Paul Sugarbaker and his colleagues have persevered in the study and treat ment of peritoneal carcinomatosis. The peritoneal cavity has many unique and incompletely appreciated properties. These properties, coupled with the biologic behavior of many cancers, results in the seeding and growth of these cancers on the peritoneum. Many of these cancers remain localized to the peritoneum only, never metastasizing to other sites. One possible reason for this may be the obstruction of the afferent lymphatics on the undersurface of the diaphragm. The mucopolysaccharides produced by many of these neoplasma are probably viscous enough to obstruct these lymphatics, leading to the syndrome of pseudomyxoma peritonei. Many of the neoplasms taking residence on the peritoneum have extremely long cell-cycle times and are resistant to radiotherapy and many chemotherapeutic agents. How ever, much can be done for these patients - resection of primary cancers, omentectomies to reduce ascites formation, management of recurrent ascites, management of intestinal obstruction, nutritional care, and, hopefully, intraperitoneal chemotherapy. We have reviewed many of these problems in the past [1-7]. Dr. Sugarbaker and his colleagues have organized the current state of knowledge and technology for continuing use. The book provides a basis for thoughtful, prospective research planning. John S. Spratt, M. D. , F. A. C. S. Professor of Surgery The James Graham Brown Cancer Center University of Louisville Louisville, Kentucky References 1. Long RTL, Spratt JS, Dowling E.

This is the first volume to provide a multidisciplinary approach to peritoneal carcinomatosis encompassing molecular mechanisms, histopathology, regional and systemic cytotoxic therapy, and surgical options. Illustrations aid the reader throughout in the many facets of this disease. The book will be of particular interest for medical, surgical and gynecological oncologists faced with the complexities of decision making in patients suffering from PC.

Peritoneal carcinomatosis dominates the clinical picture of many patients with gastrointestinal, gynecological and urological cancers. For many of them its dev astating effects contribute directly to their death. Most clinicians consider peritoneal carcinomatosis an incurable metastatic disease and give palliative treatment, re stricted to limited surgery and systemic chemotherapy. Contrary to this view, Paul Sugarbaker and his collegues base their approach on the concept that peritoneal carcinomatosis represents regional tumor spread, similar in its impact on treatment and prognosis to that of lymph node metastases in other malignancies. This concept emphasises the value of regional tumor control, as a potentially curative measure. In this book the combination of aggressive cytoreduction and intraperitoneal chemotherapy to control peritoneal carcinomatosis is extensively explored. Basic to this approach is the observation that most cancer cells show only relative resistence against commonly available drugs, which can be overcome by a sufficient increase of drug concentrations in tumor tissue. After intraperitoneal delivery, drugs will reach high tissue concentrations in the superficial few cell layers, while plasma concentrations will remain below toxic levels. Patients with only limited residual tumor at the peritoneal surface after cytoreduction may therefore benefit from intraperitoneal chemotherapy.

This book has been designed to provide the full description of the comprehensive management of peritoneal surface malignancies as a new emerging specialty. Combined treatment of cytoreductive surgery (CRS) and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) introduced by our leader Paul H. Sugarbaker are performed to treat peritoneal metastases by surgeons all around the world. Therefore this book is focused on detailed surgical anatomy of the peritoneum, preoperative clinical assessment of the peritoneal surface malignancy, patient preparation and operation room equipments, different surgical procedures for CRS and reconstruction, intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and neoadjuvant intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy (EPIC) and molecular basis of peritoneal surface malignancies. The chapter on molecular mechanisms of the formation of peritoneal carcinomatosis provides insight into a rapidly expanding knowledge within this speciality. This book should be valuable for surgical oncologists who deal with multimodal treatment for peritoneal surface malignancies, as well as for the trained peritonectomy surgeons. For the senior surgeons, it will also introduce new techniques and approaches in this field such as dealing with the omental cakes and massive organ involvement that requires multi-organ resection.

This monograph summarizes state of the art knowledge regarding peritoneal surface malignancies, with in-depth description of treatment options and the results achieved to date. It explores the most challenging problems on the basis of the authors’ very extensive clinical experience and examines the most relevant clinical trials. A comprehensive summary is provided of all phase 2 studies (the only available completed studies) and of ongoing and future phase 3 studies. Particular attention is paid to the results of integrated treatment comprising cytoreduction (peritonectomy) and hyperthermic intraperitoneal chemotherapy (HIPEC). Helpful background information is also included on the definition and clinical assessment of each clinical form. The book, drawing on data from the entire Italian experience as well as world literature, will be an outstanding benchmark for health professionals and researchers.

Maurie Markman and a panel of distinguished clinicians and leading clinical investigators comprehensively review the current status of regional antineoplastic drug delivery in the management of malignant disease. These authorities present a critical analysis of both the rationale and limitations of regional therapy and discuss potential clinical trials designed to explain the effectiveness of this method of therapy in special settings. Their presentations describe many exciting and innovative strategies for using regional drug delivery in anticancer therapy, including coverage of such areas of special interest as colorectal, skin, lung, pancreatic, ovarian, and gastrointestinal cancers. Comprehensive and authoritative, Regional Chemotherapy: Clinical Research and Practice offers surgical and medical oncologists and clinical cancer investigators a gold-standard review of the current role and future development of this increasingly powerful weapon in the battle against cancer.

Included here is a discussion of the pathophysiological aspects and risks of laparoscopic staging (such as trocar metastases) on the basis of international experience.

One reason for failure to cure solid tumors by surgery appears to be the impossibility of controlling metastases that are present but latent at the time of operation. This failure is a common clinical experience with aggressive neoplasms. but it is not always appreciated in tumors with longer survival times. e. g .• breast and colon cancer. In addition. recent evidence indicates that after resection of a primary tumor micrometas tases from it might be enhanced by suppression of immune and reticu loendothelial functions of the host. Other factors, such as increase of coagulability and stress in the perioperative period, can also promote tumor growth. The development of new metastases might be facilitated by cells forced into the circulation during operative manipulations. Such events could be important for the outcome of treatment and it is suggested that preventive measures should be directed to this systemic component of solid tumors. Radical surgery can reduce the number of tumor cells to a subclinical 3 6 stage (10 to 10 cells) in which chemotherapy might be more effective than in advanced stages. Chemotherapy, on the other hand, might aggravate the surgical morbidity by influencing the wound healing pro cess, by decreasing the immune response, and/or by toxicity to the bone marrow and to the gastrointestinal tract, for example.

This updated second edition of Diagnosis and Management of Ovarian Disorders provides thorough, yet succinct insight into the ever-changing realm of ovarian disorders. It presents a novel multidisciplinary approach to the subject as described by clinicians, surgeons, pathologists, basic scientists and related medical researchers. Topics covered include reproductive technology, early diagnosis of ovarian cancer, and management of menopause among others. The breadth of information provided by this book will appeal to clinicians and researchers involved in the study and treatment of ovarian disorders.KEY FEATURES* Includes updated information on early diagnosis of ovarian cancer* Reviews new diagnostic techniques for ovarian disorders* Discusses latest information on reproductive technology* Presents translational treatment linking laboratory research with clinical medicine