Cytoreductive surgery

Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during platinum era a meta-analysis. ] Clin Oncol 2002 20 1248-1259. 

Levine EA, Stewart JH, Russell GB, Geisinger KR, Loggie BL, Shen P (2007) Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy experience with 501 procedures. Journal of the American College of Surgeons 204 943-953. 

Stewart JH, Shen P, Russell GB, Bradley RF, Hundley JC, Loggie BL, Geisinger KR, Levine EA (2006) Appendiceal neoplasms with peritoneal dissemination outcomes after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. Annals of Surgical Oncology 13 624-634. 

SECONDARY CYTOREDUCTIVE SURGERY AND INTERVAL SURGICAL DEBULKING... 

The overall effect of interval debulking is influenced by several factors including initial response to chemotherapy, the amount of residual disease before and after second-look surgery, and the presence of microscopic residual disease. The results of recent trials suggest that secondary surgical cytoreduction does not prolong survival in patients who are treated with maximal primary cytoreductive surgery followed by appropriate postoperative chemotherapy. 

Patients with advanced disease should undergo a total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, node sampling, and aggressive cytoreductive surgery. However, there is ht-tle evidence that adjuvant chemotherapy or radiotherapy improves outcome. There have been no controlled stndies comparing postoperative treatment with no treatment. 

Goodman HM, Harlow BL, Sheets EE, et al. The role of cytoreductive surgery in the management of stage IV epithelial ovarian carcinoma. Gynecol Oncol 1992 46 367-371. 

Survival correlates with the disease-free interval before tumor recurrence and the residual disease following primary cytorective surgery [4, 44]. Patients who have a disease-free interval of more than 6 months or 1 year have a markedly improved prognosis. These patients have also been shown to benefit from following secondary cytoreductive surgery [4]. 

After cytoreductive surgery is complete closed suction drains will be placed in each quadrant of the abdomen as well as an inflow drain to apply the drug solution. These drains are connected to a specific device that allows establishment of an isolated circuit under heated conditions. Flow rates are a 1500 ml/... 

Due to rapid tumor progression peritoneal carcinosis is combined with a fast deterioration in general condition. This makes clinicians abandon further aggressive treatments. Recently, a curative approach appropriate for selected patients has been reported in the peer-reviewed literature. This treatment calls for the complete removal of all visible cancer from the abdomen and pelvis followed by intraopera-tively given intraperitoneal chemotherapy. The aim of this therapeutic endeavor is to eliminate macroscopic tumor formation by cytoreductive surgery and microscopic tumor remnants by intraoperative chemotherapy. 

Cytoreductive surgery means complete removal of all visible tumors in the peritoneal cavity by use of multivisceral resection of bulky tumor formation plus resection of infiltrated peritoneum, called peritonectomy. These peritonectomy procedures are used in the areas of visible cancer progression in... 

Bulky involvement of visceral peritoneum frequently requires resection of a portion of the stomach, small intestine or colorectum. In order to adequately perform cytoreductive surgery a specific preparation technique should be used, called lasermode electrosurgery. This technique allows the minimizing of blood loss, and due to a rim of heated necrosis cancer cells are less likely to adhere at resected areas. 

For second-line treatment no definite therapy has yet been defined. The combination of secondary cytoreduction plus hyperthermic peritoneal perfusion constitutes a feasible and effective option for this subset of patients. Several phase II trials have been published showing a positive effect of second cytoreductive surgery on survival of patients with recurrent or persistent epithelial ovarian cancer. At this moment the role intraoperative hyperthermic peritoneal perfusion is not clear and has to be determined in a prospective randomized trial. 

Kecmanovic DM, Pavlov MJ, Kovacevic PA et al (2003) Cytoreductive surgery for ovarian cancer. Eur J Surg Oncol... 

Zanon C, Clara R, Chiappino I et al (2004) Cytoreductive surgery and intraperitoneal chemohyperthermia for recurrent peritoneal carcinomatosis from ovarian cancer. World J Surg 28(10) 1040-1045... 

Additional indications for resection/ablation are isolated liver metastases of hreast cancer, renal cell cancer and Wilms tumors, sarcoma, melanoma (mostly of ocular origin), and, rarely, other G1 cancers neuroendocrine liver metastases are a frequent indication for curative resection or cytoreductive surgery in combination with the primary tumor location and extrahepatic metastases. 

---