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Kitai T.,Kishiwada City Hospital | Hirai T.,University of Fukui | Fujita T.,Tagawa Municipal Hospital | Yonemura Y.,NPO Organization to Support Peritoneal Surface Malignancy Treatment | And 2 more authors.
Japanese Journal of Cancer and Chemotherapy | Year: 2013

Purpose: Pseudomyxoma peritonei (PMP) is a rare condition characterized by massive ascites accumulation due to mucinous tumor dissemination in the peritoneal cavity. More recently, Sugarbaker has defined radical cytoreductive surgery and intraperitoneal chemotherapy as standardized therapy for PMP. The objective of this study was to investigate the incidence of PMP and the recent therapeutic approaches for this condition in Japan. Methods: Questionnaires answered by PMP patients between 2006 and 2010 were evaluated in this study. The study included 1,084 gastroenterological surgery and gynecology institutions in Japan. Results: Data from 379 institutions were analyzed (response rate: 35.0%). The mean number of diffuse PMP cases at a single institution in 5 years was 0.78. Of 266 diffuse cases, surgery was performed in 232 cases (87.2%) and chemotherapy was administered in 138 cases (51.9%). However, complete cytoreduction was achieved in only 31 of 232 operated cases (13.4%) and intraperitoneal chemotherapy was administered to only 45 of 138 patients receiving chemotherapy (32.6%). Conclusion: Despite the limited data, our results suggest that PMP occurs rarely in Japan, similar to the trend reported in Western countries. Further, the Sugarbaker procedure was not widely used in Japanese institutions.


Yonemura Y.,NPO Organization to Support Peritoneal Surface Malignancy Treatment | Yonemura Y.,Kusatsu General Hospital | Yonemura Y.,Kishiwada Tokushukai Hospital | Elnemr A.,NPO Organization to Support Peritoneal Surface Malignancy Treatment | And 7 more authors.
International Journal of Surgical Oncology | Year: 2012

Novel multidisciplinary treatment combined with neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS) and peritonectomy was developed. Ninety-six patients were enrolled. Peritoneal wash cytology was performed before and after NIPS through a port system. Patients were treated with 60 mg/m 2 of oral S-1 for 21 days, followed by a 1-week rest. On days 1, 8, and 15, 30 mg/m 2 of Taxotere and 30 mg/m 2 of cisplatin with 500 mL of saline were introduced through the port. NIPS is done 2 cycles before surgery. Three weeks after NIPS, 82 patients were eligible to intend cytoreductive surgery (CRS) by gastrectomy + D2 dissection + periotnectomy to achieve complete cytoreduction. Sixty-eight patients showed positice cytology before NIPS, and the positive cytology results became negative in 47 (69) patients after NIPS. Complete pathologic response on PC after NIPS was experienced in 30 (36.8) patients. Stage migration was experienced in 12 patients (14.6). Complete cytoreduction was achieved in 58 patients (70.7). By the multivariate analysis, complete cytoreduction and pathologic response became a significantly good survival. However the high morbidity and mortality, stringent patient selection is important. The best indications of the therapy are patients with good pathologic response and PCI ≤ 6, which are supposed to be removed completely by peritonectomy. © 2012 Yutaka Yonemura et al.


Yonemura Y.,NPO Organization to Support Peritoneal Surface Malignancy Treatment | Yonemura Y.,Kusatsu General Hospital | Yonemura Y.,Kishiwada Tokushukai Hospital | Elnemr A.,NPO Organization to Support Peritoneal Surface Malignancy Treatment | And 6 more authors.
Gastroenterology Research and Practice | Year: 2012

During 2004 to 2011, 81, 420, and 166 patients with colorectal cancer (CRC), epithelial appendiceal neoplasm (APN), and gastric cancer (GC) with PC were treated with cytoreductive surgery (CRS) plus perioperative chemotherapy. CRS was performed by peritonectomy techniques using an aqua dissection. Results. Complete cytoreduction was done in 62/81 (76.5), 228/420 (54.3), and 101/166 (60.8) of patients with CRC, APN, and GC. The main reasons of incomplete resections were involvement of all peritoneal regions and diffuse involvement of small bowel. The incidence (64, 302/470) of CC-0 resection after introduction of an aqua dissection was significantly higher than before (42, 82/197). A total of 41 (6.1) patients died postoperatively. Major complication (grade 3-4 complications) occurred in 126 patients (18.9). A reoperation was necessary in 36 patients (5.4). By the multivariate analysis, PCI scores capable of serving as thresholds for favorable versus poor prognosis in each group and CC scores demonstrated as the independent prognostic factors. Conclusions. Peritonectomy using an aqua dissection improves the incidence of complete cytoreduction, and improves the survival of patients with PC. Patients with PCI larger than the threshold values should be treated with chemotherapy to improve the incidences of complete cytoreduction. Copyright © 2012 Y. Yonemura et al.


PubMed | Capital Medical University, NPO Organization to Support Peritoneal Surface Malignancy Treatment, Kishiwada Tokushukai Hospital and Kusatsu General Hospital
Type: Journal Article | Journal: Annals of surgical oncology | Year: 2016

The Peritoneal Cancer Index (PCI) is the most important prognostic factor following comprehensive treatment for peritoneal metastasis (PM) from gastric cancer (GCPM); however, 70% of patients with GCPM showed a PCI score above the cut-off level at the time of diagnosis. Furthermore, neoadjuvant chemotherapy may reduce the PCI score to lower than the cut-off levels. In this study, the effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion (NLHIPEC) and neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were investigated.In group A, NLHIPEC was performed twice in 53 patients with GCPM, separated by a 1-month rest interval. Changes in the PCI were studied at the time of first and second laparoscopy. In group B, after NLHIPEC, a series of 3-week cycles of NIPS were performed over three courses in 52 patients. A laparotomy for cytoreductive surgery (CRS) was then carried out and the PCI changes were studied.In group A, the PCI score at the time of the second session (11.811.0) was significantly lower than at the time of the first session (14.210.7), while in group B, the PCI at the time of laparotomy (9.911.3) was significantly lower than at the time of NLHIPEC (14.811.4). After NLHIPEC plus NIPS, complete cytoreduction was achieved in 30 (57.6%) patients.NLHIPEC and NIPS are effective methods of reducing PCI levels before CRS.


Elnemr A.,NPO Organization to Support Peritoneal Surface Malignancy Treatment | Elnemr A.,Tanta University | Yonemura Y.,NPO Organization to Support Peritoneal Surface Malignancy Treatment | Shinbo M.,NPO Organization to Support Peritoneal Surface Malignancy Treatment | Nishino E.,Kishiwada okushukai Hospital
Rare Tumors | Year: 2010

Mullerian tumors are extremely rare malig-ancies in the retroperitoneum. We report a ase of a 46-year old woman who presented with an eight year history of lower abdominal mass. Ultrasonography (US) and computed omography (CT) demonstrated a 15×10 cm ystic mass in the left lower retroperitoneum. s serial percutaneous needle aspiration cytol-gy was negative for malignancy, she was bserved for seven years. Eleven months ago, he mass was excised. The histopathology was eported as mucinous adenocarcinoma of the etroperitoneum. Six cycles of intraperitoneal IP) chemotherapy was administered during he last six months after diagnosis of recur-ence by aspiration cytology and high serum umor markers (CEA, CA19-9). A few days ago, ositron emission tomographic (PET) scan-ing showed evidence of local recurrence and ingle vertebral metastasis, so she was admit-ed again for systemic chemotherapy. Meticulous revision of additional sections of he tumor revealed papillary, serous, muci-ous, and endometrioid subtypes of the mul-erian adenocarcinoma. To our knowledge, here has been no similar case described in he literature. © Copyright A. Elnemr et al., 2010.


Yonemura Y.,NPO Organization to Support Peritoneal Surface Malignancy Treatment.
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

Operation results of 81 colorecatal cancer-patients with peritoneal carcinomatosis (PC) treated with peritonectomy plus perioperative chemotherapy are reported. The patients who had the following evidences are considered to be eligible for peritonectomy: 1) No evidence of N3 lymph node involvement, 2) No evidence of hematogenous metastasis, 3) No progressive disease after preoperative chemotherapy, 4) No severe co-morbidities or no poor general condition. Complete cytoreduction resection is aimed for removing all macroscopic tumors by peritonectomy using electrosurgical techniques. The completeness of cytoreduction (CC scores) after peritonectomy is classified into the following 4 criteria: CC-0-no peritoneal seeding was exposed during the complete exploration, CC-1-residual tumor nodules are less than 2.5 mm in diameter, CC-2-nodules are between 2 .5 mm and 25 mm in diameter, CC-3-nodules are greater than 25 mm in diameter, CC-2 and CC-3 are regarded as incomplete cytoreduction. Operation time and blood loss were 237 ± 124 min. (799-90 min) and 1,598 ± 1,411 mL (6,500-20 mL), respectively. Postoperative complications developed in 37( 46%) patients. The patients received CC-0/ -1 resection survived significantly longer than those of CC-2/ -3 group. The patients with PCI ≤ 10 survived significantly longer than those with PCI≥ 11. CC and PCI scores are the independent prognostic factors. The relative risk for death of CC-2/-3 group was 4.6-fold higher than that of CC-0/ -1 group. Accordingly, peritonectomy is indicated for patients with PCI score≤ 10.


Yonemura Y.,NPO Organization to Support Peritoneal Surface Malignancy Treatment
Chinese Journal of Clinical Oncology | Year: 2012

Objective: This study aimed to develop a novel multidisciphnary treatment strategy combining neoadjuvant intrapentoneal-systemic chemotherapy protocol (NIPS) and peritonectomy. Methods: Gastric cancer patients with peritoneal carcinomatosis (PC) (n=96) were enrolled. Peritoneal wash cytology was performed before and after NIPS through a port system. For systemic chemotherapy, the patients were treated with 60 mg/m2 of oral S-1 for 21 d, followed by a 1-week rest. For intraperitoneal chemotherapy, 30 mg/m2 of Docetaxel and 30 mg/m2 of cisplatin with 500 mL of saline were introduced through the port on d 1, 8, and 15. Two cycles of the NIPS regimen was conducted before surgery. Three weeks after NIPS, 82 eligible patients underwent complete cytoreductive surgery (CRS) by gastrectomy plus D2 dissection and peritonectomy. Results: Positive cytologic result was observed in 68 patients treated with peritoneal washing before NIPS. The number was reduced to 47 (69.1%) after NIPS. After NIPS, complete pathologic response on PC was observed in 30 (36.8%) patients. Reduction of tumor stages occurred in 12 patients (14.6%). Complete cyto-reduction was achieved in 58 of the total patients (70.7%). Grade 4 toxicities occurred in 9 cases, and the overall perioperative mortality rate was 3.7% (3/82). By multivariate analysis, complete cytoreduction and pathologic response were found to be independent factors for achieving a satisfactory survival rate. Conclusion: The optimal candidates for such multidisciplinary approach are patients with favorable pathologic response and PCI ≤6, among whom complete CRS could be achieved with peritonectomy.


PubMed | NPO Organization to Support Peritoneal Surface Malignancy Treatment
Type: | Journal: International journal of surgical oncology | Year: 2012

Novel multidisciplinary treatment combined with neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS) and peritonectomy was developed. Ninety-six patients were enrolled. Peritoneal wash cytology was performed before and after NIPS through a port system. Patients were treated with 60mg/m(2) of oral S-1 for 21 days, followed by a 1-week rest. On days 1, 8, and 15, 30mg/m(2) of Taxotere and 30mg/m(2) of cisplatin with 500mL of saline were introduced through the port. NIPS is done 2 cycles before surgery. Three weeks after NIPS, 82 patients were eligible to intend cytoreductive surgery (CRS) by gastrectomy + D2 dissection + periotnectomy to achieve complete cytoreduction. Sixty-eight patients showed positice cytology before NIPS, and the positive cytology results became negative in 47 (69%) patients after NIPS. Complete pathologic response on PC after NIPS was experienced in 30 (36.8%) patients. Stage migration was experienced in 12 patients (14.6%). Complete cytoreduction was achieved in 58 patients (70.7%). By the multivariate analysis, complete cytoreduction and pathologic response became a significantly good survival. However the high morbidity and mortality, stringent patient selection is important. The best indications of the therapy are patients with good pathologic response and PCI 6, which are supposed to be removed completely by peritonectomy.


PubMed | NPO Organization to Support Peritoneal Surface Malignancy Treatment
Type: | Journal: Gastroenterology research and practice | Year: 2012

During 2004 to 2011, 81, 420, and 166 patients with colorectal cancer (CRC), epithelial appendiceal neoplasm (APN), and gastric cancer (GC) with PC were treated with cytoreductive surgery (CRS) plus perioperative chemotherapy. CRS was performed by peritonectomy techniques using an aqua dissection. Results. Complete cytoreduction was done in 62/81 (76.5%), 228/420 (54.3%), and 101/166 (60.8%) of patients with CRC, APN, and GC. The main reasons of incomplete resections were involvement of all peritoneal regions and diffuse involvement of small bowel. The incidence (64%, 302/470) of CC-0 resection after introduction of an aqua dissection was significantly higher than before (42%, 82/197). A total of 41 (6.1%) patients died postoperatively. Major complication (grade 3-4 complications) occurred in 126 patients (18.9%). A reoperation was necessary in 36 patients (5.4%). By the multivariate analysis, PCI scores capable of serving as thresholds for favorable versus poor prognosis in each group and CC scores demonstrated as the independent prognostic factors. Conclusions. Peritonectomy using an aqua dissection improves the incidence of complete cytoreduction, and improves the survival of patients with PC. Patients with PCI larger than the threshold values should be treated with chemotherapy to improve the incidences of complete cytoreduction.


PubMed | NPO Organization to Support Peritoneal Surface Malignancy Treatment.
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2015

The purpose of this manuscript is to report the pharmacokinetics of docetaxel during hyperthermic intraperitoneal chemotherapy (HIPEC) after peritonectomy.Eleven patients with peritoneal metastasis (PM) underwent peritonectomies combined with 40 min of HIPEC with 40 mg/body of docetaxel. The pharmacokinetics of docetaxel were studied by using high-performance liquid chromatography.The docetaxel concentration at the start of HIPEC (0 min) was 9.084 0.972 mg/L. The concentration gradually decreased to 5.599 0.458 mg/L 40 min after HIPEC. In contrast, serum docetaxel levels increased during HIPEC, reaching a maximum level of 0.1334 0.0726 mg/L at 40 min. The clearance (CLp) was 3.164 1.383 L/hr, and the area under the curve (AUC) ratio was 95.12 87.32. The AUC ratio of less-extensive peritonectomies was significantly higher than that of extended peritonectomies. The docetaxel concentration in the tumor tissue increased at 40 min (4.45 mg/gr). The apparent permeability (Papp, 40 min) was 1.47 0.67 mm/40 min. No severe adverse effects were observed after HIPEC.From these results, 40 mg is a safe dose for docetaxel combined with HIPEC, and the locoregional intensity of docetaxel is enough to control PM less than 1.47 mm in diameter.

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