|
4.1. In case of limited disease dissemination to parietal peritoneum in which one of the following situations a partial parietal peritonectomy restricted to the macroscopically involved regions could be indicated?(more than one alternative allowed)
|
Pseudomyxoma peritonei;
First round: 45,16 % - Second round: 65,63 % |
|
Cystoadenocarcinoma G1 of the appendix;
First round: 74,19 % - Second round: 81,25 % |
|
Cystoadenocarcinoma G2 G3 of the appendix;
First round: 67,74 % - Second round: 78,13 % |
|
Adenocarcinoma of the appendix;
First round: 83,87 % - Second round: 90,63 % |
|
Carcinoid tumor of the appendix;
First round: 83,87 % - Second round: 87,50 % |
|
Mucinous G1 G2 G3 colorectal cancer;
First round: 70,97 % - Second round: 78,13 % |
|
Intestinal colorectal cancer;
First round: 87,10 % - Second round: 90,63 % |
|
Diffuse gastric cancer;
First round: 64,52 % - Second round: 75,00 % |
|
Intestinal gastric cancer;
First round: 70,97 % - Second round: 87,50 % |
|
Serous ovarian cancer;
First round: 80,65 % - Second round: 96,88 % |
|
Mucinous ovarian cancer;
First round: 61,29 % - Second round: 75,00 % |
|
Diffuse malignant mesothelioma;
First round: 29,03 % - Second round: 46,88 % |
|
There is no circumstance in the above mentioned diseases in which a surgically sparing approach could be considered. A complete parietal peritonectomy is indicated in all these situations even in the presence of a localized disease, irrespective of the primary tumor histology.
First round: 0 % - Second round: 0 % |
4.2. In the presence of numerous small metastatic nodules (<2.5mm) in the mesentery, without infiltration, after the completion of cytoreduction in other intra-abdominal districts which approach could be the best one? (just one alternative allowed)
|
cytoreduction with electro evaporization;
First round: 90,32 % - Second round: 100,00 % |
|
sparing policy leaving these residues to be treated by the intraperitoneal chemotherapy.
First round: 9,68 % - Second round: 0 % |
4.3. In the closed abdomen technique for the hyperthermic intraperitoneal chemotherapy which one is the optimal timing for intestinal anastomosis after the peritonectomy?
(just one alternative allowed)
|
Before the perfusion; ([24],[25])
First round: 35,48 % - Second round: 34,38 % |
|
After the perfusion;
First round: 48,39 % - Second round: 53,13 % |
|
The constructive procedure could be performed in any time after the cytoreduction, without a significant impact on the morbidity and/or mortality.
First round: 16,13 % - Second round: 12,50 % |
4.4. Indications of protective proximal ostomies after cytoreductive surgery are not uniform, with no consensus in the literature. When a protective ostomies should be indicated?
(more than one alternative allowed)
|
whenever all rectal resections is performed;([26])
First round: 22,58 % - Second round: 12,50 % |
|
in cases of low anterior resections in which the preservation of the rectum is not possible;([27],[28])
First round: 32,26 % - Second round: 21,88 % |
|
In case of ileo-rectal anastomoses;
First round: 29,03 % - Second round: 15,63 % |
|
the policy for protective stoma could be flexible and the procedure done at surgeon discretion; the performance of unprotected colorectal anastomoses does not influence significantly the morbidity and mortality.([29])
First round: 61,29 % - Second round: 87,50 % |
| [24] Kusamura S, Younan R, Baratti D, Costanzo P, Favaro M, Gavazzi C, Deraco M.
Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer. 2006 Mar 1;106(5):1144-53. |
| [25] Younan R, Kusamura S, Baratti D, Oliva GD, Costanzo P, Favaro M, Gavazzi C, Deraco M. Bowel complications in 203 cases of peritoneal surface malignancies treated with peritonectomy and closed-technique intraperitoneal hyperthermic perfusion. Ann Surg Oncol. 2005 Nov;12(11):910-8. Epub 2005 Sep 21 |
| [26] Verwaal VJ, van Tinteren H, Ruth SV, Zoetmulder FA. Toxicity of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. J Surg Oncol 2004;85:61-7. |
| [27] Moran BJ, Cecil TD. The etiology, clinical presentation, and management of pseudomyxoma peritonei. Surg Oncol Clin N Am 2003; 12:585-603. |
| [28] Sugarbaker PH, Ronnett BM, Archer A, Averbach AM, Bland R, Chang D, et al. Pseudomyxoma peritonei syndrome. Adv Surg 1997;30:233-80. |
| [29] Shen P, Hawksworth J, Lovato J, Loggie BW, Geisinger KR, Fleming RA, Levine EA. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol 2004; 11:178-86. |
|
