CHAPTERS
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Chapter 1
Introduction to Peritoneal Carcinomatosis (PC).
. Definition, incidence, symptoms and clinical presentation
. Mechanisms related to peritoneal spread of tumors
. Results of conventional treatment (systemic CT)
. Paradigms related to CP
. Conclusions (take-home messages)
Chapter 2
Clinical evaluation of patients with PC.
. Predictive factors of survival (SV) in CRS+HIPEC:
– Tumor histology
– Peritoneal disease volume (PCI)
– Degree of completion of surgery (CC-S)
– Response to Neoadjuvant CT
– Previous surgery (PS-S)
. Diagnosis by imaging and role of laparoscopy
. Conclusions (take-home messages)
Chapter 3
Basic concepts of combined radical treatment (CRS+HIPEC).
. Origin of treatment and fundamental principles
. Premises for the effective and safe use of the CRS+HIPEC:
– Radical cytoreduction (CRS)
– Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
– Perioperative systemic chemotherapy (CT)
. Patient selection (inclusion and exclusion criteria)
. Chronological evolution of CRS+HIPEC treatment
. Conclusions (take-home messages)
Chapter 4
Cytoreductive Surgery (CRS).
. General principles, objective and quality of the CRS
. Extrafascial, centripetal and en bloc approach to tumors
Chapter 5
Peritonectomy procedures (+/- visceral resection)
Description “original” (Sugarbaker).
. Introduction, general principles and indications for peritonectomy procedures
. Technical description of peritonectomy procedures
(+/- visceral resections)
Chapter 6
New technical contributions to the “original” peritonectomy procedures.
. Complete Mesenteric Peritonectomy
. Pelviperitonectomy extended to the right colon (en bloc)
. Removal of perigastric tumor
. Cytoreduction of the small intestine and mesentery
. CRS associated with lymphadenectomies
. Other types of resections
Chapter 7
Digestive anastomoses (without stoma) in CRS+HIPEC.
. Factors related to anastomotic complications
. Technical aspects related to the safety of digestive anastomoses
. “True” end-to-end colorectal anastomosis without stoma
. End-to-side ileocolic anastomosis
. Digestive reconstruction after total gastrectomy
Chapter 8
Resection and reconstruction of the urinary tract in CRS+HIPEC.
. Incidence of urinary tract involvement in PM
. Technical recommendations in urinary repair
. Repair techniques:
Ureteroureterostomies. Ureterocystostomies. Ureteral plasties: small intestine, appendix). Ureterocystoplasties. Bladder enlargement. Continent and incontinent ileal conduits. Bladder replacement (neobladders)
. Personal modifications to conventional techniques
. Own results
Chapter 9
Digestive reconstruction techniques to avoid rapid intestinal emptying.
. Limits of intestinal resection in CRS+HIPEC. “Short intestine” syndrome
. Types of reconstruction of the digestive tract aimed at slowing intestinal transit: circumferential and intercalated sections of the seromuscular layer of the small intestine. Antiperistaltic interposition of small intestine segments. Segmental antiperistaltic interposition of the transverse colon. Blind interposition. Interposition of multiple intestinal segments (“Scalextric” technique)
. Personal series results
Chapter 10
Pelvic Exenteration associated with CRS+HIPEC.
. Anatomy of the pelvis
. Modalities (types) of pelvic exenteration
. Patient inclusion and exclusion criteria
. Pelvic exenteration associated with CRS+HIPEC
. Pelvic floor filling
. Total Pelvic Exenteration without digestive stoma or external urinary diversion
. Own results
Chapter 11
Intraperitoneal Chemohyperthermia (HIPEC).
. Theoretical foundations of HIPEC
. Effect of heat on QT IP
. Drugs, dosage, time and temperature
. HIPEC administration modalities
. HIPEC protocols for tumor pathologies
. Adverse effects of HIPEC
. Conclusions (take-home messages)
Chapter 12
Surgical management of epithelial tumors of the appendix.
. Incidence, histology and clinic of appendiceal tumors
. Appendicular mucocele. Surgical management according to histology, size and clinical presentation
. Therapeutic strategy against appendix tumors +/- PMP Clinical guidelines and consensus
Chapter 13
CRS+HIPEC in Pseudomyxoma peritonei (PMP).
. Incidence, histological variants and clinical manifestations
. Selection of patients for CRS+HIPEC treatment
. Reference studies
. Own results
. Conclusions (take-home messages)
Chapter 14
CRS+HIPEC in Malignant Peritoneal Mesothelioma (MPM).
. Incidence, clinical and histology
. CRS+HIPEC: Indications and patient selection
. Reference studies
. Own results
. Conclusions (take-home messages)
Chapter 15
CRS+HIPEC in CP of colo-rectal origin.
. Incidence, histology and clinical presentation of colorectal MPs
. Results of conventional treatment (systemic CT)
. Indications of the CRS+HIPEC. Patient selection
. Baseline studies prior to the PRODIGE 7 study
. PRODIGE Study 7. Controversies and repercussions
. Other indications for CRS+HIPEC in CRC: “second look”, Prophylactic treatment
. Results of CRS+HIPEC in the therapeutic indication
. Conclusions (take-home messages)
Chapter 16
CRS+HIPEC in Epithelial Ovarian Cancer (EOC)
with peritoneal dissemination.
. Incidence, histology and clinical manifestations
. Chronological evolution of the CEO’s treatment. Role of surgery
. CRS+HIPEC: primary treatment and recurrence
. Own results
. Conclusions (take-home messages)
Chapter 17
CRS+HIPEC in CP of gastric origin.
. Etiopathogenesis. Peritoneal Free Cancer Cell (PFCs)
. Incidence and generalities
. Diagnostic process. Role of laparoscopy
. Results of conventional treatment (systemic CT)
. CRS+HIPEC. Indications. Patient selection
. Combined application of different QT modalities: NIPS, BIPSC, …
. Reference studies and own results
. Conclusions (take-home messages)
Chapter 18
CRS+HIPEC in PM of rare origin.
. Mucinous adenocarcinoma of the urachus
. Small intestine adenocarcinoma
. Neuroendocrine tumors of the small intestine
. Peritoneal sarcomatosis (non-GIST)
. Desmoplastic Round and Small Cell Tumor
. Frantz pancreatic tumor
. Reference studies
. Own results
Chapter 19
Treatment of Pleuro-pulmonary Mucinosis.
. Mechanism and routes of spread of PMP to the thoracic cavity
. Prophylaxis of pleuro-pulmonary dissemination
. Treatment: Thoracic surgery
Hyperthermic Intrathoracic Chemotherapy (HITHOC)
. Reference studies
. Own results
Chapter 20
Iterative CRS+HIPEC (iCRS+HIPEC).
. Therapeutic failure of CRS+HIPEC. Causes
. Indication and patient selection for iCRS+HIPEC
. Reference studies
. Own results
. Conclusions (take-home message)
Chapter 21
General Surgeon and Peritoneal Carcinomatosis.
. What you should know about peritoneal dissemination
. What you should know about CRS+HIPEC treatment
. Attitude towards the unexpected surgical discovery of PM
. Concept, indications and technique of “radical” appendectomy
. Most frequent patterns of MP manifestation
. Conclusions (take-home messages)