
RESULTS:
Median follow-up time was 32 months (range, 2-170). Median age at diagnosis was 57 years (range, 32-77). In 89.5 % of patients, optimal cytoreduction CC-0 (57.9 %) and CC-1 (31.6 %) was achieved. In the remaining 10.5 %, cytoreduction was classified as CC-2. The median PCI score was 21 (range, 4-38). Morbidity complications ≥Grade 3 in the CTCAE v 3.0 classification was 18.4 %. One patient died 45 days postsurgery. Median OS at the end of follow-up was 36 months (range, 9-83); overall 5-year survival rate was 58.7 %. In the univariate analysis for OS, significant values were obtained for lymph-node involvement and suboptimal cytoreduction. The 5-year OS was 64.5 % when an optimal cytoreduction was achieved. Median DFS was 36 months (17-54); 3-year DFS rate was 49.1 %. Neoadjuvant therapy did not affect the survival of these patients; there was no difference in the 5-year OS (43 % vs. 75 %, p = 0.068).
CONCLUSIONS:
In aggressive PMP, cytoreduction with peritonectomy procedure plus HIPEC is a safe procedure that suggests an improvement to the survival rates. Because optimal cytoreduction is a primary prognostic factor for survival rates, this procedure would have to be performed in an experienced center with a low morbidity.
Neoadjuvant chemotherapy has not demonstrated benefits in these patients and further research will be required.
World J Surg. 2013 Mar 27
Cytoreductive Surgery in conjunction with HIPEC
CRS (Cytoreductive Surgery) in conjunction with HIPEC:
Articles and Abstracts
Study of 300+ Patients Treated with CRS and PIC
Abstract of a study of 300+ Pseudomyxoma Peritonei patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Describes "gold standard " of treatment.
Source: Elias D, Gilly F, Quenet F, Bereder JM, Sidéris L, Mansvelt B, Lorimier G, Glehen O; the Association Française de Chirurgie.
Department of Oncologic Surgery, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif Cédex, France March 2010
Radiofrequency Ablation for Treatment of Unresectable Colorectal Pulmonary Metastes
Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases. Radiofrequency ablation for colorectal pulmonary metastases represents a step forward towards a nonsurgical option of combining systemic and local treatment for metastatic disease and is a safe treatment with a low risk profile.
Terence C. Chua, BScMed (Hons), MBBS 1, Kelly Thornbury, BMed 1, Akshat Saxena, BMedSc 1, Winston Liauw, MBBS, M Med Sci 2, Derek Glenn, MBBS 3, Jing Zhao, MD 1, David L. Morris, MD, PhD 1 *
1Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
2Cancer Care Center, St George Hospital, Sydney, Australia
3Department of Radiology, St George Hospital, Sydney, Australia
Source: AMC Feb 2010
Treatment of Peritoneal Malignancies, including Pseudomyxoma Peritonei with CRS and HIPEC
CONCLUSION: It is important to recognize the role of and indications for CRS and HIPEC. Biologic factors of the disease and completeness of resection are important prognostic factors. Cytoreductive surgery, combined with intraperitoneal chemotherapy, can improve survival in selected patients with peritoneal-based malignancies.
Source:Department of Surgical Oncology, National Cancer Centre of Singapore, Singapore 2010
Study of 523 Colorectal Peritoneal Carcinomatosis Cases: CRS and IPC
Source: Journal of Clinical Oncology,2010
12 Year Study of CRS and HIPEC for Pseudomyxoma Peritonei Treatment
Source: In Vivo, 2009
Morbidity and Mortality: Study of HIPEC and CRS for Treatment of Peritoneal Carcinomatosis
Source: Annals of Surgery, Feb 2009, Dr David Morris, Dr Tristan Yan
CRS with HIPEC have improved quality and quantity of life for patients
Source:Dr Brian Loggie, 2007
HIPEC: Complexity
Source: Dr David L Bartlett,Journal of Surgical Oncology
Twelve year study of Pseudomyxoma Peritonei Treatment with CRS and HIPEC
Source: San Giuseppe Hospital, June 2009
Pleural Pseudomyxoma Peritonei Treatment with Thoracic CRS and HIPEC
Source: University of New South Wales, Australia, 2009
Pseudomyxoma Peritonei Treatment with CRS and HIPEC
Source: Universite de Montreal, Canada, 2009
HIPEC Treatment provided at St Agnes
Source: Dr Jesus Esquivel
Pseudomyxoma Peritonei Treatment with Cytoreductive Surgery and HIPEC
Source: British Journal of Surgery, Aug 2008
Tailgut Cyst: An Unusual Case of Pseudomyxoma Peritonei
Source: Tumori, Dr Paul H Sugarbaker, 2009
Pseudomyxoma Peritonei Treatment with Chemo Hyperthermic Perfusion(CHPP)
Source: Pub Med 2009
CRS and HIPEC for Treatment of Peritoneal Carcinomatosis
Source: Annuals of Surgical Oncology, 2008
International Consensus of PSMG for CRS and HIPEC
Source: Springerlink, Oct 2006
Laparoscopy; Minimally Invasive Staging and Surgery
Laparoscopy surgery includes the use of a thin, narrow, tube shaped instrument inserted into the abdominal wall. Laparoscopy may be used as a diagnostic tool, and has become a surgical option for specific patients, providing a less invasive (and less expensive) alternative to more extensive surgery. Recuperation from laparoscopy requires less hospitalization due to a faster recovery period, with less trauma and post op pain.
The following articles and abstracts pertaining to mesothelioma, pseudomyxoma peritonei, gastric, liver, ovarian and pancreatic cancer are posted for your reference.
Laparoscopy for Oncological Surgery (this article provides a detailed explanation for patients)
Source: MDAnderson, Houston TX
Laparoscopic Mucin Removal of Pseudomyxoma Peritonei
Source: Dept of OB GYN, Kinko Univ, Osaka Japan, 2009
Minimally Invasive Laparoscopic Surgery
Source: Mercy Medical Center
Minimally Invasive Laparoscopic Surgery, Liver, Pancreas
Source: UCSD, Dr Andrew Lowy, 2009
Laparoscopic CRS and HIPEC Treatment for Peritoneal Mesothelioma
Source: Dr Jesus Esquivel, 2009
Laparoscopic Surgery for the Treatment of Peritoneal Surface Malignancies including Pseudomyxoma Peritonei
Source: Memorial Sloan Kettering, NY
Laparoscopic Surgery for the Treatment of Liver Cancer, Pancreas Cancer
Source: University of Southern California
Laparoscopic Staging for Gastric Cancer
Source: Dr Paul Mansfield, MDACC, Annals of Surgical Oncology, 2001
Laparoscopic Colon Resection
Source: UPMC Koch Cancer Treatment Center
Laparoscopic Surgery for Liver Cancer
Source: Dr David L Bartlett UPMC Koch Cancer Center
Laparoscopic Surgery for Whipple Procedure, Pancreatic
Source: USC Norris Cancer Center
Laparoscopic Surgery, Gastric and Esophageal Cancers
Source: Dr Charles Filipi, Creighton University
Laparoscopic restoration of the colon continuity after Hartmann procedure
Source: Pub Med 2009
Laparoscopic Management of Ovarian Cyst
Source: Springerlink:2008
Laparoscopic Management of Pseudomyxoma Peritonei
Source: Cleveland Clinic 1999
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We neither solicit nor receive funds from pharmaceutical companies or healthcare providers, thus maintaining our dedication to serving as patient advocates.Copyright 2013 by PMP Pals' Network.
The PMP Pals' Network updates our website 363 days per year with a wide variety of new information to keep you informed about maintaining optimal health!
Whether you seek information about research studies, health insurance, personal mentoring, diet and exercise, new treatment options, and so much more, the PMP Pals' Network is your "go to" place for information!
Last update 004.23.13
