scholarly journals Staging laparoscopy and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for peritoneal metastasis: safe access to the abdomen

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Torben Glatz ◽  
Philipp Horvath ◽  
Sven A. Lang ◽  
Rami Archid ◽  
Giorgi Nadiradze
Keyword(s):  
Peritoneal Metastasis ◽  
Saline Solution ◽  
Palliative Therapy ◽  
Staging Laparoscopy ◽  
Previous Surgery ◽  
Innovative Drug ◽  
Delivery Technique ◽  
Bowel Lesion ◽  
Access Technique ◽  
Safe Access

AbstractBackgroundPressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is an innovative drug delivery technique. Most common indication is palliative therapy of peritoneal metastasis of gastrointestinal and gynecological origin in the salvage situation. Access to the abdomen is the critical step of the procedure, since most patients had previous surgery. Potential pitfalls include non-access because of adhesions, bowel access lesions and postoperative subcutaneous toxic emphysema.MethodsWe propose a technique, the “finger-access technique” that might prevent largely these pitfalls. A minilaparotomy of 3 cm is performed in the midline, a finger introduced into the abdomen and a 5-mm double-balloon trocar (no Hasson trocar) is placed under finger protection at some distance of the first incision. The fascia of the minilaparotomy, not the skin, is then closed. The abdomen is insufflated with CO2 and tightness is controlled with saline solution in the minilaparotomy. A second 10–12 mm trocar is then introduced under videoscopic control. The first trocar is then visualized through the second one to exclude a bowel lesion during first access.Results and conclusionsIn our hands, this access technique has shown to be safe and effective.

Conversion Surgery for Gastric Cancer with Peritoneal Metastasis Based on the Diagnosis of Second-Look Staging Laparoscopy

2018 ◽  
Vol 23 (9) ◽  
pp. 1758-1766 ◽  
Author(s):  
Masaki Nakamura ◽  
Toshiyasu Ojima ◽  
Mikihito Nakamori ◽  
Masahiro Katsuda ◽  
Toshiaki Tsuji ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Metastasis ◽  
Staging Laparoscopy ◽  
Conversion Surgery ◽  
Second Look

The role of staging laparoscopy in type 4 gastric cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 35-35
Author(s):  
Norihiko Sugisawa ◽  
Etsuro Bando ◽  
Yuichiro Miki ◽  
Rie Makuuchi ◽  
Hironobu Goto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Metastasis ◽  
Invasive Procedure ◽  
Staging Laparoscopy ◽  
Peritoneal Cytology ◽  
Clinical Imaging ◽  
Surgical Interventions ◽  
Peritoneal Lavage Cytology ◽  
Positive Peritoneal Cytology

35 Background: In type 4 gastric cancer, the incidence of peritoneal metastasis which was unexpectedly found during surgery was as high as 40 percent. It is very difficult to detect peritoneal metastasis in clinical imaging such as computed tomography or ultrasound before operation. Staging laparoscopy (SL) is considered to be an only minimal invasive procedure to detect peritoneal metastasis. However, the significance of SL had not yet been fully elucidated. The aim of this study is to assess the role of SL in type 4 gastric cancer. Methods: From September 2002 to March 2012, a total of 169 patients with type 4 gastric cancer who were diagnosed as not having distant metastasis in clinical imaging were enrolled in this study. SL was performed for 56 patients, and the other 113 patients underwent open laparotomy (OL) without SL. We retrospectively examined the incidence of peritoneal metastasis and positive peritoneal cytology and treatment courses in patients who underwent SL and OL. Results: In 56 patients undergoing SL, 23 (41%) had peritoneal metastasis and 40 (71%) had positive peritoneal cytology. Similarly, 54 (48%) had peritoneal metastasis and 86 (76%) had positive peritoneal cytology in 113 patients undergoing OL. There were no significant differences of the incidence of peritoneal metastasis and positive peritoneal cytology between the two groups. Subsequent treatments after SL or OL were diverse depends on patients condition and participating clinical trials, however, 17 (32%) in SL group and 13 (12%) in OL group were treated without surgical interventions. There was no morbidity and mortality in both SL group and OL group. In SL group, open surgery was performed soon afterword in 39 patients. Among them, 2 patients was failed to detect peritoneal metastasis by SL. Therefore the accuracy of detecting peritoneal metastasis in SL was 23/25 (92%). Conclusions: In type 4 gastric cancer, the incidence of peritoneal metastasis was around 40% and positive peritoneal lavage cytology was around 70% in both SL and OL. As SL is less invasive than OL, SL appears to be a useful way to detect peritoneal seeding and establish treatment strategy in patients with type 4 gastric cancer.

scholarly journals Study protocol: phase 1 dose escalating study of Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) with oxaliplatin in peritoneal metastasis

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Guowei Kim ◽  
Hon Lyn Tan ◽  
Elya Chen ◽  
Siok Chin Teo ◽  
Clarisse Jia Min Jang ◽  
...  
Keyword(s):  
Phase I ◽  
Intraperitoneal Chemotherapy ◽  
Peritoneal Metastasis ◽  
Peritoneal Cancer Index ◽  
Phase 1 ◽  
Pathologic Response ◽  
Homogeneous Distribution ◽  
Pharmacokinetic Analysis ◽  
Dose Escalation Study ◽  
Delivery Technique

AbstractBackgroundPressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) is a novel laparoscopic intraperitoneal chemotherapy technique, with advantages such as homogeneous distribution of aerosol and deeper tissue penetration. Thus far, PIPAC oxaliplatin has been administered at an arbitrary dose of 92 mg/m2.AimWe aim to determine the dose-related safety profile and tolerability of PIPAC oxaliplatin using an evidence-based approach. The secondary aim is to evaluate clinic-pathologic response and the pharmacokinetic profile.MethodsThis is a phase I 3+3 dose escalation study for gastric and colorectal cancer with predominant peritoneal metastasis starting at a dose of 45 mg/m2. Safety is assessed according to Clavien-Dindo Classification and Common Terminology Criteria for Adverse Events (version 4.0). Clinico-pathologic response is assessed using the Peritoneal Regression Grading Score, Peritoneal Cancer Index, and Response Evaluation Criteria In Solid Tumour criteria (version 1.1). Pharmacokinetic analysis is performed using Inductively Coupled Plasma-Mass Spectrometry assay. This trial is registered on ClinicalTrials.gov (NCT03172416).ConclusionsThis phase I study can provide the scientific basis to identify the optimal dose for PIPAC with oxaliplatin such that the benefits of this novel and promising intraperitoneal chemotherapy delivery technique can be maximized.

scholarly journals Response to: “timing of administration of indocyanine green for fluorescence-guided surgery in pancreatic cancer: response to Shirakawa et al.”

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sachiyo Shirakawa ◽  
Hirochika Toyama ◽  
Masahiro Kido ◽  
Takumi Fukumoto
Keyword(s):  
Pancreatic Cancer ◽  
Indocyanine Green ◽  
Hepatic Metastasis ◽  
Peritoneal Metastasis ◽  
Near Infrared ◽  
Staging Laparoscopy ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
Near Infrared Fluorescence Imaging ◽  
White Light Imaging

Abstract This is the response article to correspondence article received for our published article in BMC surgery titled “A prospective single-center protocol for using near-infrared fluorescence imaging with indocyanine green during staging laparoscopy to detect small metastasis from pancreatic cancer”. Peter L. Labib, MBChB pointed out the necessity to administer indocyanine green intravenously in separate timing for detection of metastasis in liver and peritoneum. Preoperative injection is suitable to detect hepatic metastasis and intraoperative injection is reported to be well suited to detect peritoneal metastasis. However, we could not find the usefulness of intraoperative injection of indocyanine green for detecting peritoneal metastasis in cases with staging laparoscopy prior to this study. We employed this study protocol with only preoperative injection of indocyanine green to simplify the procedure with consideration of probably more frequent cases of hepatic metastasis that is difficult to detect with white-light imaging than those of peritoneal metastasis.

Condition mimicking peritoneal metastasis associated with preoperative staging laparoscopy in advanced gastric cancer

2018 ◽  
Vol 12 (4) ◽  
pp. 457-460
Author(s):  
Yuki Ushimaru ◽  
Yoshiyuki Fujiwara ◽  
Yuji Shishido ◽  
Takeshi Omori ◽  
Yoshitomo Yanagimoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Peritoneal Metastasis ◽  
Preoperative Staging ◽  
Staging Laparoscopy

scholarly journals Peritoneal Metastasis After Treated With Abemaciclib Plus Fulvestrant for Metastatic Invasive Lobular Breast Cancer: A Case Report and Review of the Literature

2021 ◽  
Vol 12 ◽  
Author(s):  
Hong-Fei Gao ◽  
Jun-Sheng Zhang ◽  
Qiang-Zu Zhang ◽  
Teng Zhu ◽  
Ci-Qiu Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Drug Resistance ◽  
Peritoneal Metastasis ◽  
Lobular Carcinoma ◽  
Palliative Therapy ◽  
Metastatic Breast ◽  
Peritoneal Metastases ◽  
Breast Cancer Patients ◽  
Adequate Treatment ◽  
Metastatic Lesions

Peritoneal metastases from invasive lobular carcinoma (ILC) of breast are uncommon and usually related to poor prognosis due to difficulty of detection in clinical practice and drug resistance. Therefore, recognizing the entities of peritoneal metastases of ILC and the potential mechanism of drug resistance is of great significance for early detection and providing accurate management. We herein report a case of a 60-year-old female who presented with nausea and vomiting as the first manifestation after treated with abemaciclib (a CDK4/6 inhibitor) plus fulvestrant for 23 months due to bone metastasis of ILC. Exploratory laparotomy found multiple nodules in the peritoneum and omentum, and immunohistochemistry confirmed that the peritoneal metastatic lesions were consistent with ILC. Palliative therapy was initiated, but the patient died two months later due to disease progression with malignant ascites. Whole exome sequencing (WES) was used to detect the tumor samples and showed the peritoneal metastatic lesions had acquired ESR1 and PI3KCA mutations, potentially explaining the mechanism of endocrine therapy resistance. We argue that early diagnosis of peritoneal metastasis from breast cancer is crucial for prompt and adequate treatment and WES might be an effective supplementary technique for detection of potential gene mutations and providing accurate treatment for metastatic breast cancer patients.

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