Patterns of spread of recurrent intraabdominal sarcoma.

A prominent site for recurrence of retroperitoneal and visceral sarcoma is the abdominal cavity. In an attempt to understand the causation of local and regional recurrence, 21 sarcoma patients who had previously undergone "complete" surgical removal of the primary tumor were prospectively studied. Data were obtained retrospectively from the first operation and prospectively from the reoperative procedure at the Washington Cancer Institute.

Peritoneal-plasma barrier.

The peritoneal-plasma barrier is a pharmacologic entity of importance for treatment planning in patients with malignant tumours confined to the abdominal cavity. This physiologic barrier limits the resorption of drugs from the peritoneal cavity into the blood. The sequestration of chemotherapeutic agents improves their locoregional cytotoxicity and reduces their systemic toxicity.

Pharmacokinetics of the peritoneal-plasma barrier after systemic mitomycin C administration.

The peritoneal plasma barrier (PPB) is a pharmacologic entity of importance for treatment planning in patients with malignant tumors confined to the abdominal cavity. We have examined the pharmacokinetics of the PPB by sampling abdominal fluid following intravenous mitomycin C (MMC) administration. The study included 15 cycles of treatment in seven patients with peritoneal carcinomatosis from colorectal cancer.

Peritoneal carcinomatosis from adenocarcinoma of the colon.

Peritoneal carcinomatosis is a major cause of surgical treatment failure in patients with colorectal cancer. Patients with this condition have in the past always had a lethal outcome. We reviewed the results of 56 consecutive patients treated by the cytoreductive approach.

Peritoneal mesothelioma: treatment approach based on natural history.

A more modern treatment strategy for diffuse malignant peritoneal mesothelioma may be suggested (figure 3). Clinical suspicion of diffuse malignant mesothelioma (peritoneal carcinomatosis) calls for laparoscopy with evaluation of parietal and visceral peritoneum and multiple biopsies sufficient for definitive histologic diagnosis. Cytologic examination of ascitic fluid is not likely to be of benefit.

Peritoneal carcinomatosis: natural history and rational therapeutic interventions using intraperitoneal chemotherapy.

The rationale and the treatment strategies for peritoneal carcinomatosis have gained prominence over the last decade. Their definite contribution to the management of gastrointestinal cancer has been established. The significant contributions are summarized in Table 7.

Recurrent intraabdominal cancer causing intestinal obstruction: Washington Hospital Center experience with 42 patients managed by surgery and intraperitoneal chemotherapy.

Reoperative surgery was used as a treatment for patients with recurrent obstructing cancer. In this group of patients intraperitoneal chemotherapy was used in an attempt to prolong the beneficial effects of treatment. This aggressive approach may be recommended irrespective of patient performance status if the patient is not terminally ill.

Clinical determinants of treatment failure in patients with pseudomyxoma peritonei.

Pseudomyxoma peritonei is a mucinous cancer of low biologic aggressiveness that disseminates widely throughout the abdominopelvic cavity prior to diagnosis. Complete control of the disease process on peritoneal surfaces should translate into long-term disease-free survival. In a series of 120 patients with pseudomyxoma peritonei, 46 were defined as treatment failures after cytoreductive surgery and regional chemotherapy.

Pseudomyxoma peritonei.

Pseudomyxoma peritonei is a clinical entity that has lead to much confusion about its etiology, clinical manifestations, treatment, and prognosis. Pseudomyxoma peritonei is currently defined as a grade I mucinous adenocarcinoma that arises from a primary appendiceal adenoma. The clinical entity is defined by a redistribution phenomenon.

Prognostic features for peritoneal carcinomatosis in colorectal and appendiceal cancer patients when treated by cytoreductive surgery and intraperitoneal chemotherapy.

Peritoneal carcinomatosis from appendical or colorectal cancer has been regarded as a fatal clinical entity. We used cytoreductive surgery and intraperitoneal chemotherapy to treat consecutive patients with peritoneal carcinomatosis. There were 43 colorectal and 104 appendiceal cancer patients.

Complete parietal and visceral peritonectomy of the pelvis for advanced primary and recurrent ovarian cancer.

Advanced primary and recurrent ovarian cancer within the pelvis presents a difficult oncologic problem in management. Based on a failure analysis of ovarian cancer, a new procedure was devised for the complete surgical removal of all visceral and parietal pelvic surfaces. Resections included the uterus, ovaries, rectosigmoid colon, and the complete pelvic peritoneum, including the cul-de-sac of Douglas.

Pathobiology of peritoneal carcinomatosis from ovarian malignancy.

A detailed analysis of the patterns of treatment failure of ovarian malignancy may lead to a more comprehensive understanding of the natural history of the disease. A hypothesis was generated that suggests treatment failure was caused by ovarian cancer persistence and by reimplantation of tumor emboli trapped within surgically traumatized tissues. Nine ovarian cancer patients who had previously undergone standard surgical removal of the primary cancer were prospectively studied at a reoperative procedure.

Surgically directed chemotherapy: heated intraperitoneal lavage with mitomycin C.

This chapter reported the pharmacokinetics and the toxicities of mitomycin-c (MMC) when administered as a hyperthermic intraperitoneal lavage after surgical resection of advanced primary or recurrent gastrointestinal cancer. Pharmacologic studies were performed in 10 patients and all adverse reactions were recorded in 20 patients. These 20 patients had advanced gastrointestinal malignancies with peritoneal carcinomatosis and underwent cytoreductive surgery prior to intraperitoneal lavage.

Intraoperative hyperthermic lavage with cisplatin for peritoneal carcinomatosis and sarcomatosis.

Intraoperative hyperthermic lavage with cisplatin was studied in 8 patients with peritoneal carcinomatosis and sarcomatosis. A dose of 50 mg/m2 of cisplatin used for 2 hours with an intraperitoneal temperature of 41 degrees to 43 degrees C was used. Pharmacokinetic studies showed that cisplatin left the abdomen and pelvis by simple diffusion with a half life of 48 minutes in the peritoneal fluid.

Early postoperative intraperitoneal Adriamycin as an adjuvant treatment for visceral and retroperitoneal sarcoma.

Early postoperative intraperitoneal Adriamycin (doxorubicin) may be an excellent adjuvant treatment that, when combined with complete surgical removal, may markedly improve the survival of patients with visceral and retroperitoneal sarcoma. Even if its only effect were to decrease the incidence of sarcomatosis, a markedly improved quality of life for these patients would be achieved. We suggest that these improved local treatments should be combined with aggressive systemic therapy in order to develop an optimal adjuvant approach to the treatment of sarcoma.

Abdominal computed tomographic scan in the selection of patients with mucinous peritoneal carcinomatosis for cytoreductive surgery.

Background: Cytoreductive surgery and intraperitoneal chemotherapy have been used to treat peritoneal carcinomatosis. A complete surgical resection is required for optimal results to be achieved. This study evaluated the preoperative computed tomographic (CT) findings in patients with mucinous peritoneal carcinomatosis in order to predict the probability of a complete resection.

Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to "pseudomyxoma peritonei".

Pseudomyxoma peritonei (PMP) is a poorly understood condition characterized by mucinous ascites and mucinous implants diffusely involving the peritoneal surfaces. There is considerable debate regarding the definition, pathology, site of origin, and prognosis of PMP. We analyzed the clinicopathologic features of 109 cases of multifocal peritoneal mucinous tumors to develop a pathologic definition of cases characterized by the clinical condition PMP.

Prognostic implications of chemoresistance-sensitivity assays for colorectal and appendiceal cancer.

A major problem with pharmacologic treatments for cancer is the unpredictable nature of the clinical response. Therefore, many patients are treated but few benefit from chemotherapy. Selection of patients for drug treatment would greatly benefit both responders and nonresponders.

Cancer recurrence following laparoscopic colectomy. Report of two patients treated with heated intraperitoneal chemotherapy.

Purpose: Use of laparoscopic techniques for resection of colon and rectal cancer has raised considerable controversy. There is increasing concern that wound recurrence and peritoneal dissemination may represent a potentially fatal complication of this technique.

Methods: The surgical literature was reviewed, and clinical course of two patients is presented.

Pharmacokinetic studies of intraaortic stop-flow infusion with 14C-labeled mitomycin C.

This pharmacokinetic study attempted to improve the exposure of gastrointestinal tract tissues to chemotherapy by increasing the transit time of a first pass of a drug through the vascular system. Bolus infusion of 9 mg mitomycin (MMC) mixed with 1 mg of MMC labeled by 50 microCi of 14C was performed in 18 mongrel dogs. Pharmacokinetics of MMC in peripheral, portal, and aortic blood were studied under different types of major vessel occlusion.

Intraaortic stop-flow infusion: pharmacokinetic feasibility study of regional chemotherapy for unresectable gastrointestinal cancers.

Background: This study attempted to increase the exposure of gastrointestinal tract tissues to chemotherapy by prolonging the first pass of intraaortically administered drug by temporary occlusion of vascular structures.

Methods: Bolus infusion of 14C-labeled mitomycin C (MMC) mixed with unlabeled MMC was performed in dogs. Distribution of MMC in gastrointestinal tract tissues was studied under different types of major vessel occlusion.

Pseudomyxoma peritonei in women: a clinicopathologic analysis of 30 cases with emphasis on site of origin, prognosis, and relationship to ovarian mucinous tumors of low malignant potential.

Pseudomyxoma peritonei (PMP) is a poorly understood condition characterized by the accumulation of abundant mucinous material within the peritoneal cavity and associated with a mucinous tumor of the gastrointestinal tract or ovaries. Recently there has been considerable debate over the primary site of origin of the tumor associated with PMP in women. Some investigators have proposed a primary site in the ovaries, whereas others favor the gastrointestinal tract or the peritoneum.

The use of drains in elective surgery for colorectal cancer: always, never or selectively?

Indications for the use of drains of the peritoneal and pelvic cavity following elective surgery for colorectal cancer provide a source of continuing controversy. Analysis of the experimental and clinical studies indicates that routine drainage in needless with standard elective surgery for colon cancer. Some risk factors justify the selective use of drains when there is an increased risk of postoperative morbidity.

Surgical technique and colorectal cancer: impaction on local recurrence and survival.

The survival of patients with large bowel cancer continues to improve. This may be explained by an evolution in surgical technique for cancer resection. Survival statistics between 30% and 75% can be found for the same stage of disease by different surgeons and at different institutions.

Follow-up of colorectal cancer.

Surveillance for a second primary colon or rectal cancer, detection and treatment of recurrent disease, and health maintenance are the essential components of follow-up of a patient population with potentially curative resection of a primary large bowel cancer. The value of follow-up programs have been extensively studied with colorectal cancer. Of 100 colorectal cancer patients in a follow-up program, approximately 20 patients should have prolongation of life as a result of surveillance, detection and treatment, and health maintenance.