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Hyperthermic chemotherapy applies thermal energy to both abdominal wall as well as the intra-abdominal viscera. The combination of the hyperthemia, chemotherapy and cytoreductive surgery (CRS) is associated with a defined risk of abdominal wall and intestinal morbidity reported to be as high as 15%, respectively to date, no studies have evaluated t...
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Background
Gastric cancer (GC) with peritoneal carcinomatosis (PC) is traditionally considered a terminal stage of the disease. The use of a multimodal treatment, including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), can benefit these patients. Our goal was to evaluate the morbidity and survival outcomes of th...
Up to 25% of patients with metastatic colorectal cancer (CRC) present with peritoneal carcinomatosis (PC) as the only site of metastases. Complete cytoreductive surgery (CCRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) aims for locoregional disease control and long-term survival. Oxaliplatin is effective for treating advanced CRC...
This randomized phase III study was to evaluate the efficacy and safety of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis (PC) from gastric cancer.
Sixty-eight gastric PC patients were randomized into CRS alone (n = 34) or CRS + HIPEC (n = 34) receiving cisplatin 120...
BACKGROUND
Gallbladder cancer (GC) is a common malignant tumor and one of the leading causes of cancer-related death worldwide. It is typically highly invasive, difficult to detect in the early stages, and has poor treatment outcomes, resulting in high mortality rates. The available treatment options for GC are relatively limited. One emerging trea...
Survival of patients after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy for appendiceal neoplasms is projected by conventional overall survival (OS) curves that do not address the survival time a patient has already accrued. We sought to study the conditional survival (CS) after CRS, contingent on patients surviving a fixed d...
Citations
... Intraperitoneal perfusion is another type of hyperthermia therapy to treat a metastatic tumor in the abdominal area via using hot liquid to raise the temperature to around 45 °C 239 for treatments of various types of cancer, including colorectal and ovarian carcinoma. 252 The hyperthermic intraperitoneal chemotherapy was effective in ovarian cancer treatment 253 and resulted in a faster wound healing after abdominal surgeries than that of using chemotherapy alone. 252 Various in vitro and in vivo studies have indicated the therapeutic and anticancer effects of water bath heat treatment (as a kind of whole-body hyperthermia treatments) for example at 43.5 °C and 45 °C (30 min), 254 47 °C and 37 °C (1 min heat shock), 255 37,39, and 37 °C (24-hr). ...
... 252 The hyperthermic intraperitoneal chemotherapy was effective in ovarian cancer treatment 253 and resulted in a faster wound healing after abdominal surgeries than that of using chemotherapy alone. 252 Various in vitro and in vivo studies have indicated the therapeutic and anticancer effects of water bath heat treatment (as a kind of whole-body hyperthermia treatments) for example at 43.5 °C and 45 °C (30 min), 254 47 °C and 37 °C (1 min heat shock), 255 37,39, and 37 °C (24-hr). 256 As a novel option for cancer patients, combining hyperthermia and chemotherapy at considerably reduced-drug doses can indicate an exceptional efficacy, for example, therapy of breast cancer 249 and ovarian cancer 257 . ...
Chemotherapy is the most prominent route in cancer therapy for prolonging the lifespan of cancer patients. However, its non-target specificity and the resulting off-target cytotoxicities have been reported. Recent in vitro and in vivo studies using magnetic nanocomposites (MNCs) for magnetothermal chemotherapy may potentially improve the therapeutic outcome by increasing the target selectivity. In this review, magnetic hyperthermia therapy and magnetic targeting using drug-loaded MNCs are revisited, focusing on magnetism, the fabrication and structures of magnetic nanoparticles, surface modifications, biocompatible coating, shape, size, and other important physicochemical properties of MNCs, along with the parameters of the hyperthermia therapy and external magnetic field. Due to the limited drug-loading capacity and low biocompatibility, the use of magnetic nanoparticles (MNPs) as drug delivery system has lost traction. In contrast, MNCs show higher biocompatibility, multifunctional physicochemical properties, high drug encapsulation, and multi-stages of controlled release for localized synergistic chemo-thermotherapy. Further, combining various forms of magnetic cores and pH-sensitive coating agents can generate a more robust pH, magneto, and thermo-responsive drug delivery system. Thus, MNCs are ideal candidate as smart and remotely guided drug delivery system due to a) their magneto effects and guide-ability by the external magnetic fields, b) on-demand drug release performance, and c) thermo-chemosensitization under an applied alternating magnetic field where the tumor is selectively incinerated without harming surrounding non-tumor tissues. Given the important effects of synthesis methods, surface modifications, and coating of MNCs on their anticancer properties, we reviewed the most recent studies on magnetic hyperthermia, targeted drug delivery systems in cancer therapy, and magnetothermal chemotherapy to provide insights on the current development of MNC-based anticancer nanocarrier.
... Закрытая техника заключается в установке силиконовых дренажей в брюшную полость после перитонэктомии, закрытии операционной раны и осуществлении гипертермической химиоперфузии. Как правило, ушивается только кожа (для обеспечения контакта раствора химиопрепарата с толщей брюшной стенки по краям разреза), а после завершения процедуры HIPEC брюшная полость открывается вновь, проводятся ее ревизия и санация, формируются необходимые анастомозы, после чего послеоперационная рана ушивается послойно [64]. ...
In recent years сytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) became popular in pediatric oncologic surgery. This procedure is a “treatment of choice” for determined groups of adult patients. The approaches for preoperative diagnostics and surgical technique are well described in adult patients, but not for pediatric surgery, considering limited experience in сytoreductive surgery and HIPEC in children. This review summarizes literature datas of tumor dissemination, diagnostics and technical features in peritonectomy based on tumor localization and analysis of possibility to use these techniques in pediatric patients.
... 19 If the closed technique is chosen, the abdomen is closed and peritoneal tubes are inserted for HIPEC. 23 The abdomen is filled with a carrier solution and heated to achieve an intraabdominal temperature of 41.5-43 degrees Celsius with continuous temperature monitoring. Recommended 14 carrier solutions are isotonic saline or dextrose-based peritoneal solutions. ...
... 19 If the closed technique is chosen, the abdomen is closed and peritoneal tubes are inserted for HIPEC. 23 The abdomen is filled with a carrier solution and heated to achieve an intraabdominal temperature of 41.5-43 degrees Celsius with continuous temperature monitoring. Recommended carrier solutions are isotonic saline or dextrose-based peritoneal solutions. ...
... 19 If the closed technique is chosen, the abdomen is closed and peritoneal tubes are inserted for HIPEC. 23 The abdomen is filled with a carrier solution and heated to achieve an intra-abdominal temperature of 41.5 °C to 43 °C with continuous temperature monitoring. Recommended carrier solutions are isotonic saline or dextrose-based peritoneal solutions. ...
... HIPEC is mainly used after abdominal surgeries, where wound healing resulted from surgery would be delayed with more complications if chemotherapy is used alone, hence the combination therapy is preferred. This technique was applied effectively with colorectal and ovarian origin carcinoma (Boutros et al., 2010). ...
Hyperthermia, sometimes known as thermotherapy or thermal ablation, is a new emerging therapeutic technique that depends on heating the target cells or tissues up to sufficient temperature to destroy them without affecting nearby cells. Hyperthermia is considered as one of the promising treatment regimens for cancer, which works via mechanism believed to be through the damage of microtubules. Many techniques and methods of hyperthermia have been utilized in cancer, especially the superficial, whole body, indocavity, deep and partial body hyperthermia. In addition to being an alternative to the conventional thermal ablation and chemotherapy for cancer treatment, hyperthermia is considered as one of the choices for the treatment of arthritis, wounds, and pain. Research interest on hyperthermia as a treatment procedure is growing from day to day, as a result of which various new possible therapeutic applications are emerging such as heat-controlled gene therapy, heat-enhanced immunotherapy, and vaccination, because these applications depend on the fact that heat interferes with the regulation of cell cycle, DNA repair, and cell apoptosis. Although many materials have been utilized as hyperthermia agents, biomaterials are being considered as an excellent choice due to their significant thermal conductivity, high photothermal conversion efficacy, and many other attractive properties. On the other hand, adequate accumulation of nanoparticles inside tumor cells has also been linked with a successful hyperthermia therapy. This chapter extensively discusses hyperthermia as a treatment strategy, covering various types and techniques of hyperthermia, the possible applications to tackle cancer and the concomitant use of biomaterials and nanoparticles for hyperthermia.
... Some groups have used biological meshes for abdominal wall closure after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. They reported that this technique might prevent subsequent incisional development, but at a cost of high infection rates and even enterocutaneous fistula formation (190,191). ...
Introduction: This review aimed to present common points, intersections, and potential interactions or mutual effects for hernia and cancer. Besides direct relationships, indirect connections, and possible involvements were searched.
Materials and Methods: A literature search of PubMed database was performed in July 2018 as well as a search of relevant journals and reference lists. The total number of screened articles was 1,422. Some articles were found in multiple different searches. A last PubMed search was performed during manuscript writing in December 2018 to update the knowledge. Eventually 427 articles with full text were evaluated, and 264 included, in this review.
Results: There is no real evidence for a possible common etiology for abdominal wall hernias and any cancer type. The two different diseases had been found to have some common points in the studies on genes, integrins, and biomarkers, however, to date no meaningful relationship has been identified between these points. There is also some, albeit rather conflicting, evidence for inguinal hernia being a possible risk factor for testicular cancer. Neoadjuvant or adjuvant therapeutic modalities like chemotherapy and radiotherapy may cause postoperative herniation with their adverse effects on tissue repair. Certain specific substances like bevacizumab may cause more serious complications and interfere with hernia repair. There are only two articles in PubMed directly related to the topic of “hernia and cancer.” In one of these the authors claimed that there was no association between cancer development and hernia repair with mesh. The other article reported two cases of squamous-cell carcinoma developed secondary to longstanding mesh infections.
Conclusion: As expected, the relationship between abdominal wall hernias and cancer is weak. Hernia repair with mesh does not cause cancer, there is only one case report on cancer development following a longstanding prosthetic material infections. However, there are some intersection points between these two disease groups which are worthy of research in the future.
... In a series of eight patients undergoing CRS and HIPEC followed by abdominal wall reconstruction with a bio- logical mesh, Boutros and colleagues 29 reported one her- nia recurrence during a much shorter follow-up period of about 6 months. Nunez and co-workers 17 studied 213 con- secutive patients undergoing CRS, HIPEC and abdomi- nal wall reconstruction who had abdominal wall disease. ...
Background
Patients with peritoneal malignancy often have multiple laparotomies before referral for cytoreductive surgery (CRS). Some have substantial abdominal wall herniation and tumour infiltration of abdominal incisions. CRS involves complete macroscopic tumour removal and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdominal wall reconstruction is problematic in these patients. The aim of this study was to establish immediate and long‐term outcomes of abdominal wall reconstruction with biological mesh in a single centre.
Methods
A dedicated peritoneal malignancy database was searched for all patients who had biological mesh abdominal wall reconstruction between 2004 and 2015. Short‐ and long‐term outcomes were reviewed. All patients had annual abdominal CT as routine peritoneal malignancy follow‐up.
Results
Some 33 patients (22 women) with a mean age of 53·4 (range 19–82) years underwent abdominal wall reconstruction with biological mesh. The majority (23) had CRS for pseudomyxoma (19 low grade), six for colorectal peritoneal metastasis and four for appendiceal adenocarcinoma; 18 had undergone CRS and HIPEC previously. Twenty‐five of the 33 patients had abdominal wall tumour involvement and eight had concurrent hernias. The mean duration of surgery was 486 (range 120–795) min and the mean mesh size used was 345 (50–654) cm². Ten patients developed wound infections and four had a seroma. Two developed early enterocutaneous fistulas. Mean follow‐up was 48 months. Five patients developed an incisional hernia. Four died from progressive malignancy. A further 15 patients had disease recurrence, but only one had isolated abdominal wall recurrence.
Conclusion
Biological mesh was safe and effective for abdominal wall reconstruction in peritoneal malignancy. Postoperative wound infections were frequent but nevertheless incisional hernia rates were low with no instances of mesh‐related bowel erosion or fistulation.
... was IDEAL stage 2a (low quality) and the other 26 was IDEAL stage 3 (moderate quality). Two studies25,27 reported only outcomes of patients with biological mesh; both studies were IDEAL stage 2a (very low quality).Of the 23 studies 28 -50 using biological mesh for reinforcement, all reported only elective patients undergoing ...
Background
Achieving stable closure of complex or contaminated abdominal wall incisions remains challenging. This study aimed to characterize the stage of innovation for biological mesh devices used during complex abdominal wall reconstruction and to evaluate the quality of current evidence.
Methods
A systematic review was performed of published and ongoing studies between January 2000 and September 2017. Eligible studies were those where a biological mesh was used to support fascial closure, either prophylactically after midline laparotomy, or for reinforcement after repair of incisional hernia with midline incision. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measure was the GRADE criteria for study quality.
Results
Thirty‐five studies including 2681 patients were included. Four studies considered mesh prophylaxis, 23 considered hernia repair, and eight reported on both. There was one published randomized trial (IDEAL stage 3), none of which was of high quality; the others were non‐randomized studies (IDEAL stage 2a). A detailed description of surgical technique was provided in most studies (27 of 35); however, no study reported outcomes according to the European Hernia Society consensus statement and only two described quality control of surgical technique during the study. From 21 ongoing randomized trials and observational studies, 11 considered repair of incisional hernia and 10 considered prophylaxis (seven in elective settings).
Conclusion
The evidence base for biological mesh is limited, and better reporting and quality control of surgical techniques are needed. Although results of ongoing trials over the next decade will improve the evidence base, further study is required in the emergency and contaminated settings.
... The hypothesis that CRS + HIPEC reduces the abdominal wall healing and increases the risk of IH has been suggested by Boutros et al., who conducted an experimental trial with prophylactic mesh placement in eight patients undergoing CRS + HIPEC, and within the sparse mean follow-up of 6.3 months, only one patient required re-laparotomy and presented subsequently with an IH [16]. However, no previous studies have investigated the incidence of IH following CRS + HIPEC. ...
... All 152 patients undergoing CRS + HIPEC in the period from June 2006 to April 2015 were followed. Overall, the median follow-up was 16 In total, 4/14 (28.6%) + IH patients underwent hernia repair within the follow-up period. According to descriptions in the medical records, the indications for repair were acute operation due to obstructive ileus (n = 1); repeating events of sub-ileus and pain (n = 1); the feeling of severe heaviness (n = 1); and no description (n = 1). ...
Background:
To evaluate the incidence of incisional hernia (IH) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) and its impact on health-related quality of life (HRQoL).
Method:
From June 2006 until June 2016, 152 patients were followed after CRS + HIPEC at Aarhus University Hospital, a single national center. Patients were seen postoperatively in an outpatient clinic at 3, 6, 12, 18, 24, 36 48, and 60 months. Clinical examinations at these follow-up visits were used to evaluate IH events prospectively. The incidence of IH was estimated using competing risk analysis and is presented as the cumulative incidence proportion (CIP). We expected the incidence to be 15% at 12 months. HRQoL was assessed at 12 months by the Short Form (SF-36) questionnaire, which we used to compare patients with an IH to patients without an IH.
Results:
The median follow-up time was 16.6 months [range 0.9-62.0]. During this period, 14/152 (9.2%) patients developed an IH. The 1-year CIP was 5.9% [95% CI 2.9; 10.4] (n = 8), and the 2-year CIP was 9.2% [95% CI 5.3; 14.5] (n = 14). Patients with an IH were significantly older (67 years [range 48-72]) compared to patients without IH (60 years [range 24-75], p ≤ 0.01). The rate of postoperative complications between patients with and without IH was comparable, except that a greater proportion of patients with IH had a fascial dehiscence (21.4%) compared to patients without an IH (3.6%). Reponses to the SF-36 show that patients with an IH report lower HRQoL with regard to Role-physical (mean difference - 32.9 [95% CI - 60.6; - 5.3]) and Role-emotional (mean difference - 20.2 [95% CI - 43.4; 3.1]), meaning a reduction in work and daily activities due to their physical and psychological health. We found no general decrease in HRQoL.
Conclusion:
CRS + HIPEC do not increase the risk of IH as measured within 12 months postoperatively, contrary to expectations. However, patients with an IH report a limitation in daily activities, which can best be explained by changes in physical and psychological health. A larger cohort from multiple centres is necessary to verify our findings.
... Acellular small intestine submucosa (SIS) is a resorbable biomaterial derived from porcine cell free ECM and is commonly used by surgeons (Boutros, Somasundar, & Espat, 2010;Kissane & Itani, 2012). Successful use of SIS has been reported in the correction of soft tissue defects such as hernias, abdominal wall defects, and other tissue repairs (Bibbo, 2010;Jiang et al., 2016;Nie et al., 2015). ...
Background:
Major congenital malformations affect up to 3% of newborns. Infants with prenatally diagnosed soft tissue defects should benefit from having autologous tissue readily available for surgical implantation in the perinatal period. In this study, we investigate fetal subcutaneous cells (fSC) as cellular source for tissue engineering.
Methods:
Fetal subcutaneous biopsies were collected from elective terminations at gestational week 20-21. Cells were isolated, expanded and characterized in vitro. To determine cell coverage, localization, viability and proliferation in different constructs, the cells were seeded onto a matrix (small intestine submucosa (SIS)) or in collagen gel with or without poly(ε-caprolactone) (PCL) mesh and were kept in culture for up to 8 weeks before analysis. Angiogenesis was analyzed through a tube-forming assay.
Results:
fSC could be expanded until 43±3 population doublings, expressed mesenchymal markers and readily differentiate into adipogenic and osteogenic lineages. The cells showed low adherence to SIS and did not migrate deep into the matrix. However, in collagen gels the cells migrated into the gel and proliferated with sustained viability for up to 8 weeks. The cells in the matrices expressed Ki67, CD73 and α-smooth muscle actin but not cytokeratin or CD31.
Conclusions:
Fetal cells derived from subcutaneous tissue demonstrated favorable characteristics for preparation of autologous tissue transplants before birth. Our study supports the theory that cells could be obtained from the fetus during pregnancy for tissue engineering purposes after birth. In a future clinical situation, autologous transplants could be used for reconstructive surgery in severe congenital malformations.
