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Article: Appendiceal Mucinous Neoplasms: From Clinic to Pathology and Prognosis.

González Bayón, Luis / Martín Román, Lorena / Lominchar, Pablo Lozano

2023 Volume 15, Issue 13

Abstract: Appendiceal mucinous neoplasms have been classified differently over time causing confusion when comparing results between working groups in this field and establishing a prognosis of the disease. A historical perspective of the different classification ... ...

Abstract	Appendiceal mucinous neoplasms have been classified differently over time causing confusion when comparing results between working groups in this field and establishing a prognosis of the disease. A historical perspective of the different classification systems of these tumors is essential for the understanding of the evolution of concepts and histopathological definitions that have led up to the present moment. We carried out a systematic review of the pathological classifications of appendiceal mucinous tumors and how they have included the new criteria resulting from clinical and pathological research. The latest classifications by PSOGI and AJCC 8th edition Cancer Staging have made a great effort to incorporate the new pathological descriptions and develop prognostic groups. The introduction of these new classification systems has posed the challenge of verifying how they adapt to our casuistry and which one defines best the prognosis of our patients. We reclassified our series of patients treated for mucinous appendiceal tumors with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy following the PSOGI and the AJCC 8th edition criteria and concluded that both classifications correspond well with the OS and DFS of these patients, with some advantage relative to the PSOGI classification due to a better histopathological description of the different groups.
Language	English
Publishing date	2023-06-30
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15133426
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Article ; Online: Correlation between PSOGI pathological classification and survival outcomes of patients with pseudomyxoma peritonei treated using cytoreductive surgery and HIPEC

Martín-Román Lorena / Hannan Enda / Faraz Khan Mohammad / Müller Anna Sophia / Shields Conor / Aird John / Moran Brendan / Mulsow Jurgen

Pleura and Peritoneum, Vol 8, Iss 2, Pp 65-

national referral centre experience and literature review

2023 Volume 74

Abstract: The Peritoneal Surface Oncology Group International (PSOGI) consensus subdivided pseudomyxoma peritonei (PMP) into four groups according to histopathological features. The aim of this paper is to report survival outcomes after cytoreductive surgery (CRS) ...

Abstract	The Peritoneal Surface Oncology Group International (PSOGI) consensus subdivided pseudomyxoma peritonei (PMP) into four groups according to histopathological features. The aim of this paper is to report survival outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) from a national referral centre and to correlate the PSOGI classification with survival.
Keywords	acellular mucin ; appendiceal mucinous neoplasms ; appendiceal mucinous neoplasms with signet ring cells ; cytoreductive surgery and hyperthermic intraperitoneal chemotherapy ; grading pathology and classification ; pseudomyxoma peritonei ; Medicine ; R ; Specialties of internal medicine ; RC581-951
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	De Gruyter
Document type	Article ; Online
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Article ; Online: Systemic metastases from low-grade and high-grade pseudomyxoma peritonei: Treatments and outcomes.

Baratti, Dario / Milito, Pamela / Kusamura, Shigeki / Martin Roman, Lorena / Guaglio, Marcello / Deraco, Marcello

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

2022 Volume 48, Issue 7, Page(s) 1590–1597

Abstract: Background: The metastasizing potential of pseudomyxoma peritonei (PMP) is largely unknown. We assessed incidence, impact on prognosis, treatments, and outcomes of systemic metastases after cytoreductive surgery and hyperthermic intraperitoneal ... ...

Abstract	Background: The metastasizing potential of pseudomyxoma peritonei (PMP) is largely unknown. We assessed incidence, impact on prognosis, treatments, and outcomes of systemic metastases after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Methods: A prospective database of 327 patients undergoing CRS/HIPEC for PMP of appendiceal origin was reviewed. PMP was graded according to the Peritoneal Surface Oncology Group International (PSOGI) classification. Haematogenous metastases, and non-regional lymph-node involvement were considered as systemic metastases. Results: After a median follow-up of 74.8 months (95% confidence interval [CI] = 68.0-94.8), systemic metastases occurred in 21 patients. Eleven patients were affected by low-grade PMP, and ten by high-grade PMP. Metastatic disease involved the lung (n = 12), bone (n = 1), liver (n = 4), distant nodes (n = 3), both lung and distant nodes (n = 1). Systemic metastases independently correlated with PSOGI histological subtypes (P = 0.001), and incomplete cytoreduction (P = 0.026). Median OS was 139.0 months (95%CI = 56.6-161.9) for patients who experienced systemic metastases, and 213.8 months (95%CI = 148.7-not reached) for those who did not (P = 0.159). Eight of eleven patients who had curative-intent surgery are presently alive at a median of 52.5 months (range 2.0-112.7). Seven are disease-free at a median of 27.4 months (range 2.0-110.4). At multivariate analysis, PSOGI histological subtypes (P = 0.001), completeness of cytoreduction (P = 0.001), and preoperative systemic chemotherapy (P = 0.020) correlated with poorer survival. Systemic metastases did not (P = 0.861). Conclusions: After CRS/HIPEC, systemic metastases occur in a small but clinically relevant number of patients, and the risk increases with incomplete cytoreduction and aggressive histology. In selected patients, surgical resection of metastatic disease can result in long survival.
MeSH term(s)	Appendiceal Neoplasms/pathology ; Appendiceal Neoplasms/therapy ; Combined Modality Therapy ; Cytoreduction Surgical Procedures/adverse effects ; Humans ; Hyperthermia, Induced ; Peritoneal Neoplasms/secondary ; Pseudomyxoma Peritonei/pathology ; Retrospective Studies ; Survival Rate
Language	English
Publishing date	2022-01-20
Publishing country	England
Document type	Journal Article
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2022.01.010
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Article ; Online: ASO Author Reflections: Predicting Prognosis in Patients with Pseudomyxoma.

Martín Román, Lorena / Lozano Lominchar, Pablo / Baratti, Dario / Vásquez, Wencesalo / González Bayón, Luis

Annals of surgical oncology

2022 Volume 29, Issue 12, Page(s) 7564–7565

MeSH term(s)	Humans ; Peritoneal Neoplasms ; Prognosis ; Pseudomyxoma Peritonei/surgery
Language	English
Publishing date	2022-07-27
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-12287-5
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Article ; Online: Correlation between PSOGI pathological classification and survival outcomes of patients with pseudomyxoma peritonei treated using cytoreductive surgery and HIPEC: national referral centre experience and literature review.

Martín-Román, Lorena / Hannan, Enda / Faraz Khan, Mohammad / Müller, Anna Sophia / Shields, Conor / Aird, John / Moran, Brendan / Mulsow, Jurgen

Pleura and peritoneum

2023 Volume 8, Issue 2, Page(s) 65–74

Abstract: Objectives: The Peritoneal Surface Oncology Group International (PSOGI) consensus subdivided pseudomyxoma peritonei (PMP) into four groups according to histopathological features. The aim of this paper is to report survival outcomes after cytoreductive ... ...

Abstract	Objectives: The Peritoneal Surface Oncology Group International (PSOGI) consensus subdivided pseudomyxoma peritonei (PMP) into four groups according to histopathological features. The aim of this paper is to report survival outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) from a national referral centre and to correlate the PSOGI classification with survival. Methods: A retrospective study of a prospectively maintained database was performed. Consecutive patients treated with CRS + HIPEC for PMP of appendiceal origin were included (September-2013 to December-2021). Pathological features of the peritoneal disease were used to classify patients into the four groups proposed by PSOGI. Survival analysis was performed to evaluate the correlation of pathology on overall survival (OS) and disease-free survival (DFS). Results: Overall, 104 patients were identified; 29.6 % were reclassified as acellular mucin (AM), 43.9 % as low-grade mucinous carcinoma peritonei (LGMCP), 22.4 % as high-grade MCP (HGMCP) and 4.1 % as HGMCP with signet ring cells (HGMCP-SRC). Median PCI and rate of optimal cytoreduction were 19 and 82.7 %, respectively. Median OS and DFS were not reached, 5-year OS and DFS were 88.6(SD 0.04) % and 61.6(SD 0.06) %, respectively. Log-Rank test revealed significant differences in terms of OS and DFS across the different histological subgroups (p<0.001 in both cases). However, histology did not retain its significance in the multivariate analysis for OS or DFS (p=0.932 and p=0.872, respectively). Conclusions: Survival outcomes after CRS + HIPEC for PMP are excellent. The PSOGI pathological classification correlates with OS and DFS, but differences were not significant at multivariate analysis when adjusted for other prognostic factors.
Language	English
Publishing date	2023-05-01
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2861909-2
ISSN	2364-768X ; 2364-7671
ISSN (online)	2364-768X
ISSN	2364-7671
DOI	10.1515/pp-2023-0001
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Article ; Online: Which classification system defines best prognosis of mucinous neoplasms of the appendix with peritoneal dissemination: TNM vs PSOGI?

Martín-Román, Lorena / Lozano, Pablo / Gómez, Yesica / Fernández-Aceñero, María Jesús / Vasquez, Wenceslao / Palencia, Natividad / González-Bayón, Luis

Journal of clinical pathology

2021 Volume 76, Issue 4, Page(s) 266–273

Abstract: Aims: Several classification systems are used for pseudomyxoma peritonei. The four-tiered classification system proposed by Peritoneal Surface Oncology Group International (PSOGI) and the two-tiered proposed by the eighth edition of the American Joint ... ...

Abstract	Aims: Several classification systems are used for pseudomyxoma peritonei. The four-tiered classification system proposed by Peritoneal Surface Oncology Group International (PSOGI) and the two-tiered proposed by the eighth edition of the American Joint Committee on Cancer (AJCC) result from evolution in terminology and pathological insight. The aim is to evaluate the impact of PSOGI and eighth edition of the AJCC classifications on survival. Methods: Pathological slides were reviewed from a prospectively maintained database including patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for an appendiceal mucinous neoplasm with peritoneal dissemination between January 2009 and December 2019. Patients were reclassified according to PSOGI and AJCC eighth edition criteria. Survival analysis evaluated the impact of each classification system on overall survival (OS) and disease-free survival (DFS) while the concordance-index evaluated their predictive power. Results: 95 patients were identified; 21.1% were reclassified as acellular mucin, 55.8% as low-grade mucinous carcinoma peritonei, 8.4% as high-grade MCP (HGMCP) and 14 as HGMCP with signet ring cells. Median OS was not reached, 5-year OS and DFS were 86.1% and 51.5%, respectively. Multivariate analysis revealed significant associations with OS (PSOGI: HR 10.2, p=0.039; AJCC: HR 7.7, p=0.002) and DFS (PSOGI: HR 12.7, p=0.001; AJCC: HR 3.7, p<0.001). The predictive capacity of both classification systems was unacceptable for OS and DFS (concordance-index values <0.7). Conclusions: Both classification systems behaved similarly when stratifying our series into prognostic groups. The PSOGI classification provides better histopathological description, but histology alone is insufficient for adequate patient prognostication.
MeSH term(s)	Humans ; Appendix/pathology ; Peritoneal Neoplasms/therapy ; Peritoneal Neoplasms/pathology ; Appendiceal Neoplasms/therapy ; Appendiceal Neoplasms/pathology ; Pseudomyxoma Peritonei/therapy ; Neoplasms, Cystic, Mucinous, and Serous ; Prognosis ; Retrospective Studies ; Survival Rate
Language	English
Publishing date	2021-11-01
Publishing country	England
Document type	Journal Article
ZDB-ID	80261-x
ISSN	1472-4146 ; 0021-9746
ISSN (online)	1472-4146
ISSN	0021-9746
DOI	10.1136/jclinpath-2021-207883
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Article ; Online: Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen.

Tudela Lerma, María / Turégano Fuentes, Fernando / Pérez Díaz, María Dolores / Rey Valcárcel, Cristina / Martín Román, Lorena / Ruiz Moreno, Cristina / Fernández Vázquez, María Luz / Fernández Martínez, María

Cirugia espanola

2022 Volume 100, Issue 2, Page(s) 67–73

Abstract: Introduction: The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main ... ...

Abstract	Introduction: The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results. Methods: Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location. Results: We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RH, followed by the LH and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70.5% of lumbar, 66.5% of epigastric, 62% of flank, and 59% of RH penetrating SW could have been managed without a laparotomy. Conclusions: SNOM of penetrating SW in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RH regions.
Language	English
Publishing date	2022-02-02
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.cireng.2022.01.006
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Article: Complications and Mortality Rate of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: Italian Peritoneal Surface Malignancies Oncoteam Results Analysis.

Carboni, Fabio / Valle, Mario / Vaira, Marco / Sammartino, Paolo / Federici, Orietta / Robella, Manuela / Deraco, Marcello / Framarini, Massimo / Macrì, Antonio / Sassaroli, Cinzia / Lippolis, Piero Vincenzo / Di Giorgio, Andrea / Biacchi, Daniele / Martin-Roman, Lorena / Sperduti, Isabella / Baratti, Dario

Cancers

2022 Volume 14, Issue 23

Abstract: Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy may significantly improve survival for selected patients with peritoneal surface malignancies, but it has always been criticized due to the high incidence of postoperative ... ...

Abstract	Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy may significantly improve survival for selected patients with peritoneal surface malignancies, but it has always been criticized due to the high incidence of postoperative morbidity and mortality. Methods: Data were collected from nine Italian centers with peritoneal surface malignancies expertise within a collaborative group of the Italian Society of Surgical Oncology. Complications and mortality rates were recorded, and multivariate Cox analysis was used to identify risk factors. Results: The study included 2576 patients. The procedure was mostly performed for ovarian (27.4%) and colon cancer (22.4%). The median peritoneal cancer index was 13. Overall postoperative morbidity and mortality rates were 34% and 1.6%. A total of 232 (9%) patients required surgical reoperation. Multivariate regression logistic analysis identified the type of perfusion ( Conclusions: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is a valuable option of treatment for selected patients with peritoneal carcinomatosis providing low postoperative morbidity and mortality rates, if performed in high-volume specialized centers.
Language	English
Publishing date	2022-11-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14235824
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Article ; Online: Relevance of pneumoperitoneum in the conservative approach to complicated acute diverticulitis. A retrospective study identifying risk factors associated with treatment failure.

Martín-Román, Lorena / Fernández-Martínez, María / Kayser Mata, Silvia / Colombari, Renan / Pascual-Espinosa, Pablo / Rey-Valcárcel, Cristina / Jiménez-Gómez, Luis M / Turégano-Fuentes, Fernando

Minerva surgery

2021 Volume 77, Issue 4, Page(s) 327–334

Abstract: Background: The aim of this study is to evaluate the relevance of pneumoperitoneum on the success rate of non-operative management (NOM) of patients with complicated acute diverticulitis (AD), and the risk factors associated with failure.: Methods: ... ...

Abstract	Background: The aim of this study is to evaluate the relevance of pneumoperitoneum on the success rate of non-operative management (NOM) of patients with complicated acute diverticulitis (AD), and the risk factors associated with failure. Methods: Observational retrospective cohort study of patients attended at the emergency department for AD from January 2015-August 2019. Patient demographics, blood tests, radiological data and initial treatment strategies were registered. NOM, based on intravenous antibiotics (ATB) and bowel rest, was defined as unsuccessful when emergency surgery (ES) and/or infection-related death took place. Patients initially treated with ES were excluded. Analysis was done with the IBM SPSS statistics 23.0.0.2 software. Results: According to modified Hinchey and WSES criteria, 99 (12%) of 826 AD episodes were complicated, with pneumoperitoneum on the CT scan in 89 (90.5%). NOM was undertaken in 93 (94%) cases, with a 91.5% success rate. Multivariate analysis revealed ASA class III-IV, and the presence of fluid collections >3 cm in diameter, but not distant free air, to be associated with NOM failure. However, the success rate of NOM was significantly higher in patients with pericolic pneumoperitoneum (98.5%) than in those with distant free air (80%) (P=0.02). Risk factors of NOM failure were an advanced age, high CRP and WBC values, and the presence of free fluid in >2 abdominal quadrants. Conclusions: NOM in hemodynamically stable patients with complicated AD is a safe and feasible approach, even in the context of distant free air. Nevertheless, patients with isolated pericolic air did better in our series.
MeSH term(s)	Diverticulitis/therapy ; Humans ; Pneumoperitoneum/diagnostic imaging ; Retrospective Studies ; Risk Factors ; Treatment Failure
Language	English
Publishing date	2021-08-02
Publishing country	Italy
Document type	Journal Article ; Observational Study
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.21.08997-8
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Article ; Online: Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen.

Cirugia espanola

2021

Title translation	Relación entre la localización anatómica y el manejo selectivo no operatorio de las heridas por arma blanca penetrantes en abdomen.
Abstract	Introduction: The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results. Methods: Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location. Results: We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RUQ, followed by the LUQ and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70,5% of lumbar, el 66,5% of epigastric, 62% of flank, and 59% of RUQ penetrating SWs could have been managed without a laparotomy. Conclusions: SNOM of penetrating SWs in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RUQ regions.
Language	Spanish
Publishing date	2021-02-13
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.ciresp.2020.12.003
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