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  1. Article ; Online: Bidirectional chemotherapy long-term as a treatment strategy for peritoneal metastases.

    Sugarbaker, Paul H

    Translational cancer research

    2024  Volume 13, Issue 2, Page(s) 490–495

    Language English
    Publishing date 2024-02-20
    Publishing country China
    Document type Editorial ; Comment
    ZDB-ID 2901601-0
    ISSN 2219-6803 ; 2218-676X
    ISSN (online) 2219-6803
    ISSN 2218-676X
    DOI 10.21037/tcr-23-2039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: It Is What the Surgeon Does Not See That Kills the Patient.

    Sugarbaker, Paul H

    Journal of clinical medicine

    2024  Volume 13, Issue 8

    Abstract: Background: Patients with colon cancer may present at multiple different stages of the disease process. Many patients can be cured of colon cancer as a result of a simple surgical procedure usually performed by minimally invasive techniques. However, ... ...

    Abstract Background: Patients with colon cancer may present at multiple different stages of the disease process. Many patients can be cured of colon cancer as a result of a simple surgical procedure usually performed by minimally invasive techniques. However, there are a variable number of patients, estimated at approximately 10%, who have a more advanced disease. If these patients are treated by the current conventional standard of care, the likelihood for treatment failure is extremely high.
    Methods: These are not patients with known disseminated disease but patients who are at high risk of recurrent disease unless special treatments are initiated preoperatively and intraoperatively. The identification of these patients is by (1) a high-quality CT scan, (2) tumor markers found preoperatively, (3) colonoscopic findings, and (4) symptoms.
    Results: Patients identified as being at high risk require special preoperative treatments which include neoadjuvant chemotherapy. Intraoperative chemotherapy with HIPEC should occur as part of the treatment if peritoneal metastases are documented by biopsy. In the operating room, a thorough exploration of all possible occult peritoneal spaces for metastatic disease needs to be performed. A modified cytoreductive surgical procedure along with a colon resection is performed in order to minimize sites of occult peritoneal metastases. This includes the greater omentum, ovaries, and tubes in postmenopausal women. Peritonectomy is used to create a shroud around the tumor so that all peritoneum that has been in direct contact with the tumor surface is resected and is used as a barrier against tumor cell dissemination in the process of colon cancer resection. If peritoneal metastases are visualized at any site, HIPEC should be included as part of the treatment package.
    Conclusions: I am convinced that patients at high risk of recurrence will have an improved outcome with proper preoperative evaluation, preoperative neoadjuvant chemotherapy, and a revised intraoperative management strategy.
    Language English
    Publishing date 2024-04-12
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm13082238
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  3. Article ; Online: Conquering colon cancer peritoneal metastases one state at a time.

    Sugarbaker, Paul H

    Surgical oncology

    2023  Volume 51, Page(s) 101969

    Language English
    Publishing date 2023-06-28
    Publishing country Netherlands
    Document type Editorial
    ZDB-ID 1107810-8
    ISSN 1879-3320 ; 0960-7404
    ISSN (online) 1879-3320
    ISSN 0960-7404
    DOI 10.1016/j.suronc.2023.101969
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 3409: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: A narrative review of what can HIPEC do.

    Sugarbaker, Paul H

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2023  Volume 49, Issue 9, Page(s) 106976

    Abstract: Intraperitoneal chemotherapy as in hyperthermic intraperitoneal chemotherapy (HIPEC) has limited efficacy. It should not be expected to eradicate even the smallest vascularized tumor nodules. Neither should it be used in an attempt to eradicate tumor ... ...

    Abstract Intraperitoneal chemotherapy as in hyperthermic intraperitoneal chemotherapy (HIPEC) has limited efficacy. It should not be expected to eradicate even the smallest vascularized tumor nodules. Neither should it be used in an attempt to eradicate tumor cells from within scar tissue. Perioperative intraperitoneal chemotherapy can be expected to eradicate free cancer cells or minute cancer nodules free floating in the fluid within peritoneal spaces. Also, loosely adherent tumor cells on peritoneal surfaces or within a resection site can be eradicated. This is a prevention of tumor cell entrapment. In so doing postoperative tumor progression within adhesions, within a resection site, and within scar tissue is prevented and result in improved survival. Tumor cells entrapped within scar tissue is relatively resistant to systemic chemotherapy. By eliminating tumor cell entrapment in scar HIPEC can increase the benefit of systemic chemotherapy.
    MeSH term(s) Humans ; Hyperthermic Intraperitoneal Chemotherapy ; Peritoneal Neoplasms/therapy ; Cicatrix ; Hyperthermia, Induced ; Chemotherapy, Adjuvant ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Combined Modality Therapy ; Cytoreduction Surgical Procedures
    Language English
    Publishing date 2023-07-08
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2023.07.002
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1149: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 549: Show issues

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  5. Article ; Online: Randomized trial of intravenous versus bidirectional chemotherapy after cytoreductive surgery for malignant peritoneal mesothelioma.

    Sugarbaker, Paul H

    International journal of surgery protocols

    2023  Volume 27, Issue 3, Page(s) 108–117

    Abstract: Background: Malignant peritoneal mesothelioma (MPM) is a rare disease that progresses within the peritoneal cavity and only disseminates to systemic sites in the terminal months of the disease. For this malignancy, there are several regimens of ... ...

    Abstract Background: Malignant peritoneal mesothelioma (MPM) is a rare disease that progresses within the peritoneal cavity and only disseminates to systemic sites in the terminal months of the disease. For this malignancy, there are several regimens of chemotherapy that have been accepted as standard, principally intraperitoneal chemotherapy (IPC) and intravenous chemotherapy (IVC); however, there is no standardized method of treatment. Selected patients with MPM who are amenable to cytoreductive surgery (CRS) and are fit for surgery typically undergo resection with hyperthermic intraperitoneal chemotherapy (HIPEC). Though individual toxicity and efficacy studies of IPC plus IVC (bidirectional) and IVC chemotherapy for MPM have been conducted, a prospective randomized clinical trial has not been performed for this disease.
    Materials and methods: The study objective is to compare the efficacy and toxicity of normothermic bidirectional (IPC/IVC) chemotherapy versus IVC after CRS and HIPEC for epithelial MPM. The patient population are those individuals undergoing CRS for MPM. Exclusion criteria include previous therapy form mesothelioma. The study design is a randomized, nonblinded, phase II clinical trial comparing multicycle IVC with cisplatin (CDDP) and pemetrexed (PMTX) versus multicycle bidirectional chemotherapy with IVC CDDP and IPC PMTX after optimal CRS and HIPEC with CDDP and doxorubicin. The primary endpoint is 2-year disease-free survival. The secondary endpoint is 30-day post-treatment morbidity. The primary objective is to compare the 2-year rates of disease-free survival in the two treatment arms. The secondary objective is to compare the toxicity of each treatment.
    Dissemination: The prospective randomized trial provides not only a standardized approach to treatment but also a path forward to optimize the survival of patients with MPM. In addition, any increase or decrease in the adverse events associated with PMTX administered as IPC will be demonstrated. Because MPM is a rare disease a multi-institutional implementation of the protocol is required.
    Language English
    Publishing date 2023-09-26
    Publishing country England
    Document type Journal Article
    ISSN 2468-3574
    ISSN (online) 2468-3574
    DOI 10.1097/SP9.0000000000000010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Response to Nivolumab followed by complete cytoreductive surgery with HIPEC resulted in long-term survival in a patient with sarcomatoid-predominant biphasic peritoneal mesothelioma. A case report.

    Sugarbaker, Paul H

    International journal of surgery case reports

    2023  Volume 107, Page(s) 108359

    Abstract: Introduction and importance: Sarcomatoid-predominant biphasic peritoneal metastases is a rapidly progressing and deeply invasive variant of this disease with survival measured in months. Although cytoreductive surgery (CRS) and hyperthermic ... ...

    Abstract Introduction and importance: Sarcomatoid-predominant biphasic peritoneal metastases is a rapidly progressing and deeply invasive variant of this disease with survival measured in months. Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a standard of care for epithelioid peritoneal mesothelioma, the sarcomatoid variant is so aggressive, the standard treatment is not recommended. Immunotherapy has recently been utilized for pleural mesothelioma. Partial responses to immunotherapy may be combined with CRS to achieve a favorable outcome in sarcomatoid-predominant peritoneal mesothelioma.
    Case presentation: A 39-year-old woman developed an expanding abdomen. A 10 cm pelvic mass was removed by hysterectomy. With an initial diagnosis of advanced ovarian cancer, she was treated with cisplatin plus paclitaxel. Disease progression led to a review of her original pathology and a repeat biopsy which showed biphasic peritoneal mesothelioma with sarcomatoid predominance. Treatment with Nivolumab was transiently beneficial. Repeat CT 8 months later showed partial bowel obstruction and necrotic expanding tumor masses that were partially calcified. CRS with HIPEC and normothermic long-term intraperitoneal pemetrexed (NIPEC) plus intravenous cisplatin resulted in a 5-year disease-free survival.
    Clinical discussion: The specimens removed at CRS showed marked progression within large masses. Smaller masses resected with CRS showed fibrosis and calcification. The response to Nivolumab was heterogeneous with smaller masses with good blood supply adequately treated but larger masses markedly progressed.
    Conclusions: A combination of partial response to immunotherapy with a complete CRS plus HIPEC and NIPEC can result in a long-term favorable outcome.
    Language English
    Publishing date 2023-05-27
    Publishing country Netherlands
    Document type Case Reports
    ISSN 2210-2612
    ISSN 2210-2612
    DOI 10.1016/j.ijscr.2023.108359
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  7. Article: Integration of Cytoreductive Surgery and Perioperative Chemotherapy into the Multidisciplinary Management of Intra-Abdominal Cancer.

    Sugarbaker, Paul H

    Visceral medicine

    2022  Volume 38, Issue 2, Page(s) 79–80

    Language English
    Publishing date 2022-03-11
    Publishing country Switzerland
    Document type Editorial
    ZDB-ID 2850733-2
    ISSN 2297-475X ; 2297-4725
    ISSN (online) 2297-475X
    ISSN 2297-4725
    DOI 10.1159/000522605
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2103: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  8. Article ; Online: Phase 1 trial of same day cytology to guide the use of HIPEC.

    Sugarbaker, Paul H / Deng, Tom

    International journal of surgery protocols

    2024  Volume 28, Issue 1, Page(s) 6–11

    Abstract: Background: Peritoneal metastases from gastrointestinal or gynecologic malignancy are a prominent part of the natural history of these diseases. Peritoneal metastases, if not effectively treated, will result in a decreased survival and cause an impaired ...

    Abstract Background: Peritoneal metastases from gastrointestinal or gynecologic malignancy are a prominent part of the natural history of these diseases. Peritoneal metastases, if not effectively treated, will result in a decreased survival and cause an impaired quality of life. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment specifically designed to combat peritoneal metastases. A group of patients who, from a theoretical perspective, may benefit from HIPEC are those patients with a positive peritoneal cytology. In order to identify these patients at the time of a surgical intervention, a same day cytology is to be performed.
    Materials and methods: The result of this test is to be available at or before the completion of the cancer resection. If the cytology is positive, the patient immediately becomes a candidate for HIPEC. The HIPEC will be of maximal value if a complete cytoreduction, as judged by the surgeon, has been possible. This phase 1 trial is to demonstrate that the Surgical Oncology Service, the Department of Pathology, the Pharmacy and the Operating Room personnel can co-ordinate a phase 1 protocol to successfully complete the same day cytology with an efficient delivery of HIPEC. A standardized plan for consent, cytology collection, preparation of the specimen, reading of the specimen, reporting the results in a timely manner facilitates the administration of HIPEC in peritoneal cytology positive patients.
    Dissemination: Successful completion of these requirements is a positive result for this study and allows for future protocols to be generated. Successful completion of the same day cytology phase 1 protocol will allow the efficacy, safety, and efficiency of this plan of patient management to be evaluated.
    Language English
    Publishing date 2024-01-20
    Publishing country England
    Document type Journal Article
    ISSN 2468-3574
    ISSN (online) 2468-3574
    DOI 10.1097/SP9.0000000000000017
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Selection Factors for Treatment and Stratification of Rare Abdominal or Pelvic Tumors with Peritoneal Metastases.

    Sugarbaker, Paul H

    Indian journal of surgical oncology

    2022  Volume 14, Issue Suppl 1, Page(s) 7–14

    Abstract: To maximize the results of treatments for peritoneal metastases for rare abdominal or pelvic tumors, selection of patients with a possibility for long-term success is necessary. Because these malignancies are rare, data from which these selection factors ...

    Abstract To maximize the results of treatments for peritoneal metastases for rare abdominal or pelvic tumors, selection of patients with a possibility for long-term success is necessary. Because these malignancies are rare, data from which these selection factors can be extracted do not exist. In order to facilitate knowledgeable patient selection for treatment, the well established clinical and histopathologic features of the common malignancies treated for peritoneal metastases were reviewed. The potential application of selection factors for common diagnoses was explored in an attempt to provide selection factors for rare tumors. The histopathologic grade, the lymph node status, the Ki-67 proliferation index, prior surgical score (PSS), preoperative radiologic imaging, preoperative laparoscopic assessment, response to neoadjuvant chemotherapy, peritoneal cancer index (PCI), and completeness of cytoreduction score were all included in this search for relevant selection factors for a rare disease. To facilitate the use of selection factors from common peritoneal metastases diagnoses, these diseases were divided into four groups. Placement of the rare cause of peritoneal metastases into one of these four groups will allow knowledgeable selection for treatment. Rare diseases with a natural history resembling low-grade appendiceal neoplasms are in group 1, diseases resembling lymph node negative colorectal cancer are in group 2, diseases resembling lymph node positive colorectal peritoneal metastases in group 3, and diseases resembling gastric cancer in group 4.
    Language English
    Publishing date 2022-07-30
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 2568289-1
    ISSN 0976-6952 ; 0975-7651
    ISSN (online) 0976-6952
    ISSN 0975-7651
    DOI 10.1007/s13193-022-01593-9
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  10. Article ; Online: After thirty years of experience with early postoperative intraperitoneal 5-fluorouracil now saying goodbye.

    Sugarbaker, Paul H

    Surgical oncology

    2022  Volume 42, Page(s) 101757

    Abstract: In the management of colorectal and appendiceal peritoneal metastases, intraperitoneal 5-fluorouracil (5-FU) has been used in 3 different ways. It has been used as part of an early postoperative intraperitoneal chemotherapy (EPIC) regimen along with EPIC ...

    Abstract In the management of colorectal and appendiceal peritoneal metastases, intraperitoneal 5-fluorouracil (5-FU) has been used in 3 different ways. It has been used as part of an early postoperative intraperitoneal chemotherapy (EPIC) regimen along with EPIC mitomycin C. This EPIC mitomycin C plus EPIC 5-FU has been shown to be equivalent or inferior to HIPEC. Because it is more work intensive than HIPEC and not superior, its use should be abandoned if HIPEC is available. A second way to use intraperitoneal 5-FU is along with HIPEC. Several studies suggest a survival advantage for the combination of HIPEC with EPIC 5-FU. However, patient ineligibility for EPIC 5-FU in high-risk CRS is more likely the cause for the alleged survival advantage attributed to the combination. A third use of intraperitoneal 5-FU is long-term through a peritoneal access device. This plan for 5-FU use has shown favorable results in three randomized controlled studies. Normothermic intraperitoneal chemotherapy (NIPEC) with 5-FU should be considered as a regional chemotherapy component of a randomized trial for prevention or treatment of peritoneal metastases from colorectal or appendiceal cancer. Intravenous oxaliplatin combined with NIPEC 5-FU has been suggested as a bidirectional adjuvant regimen.
    MeSH term(s) Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Colorectal Neoplasms/drug therapy ; Colorectal Neoplasms/pathology ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Fluorouracil ; Humans ; Hyperthermia, Induced ; Mitomycin/therapeutic use ; Peritoneal Neoplasms/drug therapy ; Peritoneal Neoplasms/secondary
    Chemical Substances Mitomycin (50SG953SK6) ; Fluorouracil (U3P01618RT)
    Language English
    Publishing date 2022-04-02
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 1107810-8
    ISSN 1879-3320 ; 0960-7404
    ISSN (online) 1879-3320
    ISSN 0960-7404
    DOI 10.1016/j.suronc.2022.101757
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 3409: Show issues Location:
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