Chapter 1
Introduction to Peritoneal Carcinomatosis (PC)
CONTENTS
- 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)
VIDEO ÍNDEX
- 1.1 | Peritoneal dissemination of mucinous appendiceal tumours. “Redistribution phenomenon”
Chapter 2
Clinical evaluation of patients with PC
CONTENTS
- 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)
VIDEO ÍNDEX
2.1 | Pre-operative evaluation of patients elegible for CRS+HIPEC: Video-radiology
2.2 | Computed tomography (CT scan) and diagnostic laparoscopy (LPS)
Chapter 3
Fundamentals of Radical Combination Treatment (CRS+HIPEC)
CONTENTS
- 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)
VIDEO ÍNDEX
3.1 | Perioperative preparation and management of patients undergoing CRS+HIPEC
Chapter 4
Cytoreductive Surgery (CRS)
CONTENTS
- Description, principles, grade and objective of the CRS
- Extrafascial, centripetal and en bloc excision of tumors
VIDEO ÍNDEX
There are no videos available in this chapter
Chapter 5
Peritonectomy procedures and visceral resection: ”original” description (Sugarbaker)
CONTENTS
Introduction and rationale. Types
Description of the technique
Conclusions (take-home messages)
VIDEO ÍNDEX
PARITAL PERITONECTOMIES
5.1 | Partial Anterior Parietal Peritonectomy
5.2 | Total Anterior Parietal Peritonectomy
5.3 | Xiphoidectomy and Anterior Parietal Peritonectomy with Visceral Resection (I)
5.4 | Xiphoidectomy and Anterior Parietal Peritonectomy (II)
5.5 |Anterior Parietal Peritonectomy associated with resection of tumor involving the umbilical ligament (I)
5.6 | Resection of tumor involving the umbilical ligament (II)
5.7 | Resection of tumor involving the umbilical ligament (III)
5.8 | Division of the hepatic bridge (pont hépatic)
5.9 | Anterior Parietal Peritonectomy associated with resection of surgical scar
LEFT UPPER QUADRANT PERITONECTOMIES
5.10 | Left Subphrenic Peritonectomy
5.11 | Left Subphrenic Peritonectomy with residual Omentectomy and Splenectomy
5.12 | Left Subphrenic Peritonectomy with Complete Greater Omentectomy and Splenectomy
RIGHT UPPER QUADRANT PERITONECTOMIES
5.13 | Right Subphrenic Peritonectomy (I)
5.14 | Right Subphrenic Peritonectomy (II)
5.15 | Right Subphrenic Peritonectomy (III)
5.16 | Right subphrenic peritonectomy with resetion of tumor on Glisson’s capsule (I)
5.17 | Right subphrenic peritonectomy with resetion of tumor on Glisson’s capsule (II)
5.18 | Right subphrenic peritonectomy resetion of tumor on Glisson’s capsule (III)
5.19 | Partial right subphrenic peritonectomy with partial diaphragmatic resection
5.20 | Partial right subphrenic peritonectomy with diaphragmatic and hepatic parenchyma resection
5.21 | Resection of perihepatic tumor
COMPLETE PELVIC PERITONECTOMY
5.22 | Complete Pelvic Peritonectomy without Visceral Resection
5.23 | Cul-de-sac peritonectomy (Cul-de-sacectomy)
5.24 | Complete Pelvic Peritonectomy with rectosigmoid colon resection
5.25 | Complete Pelvic Peritonectomy with resection of uterus, adnexa, ileum and right colon
5.26 | Omental Bursa Peritonectomy (bursectomy)
5.27 | Bursectomy with cholecystectomy, lesser omentum resection and splenectomy
Chapter 6
New contributions to “original” Peritonectomy procedures
CONTENTS
- 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
VIDEO ÍNDEX
NEW CONTRIBUTIONS TO PERITONECTOMY PROCEDURES | "COMPLETE" MESENTRIC PERITONECTOMY
6.1 | “Complete” Mesenteric Peritonectomy with CO2 insufflation in mesentery and electrosurgical dissection
6.2 | “Complete” Mesenteric Peritonectomy with CO2 insufflation in mesentery and blunt digital dissection
6.3 | “Complete” Mesenteric Peritonectomy associated with ileocolic resection
EXTENDED COMPLETE PELVIC PERITONECTOMY WITH "EN BLOC" MULTIVISCERAL RESERCTIONS
6.4 | “Extended” Complete Pelvic Peritonectomy (with rectosigmoid and right colon resection). Male patient
6.5 | “Extended” Complete Pelvic Peritonectomy (with rectosigmoid, right colon, uterus and adnexae resection)
6.6 | Complete Pelvic Peritonectomy associated with subtotal colectomy
6.7 | Complete pelvic peritonectomy associated with en bloc pelvic lymphadenectomy
6.8 | CRS of the perigastric region
CRS OF THE SMALL BOWEL AND MESENTERY
6.9 | CRS of the small bowel and mesentery (large and multiple implants)
6.10 | CRS of the small bowel and mesentery (small, multiple, and invasive implants)
6.11 | Multiple segmental resections of small bowel, abdominal wall, and urinary bladder
6.12 | Abdominal wall resection with prosthetic reconstruction
6.13 | Resection of tumor in second portion of the duodenum. Repair with defunctionalised small bowel path
Chapter 7
Digestive anastomoses (without stoma) in CRS+HIPEC
CONTENTS
- 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
VIDEO ÍNDEX
CRS+HIPEC AND DIGESTIVE ANASTOMOSIS (WITHOUT STOMA)
7.1 | “True” end-to-end colorectal anastomosis. Personal technique
7.2 | Reinforced mechanical end-to-side ileocolic anastomosis
7.3 | Reinforced mechanical end-to-side ileorectal anastomosis
7.4 | Hand-sewn end-to-end ileocolic anastomosis
7.5 | Hand-sewn end-to-side ileocolic anastomosis
7.6 | Ileorectal anastomosis with J- pouch
7.7 | Coloanal anastomosis
7.8 | Roux-en-Y esophagojejunal reconstruction
7.9 | Esophagoduodenal reconstruction with interposed jejunal loop (Longmire)
7.10 | Other types of anastomosis: digestive, pancreatic and biliary anastomoses associated with CRS+HIPEC
Chapter 8
Resection and reconstruction of the urinary tract in CRS+HIPEC
CONTENTS
- 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
VIDEO ÍNDEX
URINARY RECONSTRUCTION ASSOCIATED WITH CRS+HIPEC PROCEDURES
8.1 | Distal ureter resection (short segment) and partial cystectomy. E-E ureteroureteral anastomosis.
8.2 | Distal uréter resection. Ureterocystostomy: Psoas hitch (I)
8.3 | Distal uréter resection. Ureterocystostomy: Psoas hitch (II)
8.4 | Distal uréter resection. Ureterocystoplasty: Boari flap.
8.5 | Right ureteral reconstruction with appendiceal interposition
8.6 | Left ureteral reconstruction with appendiceal interposition
8.7 | Bilateral ureteral reconstruction with double bladder flap (“bicornuate bladder”)
8.8 | Abdominal ureter resection. Interposition of small bowel between both ureteral stumps
8.9 | Abdominal ureter resection. Interposition of small bowel between ureter and bladder
8.10 | Bladder augmentation with cecal plasty
8.11 | Transureteroureterostomy (“ureteral crossover”)
8.12 | Bilateral ureterosigmoidostomy
8.13 | Incontinent urinary diversion. Ileal conduit. Bricker (I)
8.14 | Incontinent urinary diversion. Ileal conduit. Bricker (II)
8.15 | Continent urinary diversion. Indiana pouch technique
Chapter 9
Digestive reconstruction techniques after massive bowel resection
(and avoid rapid bowel emptying)
CONTENTS
- 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
VIDEO ÍNDEX
DIGESTIVE RECONSTRUCTION TECHNIQUES TO AVOID "SHORT BOWEL SYNDROME"
9.1 | Interposition of an antiperistaltic jejunal segment between the residual proximal jejunum and the transverse colon. Post-CRS intestinal reserve less than one meter
9.2 | Interposition of an antiperistaltic segment of small intestine between jejunum and transverse colon. Intestinal remnant less than one meter
9.3 | Antiperistaltic small bowel interposition following extensive intestinal resection due to PM in clinical context of acute abdomen
9.4 | Antipersistaltic interposition of two intestinal segments. Intestinal reserve less than one meter
9.5 | Interposition of an antiperistaltic transverse colon segment between jejunum and rectum
9.6 | Cecal interposition between small intestine and rectum
9.7 | Multiple iso and antiperistaltic interpositions of small bowel and colon following extensive resection with minimal intestinla remnant. Scalextric” technique
Chapter 10
Pelvic exenteration associated with CRS+HIPEC
CONTENTS
- 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
VIDEO ÍNDEX
PELVIC EXENTRATION ASSOCIATED WITH CRS+HIPEC
10.1 | Posterior Pelvic Exenteration (I). En bloc resection of the lower abdominal and pelvic structures.
10.2 | Posterior Pelvic Exenteration (II). En bloc resection of the upper and lower abdominal structures. Techniques for right colon transposition into the pelvis
10.3 | Supra-sphincteric Pelvic Exenteration (without digestive or urinary stoma). Bladder reconstruction using an isolated sigmoid segment
10.4 | Supra-sphincteric Pelvic Exenteration (without digestive or urinary stoma). Bladder reconstruction using a defunctionalized ileal segment
10.5 | Posterior Pelvic Exenteration with en bloc resection of small bowel and subtotal colectomy. Ileo-rectal anastomosis without stoma
10.6 | Anterior Supra-Infrasphincteric Pelvic Exenteration. Colpovulvectomy. Continent urinary diversion (Miami pouch). vaginal reconstruction using defunctionalized ileal loop
10.7 | Total Supra-sphincteric Pelvic Exenteration (without digestive or urinary stoma). Neobladder using ileocecoappendicular segment (appendico-urethral anastomosis). Colorectal anastomosis
10.8 | Posterior Pelvic Exenteration extended to the lateral pelvic wall. Vascular prosthesis placement
10.9 | Total Pelvic Exenteration: Pelvic floor reconstruction with omentoplasty and a myocutaneous flap
Chapter 11
Hyperthermic Intraperitoneal Chemoterapy (HIPEC)
CONTENTS
- 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)
VIDEO ÍNDEX
PELVIC EXENTRATION ASSOCIATED WITH CRS+HIPEC
11.1 | HIPEC: open technique “coliseum“ modality
11.2 | HIPEC and simultaneous Hyperthermic Intrathoracic Chemotherapy (HITHOC)
11.3 | Palliative HIPEC: open technique
11.4 | Laparoscopic CRS+HIPEC
11.5 | Palliative HIPEC. Laparoscopic administration (L-HIPEC)
11.6 | HIPEC: closed technique
Chapter 12
Surgical management of Epithelial Tumors of the Appendix
CONTENTS
- 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)
VIDEO ÍNDEX
SURGERY FOR MUCOCELE AND MUCINOUS TUMORS OF THE APPENDIX
12.1 | Appendiceal mucocele (large, with intact wall and benign histology)
12.2 | Mucinous tumor of the appendix (broad base, perforated with acellular periappendicular mucin and low-grade histology)
12.3 | Mucinous tumor of the appendix (perforated, low-grade, with mucin in the pelvis and absence of peritoneal disease). Female patient
12.4 | Mucinous tumor of the appendix (bulky, perforated, low-grade and with peritoneal implants). Female patient
12.5 | Tumor of the appendix (perforated, low-grade with abundant intraperitoneal mucin and peritoneal implants): classic presentation of PMP syndrome. Female patient
12.6 | Mucinous tumor of the appendix: perforated, low grade without mesenteric lymph node involvement and peritoneal dissemination.)
12.7 | High-grade mucinous of the appendix with mesenteric lymph node and peritoneal dissemination
Chapter 13
CRS+HIPEC in Pseudomyxoma Peritonei (PMP)
CONTENTS
- Incidence, histological variants and clinical manifestations
- Patient selection for CRS+HIPEC treatment
- References articles
- Personal series results
- Conclusions (take-home messages)
VIDEO ÍNDEX
CRS+HIPEC IN LOW-GRADE PSEUDOMYXOMA PERITONEI
13.1 | Low grade PMP (G1): “typical” clinical presentation
13.2 | Low grade PMP (G1): peritoneal and retroperitoneal involvement.
13.3 | Low-grade PMP (G1): presentation as an acute abdomen.
13.4 | Low-grade PMP (G1): Peritoneal and bulky involvement of the inguinal region.
CRS+HIPEC IN HIGH GRADE PSEUDOMYXOMA PERITONEI
13.5 | High-grade PMP (G2)
13.6 | High grade PMP (G2): bulky involvement of all regions. “Two-stage surgical approach”.
13.7 | High grade PMP (G2): massive involvement of all regions. “Maximal Tumor Debulking”.
13.8 | High grade PMP (G3): extensive abdominopelvic involvement. Histology: “signet ring” cell.
Chapter 14
CRS+HIPEC in Malignant Peritoneal Mesothelioma (MPM)
CONTENTS
Incidence, histology and clinical symptoms
Indications and selection criteria for CRS+HIPEC. References articles
Personal series results
Conclusions (take-home messages)
VIDEO ÍNDEX
CRS+HIPEC IN DIFUSE MALIGNANT PERITHONEAL MESOTHELIOMA
14.1 | CRS+HIPEC in multicystic peritoneal mesothelioma: parietal peritonectomies combined with resection of the uterus and adnexa.
14.2 | CRS+HIPEC in epithelioid peritoneal mesothelioma: parietal and “complete” mesenteric peritonectomy (with pneumodissection), implant resection and omentectomy with splenectomy.
14.3 | Epithelioid peritoneal mesothelioma: CRS+HIPEC. Intraperitoneal catheter placement for delayed IP ChT
Chapter 15
CRS+HIPEC in PCs of colorectal origin
CONTENTS
- 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)
VIDEO ÍNDEX
CRS+HIPEC IN PM FROM COLORECTAL CANCER
15.1 | Occlusive right colon neoplasm (stent in situ). Peritoneal and liver disease: CRS and radiofrequency ablation (RFA) of the liver lesion followed by HIPEC and RFA.
15.2 | Metachronous PM of the left colon. Multisegmental bowel obstrution with urinary bladder infiltration: CRS+HIPEC. Demonstration of antegrade colonic lavage technique.
15.3 | Metachronous PM of the colon (signet ring cell histology). Peritoneal disease with extensive involvement of the small bowel and mesentery: CRS+HIPEC. CRS techniques of SB and mesentery.
15.4 | Occlusive rectosigmoid neoplasm with synchronous PM and septic entero-vaginal fistula. En bloc resection of the pelvic structures. Bipartition of the pelvis
15.5 | Recurrence of rectosigmoid neoplasm: extensive intestinal involvement, infiltrative ureteral tumour and LM. CRS, pelvic lymphadenectomy, urinary tract reconstruction and intraoperative RFA of the liver lesion.
15.6 | Recurrence of rectal neoplasm. Peritoneal disease involving abdominal wall, multiple bowel loops and lateral pelvic wall with transmural ureteral involvement: CRS, digestive and urinary reconstruction. Mesenteric plasty and HIPEC
15.7 | Synchronous PM from colon cancer (BRAF-mutated). Extensive peritoneal disease. Adnexal mass: CRS+HIPEC. Demonstration of right colon mobilisation techniques for bowel reconstruction without stoma.
15.8 | Synchronous PM from right colon cancer with retroperitoneal involvement (psoas muscle and proximal ureter). Primary renal tumour. CRS, partial nephrectomy, ureteral resection and urinary tract reconstruction with interposition of tubularised ileal loop.
Chapter 16
CRS+HIPEC in Epithelial Ovarian Cancer (EOC) with peritoneal spread
CONTENTS
- 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)
VIDEO ÍNDEX
CRS+HIPEC IN OVARIAL EPITHERIAL CANCER
16.1 | CRS+HIPEC: Epithelial Ovarian Cancer (FIGO IIIB)
16.2 | CRS+HIPEC: Epithelial Ovarian Cancer (FIGO IIIC)
16.3 | CRS+HIPEC: Epithelial Ovarian Cancer (FIGO IV)
16.4 | CRS+HIPEC: peritoneal recurrence of Epithelial Ovarian Cancer
16.5 | Primary surgical treatment of advanced borderline ovarian cancer
16.6 | CRS+HIPEC: peritoneal recurrence of “borderline” ovarian cancer
CRS+HIPEC IN OTHER GYNECOLOGIC TUMORS
16.7 | CRS+HIPEC in peritoneal recurrence of Endometrial Cancer (surgery and previous RDT)
16.8 | CRS+HIPEC in Peritoneal Recurrence of Primary Peritoneal Serous Carcinoma
16.9 | CRS+HIPEC in peritoneal recurrence of Mucinous Endocervical Adenocarcinoma
16.10 | CRS+HIPEC in uterine sarcoma
16.11 | CRS+HIPEC in Peritoneal Recurrence of Immature Teratoma (G2)
Chapter 17
CRS+HIPEC in PC of gastric origin
CONTENTS
- Mucinous Adenocarcinoma of the Endocervix
- Malignant tumors of the endometrium
- Uterine sarcoma
- Primary Peritoneal Carcinoma
- References articles
- Personal series results
VIDEO ÍNDEX
CRS+HIPEC IN GASTRIC CANCER-RELATED PM
17.1 | CRS+HIPEC for synchronous PM (female patient)
17.2 | CRS+HIPEC for synchronous PM (male patient)
17.3 | CRS+HIPEC for synchronous PM with D2 lymphadenectomy
17.4 | CRS+HIPEC for metachronous PM
17.5 | Iterative CRS+HIPEC. Peritoneal recurrence (colon) and urinary tract involvement
Chapter 18
CRS+HIPEC in PC originating in rare/infrequent tumors
CONTENTS
- 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
VIDEO ÍNDEX
CRS+HIPEC IN PM FROM RARE TUMORS
18.1 | CRS+HIPEC: adenocarcinoma of the small bowel (originating from Meckel’s diverticulum)
18.2 | CRS+HIPEC: recurrence of mucinous urachal tumor
18.3 | CRS+HIPEC: peritoneal recurrence of functional malignant paraganglioma.
18.4 | CRS+HIPEC: Neuroendocrine tumor (NET) of the small bowel
18.5 | Surgical treatment of retroperitoneal sarcoma without sarcomatosis: non-HIPEC
18.6 | CRS+HIPEC: Desmoplastic Small Round Cell Tumor (DSRCT) in male patient.
18.7 | CRS+HIPEC: Desmoplastic Small Round Cell Tumor (DSRCT) in female patient.
18.8 | CRS+HIPEC: PM from Frantz pancreatic tumor.
18.9 | CRS+HIPEC: peritoneal recurrence of globet cell tumor.
18.10 | CRS+HIPEC: PMP originating from a mucinous colon tumor.
Chapter 19
Treatment of Pleuropulmonary Mucinous
CONTENTS
- 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
VIDEO ÍNDEX
THORACIC CRS + HITHOC IN PLEUROPULMONARY MUCINOUS DISEASE (PSEUDOMYXOMA PLEURI)
19.1 | Thoracic CRS + HITHOC for mucinous involvement of the chest wall, parietal and visceral pleura
19.2 | Thoracic CRS + HITHOC in pleural and focal pulmonar parenchymal involvement
Chapter 20
Treatment of Pleuropulmonary Mucinous
CONTENTS
- Causes of treatment failure of CRS+HIPEC
- Indications and patient selection for iCRS+HIPEC
- References articles
- Personal series results
- Conclusions (take-home messages)
VIDEO ÍNDEX
20.1 | iCRS+HIPEC: tumor resection in region 2, including skeletonization of the celiac trunk and hepatic hilum vascular structures
Chapter 21
General Surgeon and Peritoneal Carcinomatosis
CONTENTS
- 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)
VIDEO ÍNDEX
There are no videos available in this chapter
Chapter 22
Implementation Model for a Peritoneal Carcinomatosis Program
CONTENTS
- Peritoneal Carcinomatosis Program of Catalonia, Spain