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 third edition manual provides a comprehensive, insightful, evidenced-based review of general surgical oncology and serves as a valuable resource for general surgeons in training, practicing general surgeons, and surgical oncologists. The volume describes a multidisciplinary approach that integrates clinical, radiologic, and pathologic data in formulating practical clinical management, and offers a practical approach to the most common situations when treating cancer patients. Each chapter focuses on an individual malignancy and describes the presentation of the malignancy, integrated management based on stage, landmark trials, and suggestions for who to discuss at multidisciplinary cancer conferences. Multiple tables in each chapter provide a concise yet comprehensive summary of the current status of the field. Clinical “pearls” or tips and tricks from high volume surgeons at the University of Toronto are also discussed. The third edition of the Surgical Oncology Manual will serve as a critical resource for general surgeons in training and practicing surgeons dealing with this challenging field.

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.

Peritoneal malignancy is a rapidly growing field within surgical oncology. National and International treatment programmes and training curricula are being established worldwide to co-ordinate treatment and management of these challenging clinical problems. A large body of evidence now exists, but the practical implications of this evidence base remain unclear. The Peritoneal Malignancy Institute in Basingstoke, the largest centre in the world, is at the forefront of new developments and techniques. This manual combines the experience of the PMI with the latest evidence to provide a practice-oriented guide to the successful set up and running of a peritoneal malignancy unit.

The fourth edition of this well-received book offers a comprehensive update on recent developments and trends in the clinical and scientific applications of multislice computed tomography. Following an initial section on the most significant current technical aspects and issues, detailed information is provided on a comprehensive range of diagnostic applications. Imaging of the head and neck, the cardiovascular system, the abdomen, and the lungs is covered in depth, describing the application of multislice CT in a variety of tumors and other pathologies. Emerging fields such as pediatric imaging and CT-guided interventions are fully addressed, and emergency CT is also covered. Radiation exposure, dual-energy imaging, contrast enhancement, image postprocessing, CT perfusion imaging, and CT angiography all receive close attention. The new edition has been comprehensively revised and complemented by contributions from highly experienced and well-known authors who offer diverse perspectives, highlighting the possibilities offered by the most modern multidetector CT systems. This book will be particularly useful for general users of CT systems who wish to upgrade and enhance not only their machines but also their knowledge.

In an era of promising advances in cancer research, there are considerable and even alarming gaps in the fundamental knowledge and understanding of ovarian cancer. Researchers now know that ovarian cancer is not a single disease-several distinct subtypes exist with different origins, risk factors, genetic mutations, biological behaviors, and prognoses. However, persistent questions have impeded progress toward improving the prevention, early detection, treatment, and management of ovarian cancers. Failure to significantly improve morbidity and mortality during the past several decades is likely due to several factors, including the lack of research being performed by specific disease subtype, lack of definitive knowledge of the cell of origin and disease progression, and incomplete understanding of genetic and non-genetic risk factors. Ovarian Cancers examines the state of the science in ovarian cancer research, identifies key gaps in the evidence base and the challenges to addressing those gaps, considers opportunities for advancing ovarian cancer research, and examines avenues for translation and dissemination of new findings and communication of new information to patients and others. This study makes recommendations for public- and private-sector efforts that could facilitate progress in reducing the incidence of morbidity and mortality from ovarian cancers.

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.

The widespread acceptance among the oncology community at large of cytoreductive surgery and HIPEC as a potentially curative treatment for peritoneal metastases has paved the way for innovative new therapies that could benefit a larger proportion of patients. Much has been and continues to be published on this subject. This book provides comprehensive reviews on the various aspects of managing peritoneal metastases. The authors highlight essential practical issues that surgical oncologists encounter in their day-to-day practice, and try to before provide evidence based answers to address them. All chapters were written and/or reviewed by leading experts in this field.

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 dissemination is a common route of cancer metastasis. The benefit of administering chemotherapy directly into the peritoneal cavity is supported by preclinical and pharmacokinetic data. In comparison to intravenous (IV) treatment, intraperitoneal (IP) administration results in a several-fold increase in drug concentration within the abdominal cavity. There is now growing evidence from clinical studies showing a survival advantage for IP chemotherapy in various tumor typies, including ovarian, gastric and colorectal cancer. However, while the use of IP chemotherapy is slowly gaining acceptance, it is not universal, largely due to the greater toxicity associated with this approach. Moreover, efficacy of IP chemotherapy is limited by poor distribution within the abdominal cavity and by poor tissue penetration. A new way of IP chemotherapy is the application of cytotoxics in form of a pressurized aerosol into the abdominal of thoracic cavity. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is applied through laparoscopic access using two balloon trocars in an operating room equipped with laminar air-flow. In a first step,a normothermic capnoperitoneum is established with a pressure of 12 mmHg. A cytotoxic solution (about 10% of a normal systemic dose) is nebulized with a micropump into the abdominal cavity, and maintained for 30 min. The aerosol is then removed through a closed suction system. Applying an aerosol in the peritoneal cavity allows a homogeneous distribution of the chemotherapeutic agent within the abdomen. Furthermore, an artificial pressure gradient is generated that overcomes tumoral interstitial fluid pressure, an obstacle in cancer therapy. This results in a higher local drug concentration compared to conventional IP or IV chemotherapy. At the same time the plasma concentration of the chemotherapeutic agent remains low. In first clinical studies with limited number of patients in ovarian, gastric and colorectal cancer, as well as peritoneal mesothelioma, PIPAC has obtained encouraging tumor response rates and survival, with a low-side effects profile. Larger clinical trials are currently ongoing to examine if these data can be reproduced and extrapolated to other situations.