Chapter 1
Introduction to Peritoneal Carcinomatosis (PC)
. Definition, incidence and symptomatology
. Conventional treatment outcomes (Systemic CT)
. Pathophysiology of the peritoneum and factors related to peritoneal spread of tumors
. Manifestation patterns of peritoneal disease
. Paradigms related to PC
. Conclusions (take-home messages)
Chapter 2
Clinical evaluation of patients with PC
. Predictors of survival: Tumor histology, Peritoneal Cancer Index (PCI). Completeness of Cytoreduction Score (CSS). Response to Neoadjuvant CT. Prior Surgical Score (PSS)
. Preoperative patient selection
. Role of imaging tests (CT, CT/PET and MRI) and laparoscopy
. Conclusions (take-home messages)
Chapter 3
Fundamentals of Radical Combination Treatment (CRS+HIPEC)
. Origin and theoretical foundations of CRS+HIPEC
. “Pillars” of Radical Combination Therapy
Patient pelection
Cytoreductive Surgery (CRS)
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Perioperative systemic chemotherapy (CT)
. Conclusions (take-home messages)
Chapter 4
Cytoreductive Surgery (CRS)
. Description, principles, grade and objective of the CRS
. Extrafascial, centripetal and en bloc excision of tumors
Chapter 5
Peritonectomy procedures and visceral resection: ”original” description (Sugarbaker)
. Introduction and rationale. Types
. Description of the technique
. Conclusions (take-home messages)
Chapter 6
New contributions to “original” Peritonectomy procedures
. Complete mesenteric peritonectomy
. Extended pelvi-peritonectomy to the right colon (en bloc)
. Excision of perigastric tumor
. Cytoreduction of small bowel and its mesentery
. Extended small bowel (and colon) resections
. Other types of visceral resections
Chapter 7
Digestive anastomoses (without stoma) in CRS+HIPEC
. Technical aspects related to the safety of anastomoses
. “True” end-to-end mechanical colorectal anastomoses with manual reinforcement
. Mechanical end-to-side ileocolic anastomoses with manual reinforcement
. Digestive reconstruction after total gastrectomy
Chapter 8
Resection and reconstruction of the urinary tract in CRS+HIPEC
. Incidence and technical recommendations
. Ureteroureterostomy. Ureterocistostomy. Ureteral plasties: small intestine, appendix). Ureterocystoplasties. Bladder enlargement. Bricker ileal conduit diversion. Continent ileocolonic urinary reservoir (Miami pouch). Bladder replacement (neobladders)
. Personal technical modifications. Results
Chapter 9
Digestive reconstruction techniques after massive bowel resection
(and avoid rapid bowel emptying)
. Limits of bowel resection in CRS+HIPEC. Short bowel syndrome
. Reconstructions of the digestive tract to slow intestinal transit: Complete and interspersed circumferential section of the muscular wall of the small bowel. Antiperistaltic interposition of an isolated segment of the small bowel. Segmental antiperistaltic interposition of the transverse colon. Interposition of the cecum. Interposition of multiple small bowel and colon segments (“Scalextric” technique).
. Results
Chapter 10
Pelvic exenteration associated with CRS+HIPEC
. Anatomy of the pelvis
. Modalities (types) of exenteration
. Patient inclusion and exclusion criteria. Indications
. Managing the empty pelvis
. Total pelvic exenteration without stomata. Results.
. Conclusions (take-home messages)
Chapter 11
Hyperthermic Intraperitoneal Chemoterapy (HIPEC)
. Mechanism of action of intraperitoneal chemotherapy (IP CT)
. Effect of heat on IP CT . Drugs, dosage, time and temperature. Most commonly used regimens
. Modalities of administration of HIPEC
. Adverse effects of HIPEC
. Conclusions (take-home messages)
Chapter 12
Surgical management of Epithelial Tumors of the Appendix
. Incidence, histology and clinical symptoms of Appendix Tumors
. Appendicular mucocele. Surgical strategy according to size, tumor histology and clinical manifestation
. Therapeutic algorithm
. Conclusions (take-home messages)
Chapter 13
CRS+HIPEC in Pseudomyxoma Peritonei (PMP)
. Incidence, histological variants and clinical manifestations
. Patient selection for CRS+HIPEC treatment
. References articles
. Personal series results
. Conclusions (take-home messages)
Chapter 14
CRS+HIPEC in Malignant Peritoneal Mesothelioma (MPM)
. Incidence, histology and clinical symptoms
. Indications and selection criteria for CRS+HIPEC. References articles
. Personal series results
. Conclusions (take-home messages)
Chapter 15
CRS+HIPEC in PCs of colorectal origin
. Incidence, histology and clinical presentation
. Conventional treatment outcomes (systemic CT)
. Indications for radical treatment and patient selection
. References articles
. Personal series results
. Conclusions (take-home messages)
Chapter 16
CRS+HIPEC in Epithelial Ovarian Cancer (EOC) with peritoneal spread
. Incidence, histology and clinical manifestation
. Chronological evolution of the CEO’s treatment. Role of Surgery
. CRS+HIPEC: primary and recurrence treatment
. Personal series results
. Conclusions (take-home messages)
Chapter 17
CRS+HIPEC in gynecologic tumors (non-CEO)
. Mucinous Adenocarcinoma of the Endocervix
. Malignant tumors of the endometrium
. Uterine sarcoma
. Primary Peritoneal Carcinoma
. References articles
. Personal series results
Chapter 18
CRS+HIPEC in PC of gastric origin
. Etiopathogenesis. Peritoneal Free Cancer Cell (PFCCs)
. Incidence and generalities
. Diagnostic process. Role of laparoscopy
. Conventional treatment outcomes (Systemic CT)
. Combined application of different QT modalities: NIPS, BIPSC
. References articles
. Personal series results
Chapter 19
CRS+HIPEC in PC originating in rare/infrequent tumors
. Mucinous adenocarcinoma of urachus
. Adenocarcinoma of the small bowel
. Neuroendocrine tumors of the small bowel
. Sarcomatosis (not GIST)
. Desmoplastic Round and Small Cell Tumor
. Frantz’s pancreatic tumor
. References articles
. Personal series results
Chapter 20
Treatment of Pleuropulmonary Mucinous
. Mechanism and routes of dissemination of PMP to the thoracic cavity
. Prophylaxis of pleuropulmonary spread
. Treatment: Thoracic surgery
Hyperthermic Intrathoracic Chemotherapy (HITHOC)
. References articles
. Personal series results
Chapter 21
Iterative CRS+HIPEC (iCRS+HIPEC)
. Causes of treatment failure of CRS+HIPEC
. Indications and patient selection for iCRS+HIPEC
. References articles
. Personal series results
. Conclusions (take-home messages)
Chapter 22
General Surgeon and Peritoneal Carcinomatosis
. What you should know about PC
. What you need to know about CRS+HIPEC
. Attitude to an unexpected operative finding of PC
. Concept, indications and technique of “Radical Appendectomy”
. Most frequent PC manifestation patterns
. Conclusions (take-home messages)
Chapter 23
Documents and articles generated by the authors
Documents and articles generated by the authors
Chapter 24
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