Age alone is not a barrier to efficacy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: analysis of 1138 patients from the UK and Ireland Colorectal Peritoneal Metastases Registry.

Background: The management of colorectal peritoneal metastases continues to be a challenge but recent evidence suggests cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve survival. Uncertainty about the relationship between age and tumour biology makes patient selection challenging particularly when reported procedure related morbidity is high and impact on survival outcomes unknown. The UK and Ireland Colorectal Peritoneal Metastases Registry was reviewed to assess the influence of age on efficacy of CRS and HIPEC.

Low Preoperative Serum Albumin Levels Are Associated With Impaired Outcome After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies.

Preoperative hypoalbuminemia is known to be associated with postoperative morbidity and mortality, as well as with poor survival after gastrointestinal cancer surgery. However, limited data exist regarding the prognostic significance of hypoalbuminemia in patients with peritoneal metastases undergoing cytoreductive surgery, combined with perioperative intraperitoneal chemotherapy. We performed a systematic literature review of the previously published studies addressing the potential association between preoperative albumin levels and overall surgical outcomes after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancies.

The transition from primary colorectal cancer to isolated peritoneal malignancy is associated with an increased tumour mutational burden.

Colorectal Peritoneal metastases (CPM) develop in 15% of colorectal cancers. Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS & HIPEC) is the current standard of care in selected patients with limited resectable CPM. Despite selection using known prognostic factors survival is varied and morbidity and mortality are relatively high.

Malnutrition is associated with adverse postoperative outcome in patients undergoing elective colorectal cancer resections.

Purpose: Malnutrition results in a significant increase in postoperative morbidity and mortality after abdominal surgery. Apart from the anthropometric assessments, malnutrition can be also assessed using laboratory scores, with the most widely used being Onodera's Prognostic Nutritional Index (PNI). The purpose of our study was to assess if the presence of malnutrition as calculated by the Onodera's PNI was associated with higher postoperative morbidity after elective colorectal cancer resection.

Urinary tract involvement in peritoneal metastatic disease: Is this a contraindication to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?

Urinary tract involvement in resectable peritoneal malignancies might require extensive resections and reconstructions in the genitourinary tract during the performance of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), a fact which could impair the postoperative course and survival of these patients. We performed a review of the literature to assess whether urinary tract involvement in patients with peritoneal metastases undergoing CRS and HIPEC could affect the postoperative outcomes with respect to morbidity, mortality and survival rates, identifying a total of 6 retrospective studies addressing these clinical questions. Despite their heterogeneity, the existing studies demonstrate that despite a possible increase in postoperative complications when urological procedures are required as part of cytoreduction, survival outcomes do not seem to be affected.

The Role of Neoadjuvant and Adjuvant Systemic Chemotherapy with Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Systematic Review.

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for colorectal peritoneal metastases (CPM), increasing overall survival in selected patients. The aim of this systematic review was to assess the effect of neoadjuvant and adjuvant systemic chemotherapy on overall survival in patients with CPM undergoing CRS and HIPEC, compared with those who receive CRS and HIPEC alone.

Methods: A systematic literature review was performed using the PubMed database, and the preferred reporting items for systematic reviews and meta-analyses guidelines formed the structure of the review.

Management of colorectal cancer patients at high risk of peritoneal metastases.

Purpose: Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic dissemination is termed "peritoneal metastases" (PM). Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a radical strategy to treat selected CRC patients with PM. Studies suggest that identification of CRC patients at high risk of PM may lead to earlier treatment strategies and improve survival in this subset of patients.

Hypercoagulation in colorectal cancer: what can platelet indices tell us?

Colorectal cancer, as all solid malignancies, is accompanied by changes in the haemostatic mechanism favoring the establishment of a thrombotic potential, with platelets playing a key-role in this framework; they further link colorectal cancer progression and hypercoagulation with the immune-response against the neoplastic spread. Under this rationale, various studies have assessed the use of platelet indices as prognostic markers of the biological behavior of colorectal cancer, demonstrating significant results. We herein attempt to summarize in a narrative and critical approach the relevant available data and the underlying pathophysiology, stressing the necessity of a more thorough understanding and future implementation of platelet indices in all stages of care we deliver to colorectal cancer patients.

Colorectal cancer: seed and soil hypothesis revisited.

The local growth and metastatic potential of colorectal cancer is the outcome of a dynamic balance between cancer cells and the immune system, at both a local and systemic level, summarized as the "seed and soil" hypothesis. Until recently, the staging and treatment approaches for colorectal cancer appeared to be orientated predominantly to the 'seed' component, virtually neglecting, in daily clinical practice, the impact of the 'soil' in the natural course of the disease. We are currently witnessing an increasing amount of evidence, spanning from clinical to laboratory research, which highlight that cancer growth and metastasis is the result of the dynamic balance between the disease itself and the impaired function of the immune system.

Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI Trial).

Objective: To determine the clinical effectiveness of wound edge protection devices in reducing surgical site infection after abdominal surgery.

Design: Multicentre observer blinded randomised controlled trial.

Participants: Patients undergoing laparotomy at 21 UK hospitals.

Systematic review of the clinical effectiveness of wound-edge protection devices in reducing surgical site infection in patients undergoing open abdominal surgery.

Objective: Assess the existing evidence on the clinical effectiveness of wound-edge protection devices (WEPDs) in reducing the surgical site infection (SSI) rate in patients undergoing open abdominal surgery.

Background: Surgical site infections are a common postoperative complication associated with considerable morbidity, extended hospital stay, increased health care costs, and reduced quality of life. Wound-edge protection devices have been used in surgery to reduce SSI rates for more than 40 years; however, they are yet to be cited in major clinical guidelines addressing SSI management.

Reduction of surgical site infection using a novel intervention (ROSSINI): study protocol for a randomised controlled trial.

Background: Surgical site infection (SSI) is a common complication following abdominal surgery. It is associated with considerable morbidity and mortality, and its management results in significant cost to health services within both primary and secondary care. Some surgeons believe that the use of a wound-edge protection device may reduce the incidence of SSI.

Operative findings, early complications, and long-term survival in 456 patients with pseudomyxoma peritonei syndrome of appendiceal origin.

Background: Pseudomyxoma peritonei syndrome is a clinical entity characterized by mucinous ascites usually originating from a perforated mucinous appendiceal tumor. Currently optimal therapy is considered complete macroscopic tumor removal (complete cytoreduction) combined with heated intraperitoneal chemotherapy. When complete cytoreduction is not achievable, major tumor debulking is undertaken.

Small bowel volvulus in a patient with chronic idiopathic intestinal pseudo-obstruction.

Chronic idiopathic intestinal pseudo-obstruction (CIIP) is a rare syndrome of ineffectual gut motility associated with clinical, endoscopic and radiological exclusion of mechanical causes, as well as evidence of air-fluid levels in distended bowel loops. A case of small bowel volvulus in a patient with an established diagnosis of CIIP is presented. The case is illustrated by images of operative findings and computed tomography scan reconstruction, showing the classical appearances of small bowel volvulus.