Magnetic Resonance Imaging with Diffuse Weighted Imaging and Computed Tomography with Intravenous Contrast in Staging of Disseminated Ovarian, Stomach, Colorectal Cancer

The aim of the research. Development and implementation of new methods for pre-operative staging of advanced ovarian, gastric and colorectal cancer to improve patient selection for cytoreductive surgery and increase its radicality.Materials and methods. Data from 120 patients with advanced ovarian cancer, 28 with advanced gastric cancer and 119 with advanced colorectal cancer were analyzed. Preoperative detection of the incidence of peritoneal carcinoma and the possibility of surgery in radical or cytoreductive volume performed by CT with intravenous contrast (72 patients with ovarian cancer, 17 patients with gastric cancer, and 69 patients with colorectal cancer), and MR T1 and T2, contrast-enhanced T1, and diffuse-weighted sequences (48 patients with ovarian cancer, 11 patients with gastric cancer, and 50 patients with colorectal cancer). Subsequently, preoperative and intraoperative assessment of the prevalence of the tumour process with peritoneal carcinoma index (PCI) by Sugarbaker was performed.Results. A statistically significant increase in the informativeness of the preoperative assessment of the incidence of tumour process in peritoneum and the presence of distant metastases using DWI / MRI compared with CT with intravenous contrast was determined. Patients from all groups were categorized according to the completeness index of cytoreduction achieved by preoperative staging and patient selection using DWI / MRI and CT. The use of DWI / MRI allowed to significantly reduce the number of suboptimal and non-optimal cytoreductive interventions.Conclusions. DWI / MRI has made it possible to significantly improve the preoperative incidence of advanced ovarian, gastric, and colorectal cancer compared to CT, predict the radicality of future surgery, and detect inoperable cases

Циторедуктивна хірургія при хіміорезистентній лейоміосаркомі матки

Циторедуктивна хірургія при хіміорезистентній лейоміосаркомі матк

Synchronous metastatic colon carcinoma presenting as ovarian metastasis: a case report

The aim of the study was to discuss a rare case of synchronously metastatic colon cancer, which clinically manifested as intestinal obstruction due to the presence of ovarian metastasis. Materials and methods. The clinical case of a 47-year-old patient with synchronously metastatic colorectal cancer with an affected disease, peritoneal carcinomatosis and metastatic ovarian lesions was analyzed. Case presentation. In July 2021, patient R., 47 years old, developed a clinic of sub-compensated intestinal obstruction. According to CT and MRI data, a volume formation of the small pelvis with a diameter of about 15 cm with compression of the surrounding soft tissues and metastases of the 6th and 4a segments of the liver were determined. According to a colonoscopy, a neoplasm of the sigmoid colon was verified as adenocarcinoma. The presence of peritoneal carcinomatosis was determined intraoperatively; the operation was performed in the following scope: SS-0 (complete cytoreduction) – right-sided ovariectomy with a tumour, resection of the sigmoid colon with a tumour, resection of the rectum with TME, extirpation of the cervical stump with the left ovary and pelvic peritonectomy en block resection and diathermocoagulation of foci of peritoneal carcinomatosis on the visceral peritoneum of the small intestine, omentectomy, radiofrequency ablation of a liver tumour under ultrasound guidance. According to histopathological examination: adenocarcinoma (G2) with foci of mucus production in the sigmoid colon, metastatic lesion of the right ovary, cervix, peritoneum, and liver. Subsequently, from September 2021 to July 2022, the patient underwent 8 courses of adjuvant polychemotherapy according to the FOLFOX scheme and 2 courses according to the FOLFOX scheme and bevacizumab. In August 2022, due to signs of disease progression, the patient underwent SS-0 cytoreductive surgery: removal of tumour nodes of the parietal and visceral peritoneum, partial peritonectomy of the anterior abdominal wall, argon plasma coagulation of foci of peritoneal carcinomatosis of the parietal and visceral peritoneum, resection of the round ligament of the liver, NIRES. According to the results of the histological examination, metastases of mucinous adenocarcinoma of the intestinal type with the II–III degree of medical pathomorphosis were determined. From September 2022, the patient received 2 courses according to the IRINOX + bevacizumab regimen and 6 courses according to the FOLFIRI + bevacizumab regimen. According to the control MRI of the abdominal organs with intravenous contrast, metastases of the 7th and 8th segments of the liver were determined. Performed percutaneous radiofrequency ablation of liver metastases under ultrasound control Results. According to the results of the MRI of the OCP with intravenous contrast, there are currently no data on the progression of the disease. The patient’s quality of life is satisfactory; the ESOG score is 0. It has been 22 months since the onset of the disease. Conclusions. Cytoreductive surgical interventions for synchronously metastatic colorectal cancer can significantly improve patients’ quality of life and their oncological outcomes rather than only symptomatic treatment

Magnetic resonance imaging with diffuse weighted imaging and computed tomography with intravenous contrast in staging of disseminated ovarian, stomach, colorectal cancer

The aim of the research. Development and implementation of new methods for pre-operative staging of advanced ovarian, gastric and colorectal cancer to improve patient selection for cytoreductive surgery and increase its radicality. Data from 120 patients with advanced ovarian cancer, 28 with advanced gastric cancer and 119 with advanced colorectal cancer were analyzed. Preoperative detection of the incidence of peritoneal carcinoma and the possibility of surgery in radical or cytoreductive volume performed by CT with intravenous contrast (72 patients with ovarian cancer, 17 patients with gastric cancer, and 69 patients with colorectal cancer), and MR T1 and T2, contrast-enhanced T1, and diffuse-weighted sequences (48 patients with ovarian cancer, 11 patients with gastric cancer, and 50 patients with colorectal cancer). Subsequently, preoperative and intraoperative assessment of the prevalence of the tumour process with peritoneal carcinoma index (PCI) by Sugarbaker was performed. A statistically significant increase in the informativeness of the preoperative assessment of the incidence of tumour process in peritoneum and the presence of distant metastases using DWI/MRI compared with CT with intravenous contrast was determined. Patients from all groups were categorized according to the completeness index of cytoreduction achieved by preoperative staging and patient selection using DWI/MRI and CT. The use of DWI/MRI allowed to significantly reduce the number of suboptimal and non-optimal cytoreductive interventions. DWI/MRI has made it possible to significantly improve the preoperative incidence of advanced ovarian, gastric, and colorectal cancer compared to CT, predict the radicality of future surgery, and detect inoperable cases

Correlation analysis of GSTP1 gene polymorphism with morbidity of primary metastatic colorectal cancer

Colorectal cancer (CRC) is one of the most common malignancies. Susceptibility to malignant processes is mediated by genetically driven differences in the effectiveness of detoxification of potential carcinogens. One of the factors that may influence the risk of CRC is the glutathione-S-transferase (GST) gene family that encodes glutathione transferase enzymes. The GSTP1 gene is expressed both in normal and pathological conditions. Determining its specific alleles may be a marker of CRC. The aim of the research – to study GSTP1 gene polymorphism, which is likely to be more common among patients with primary metastatic colorectal cancer compared with healthy population. Materials and methods. The study involved 12 patients with primary metastatic colorectal cancer aged 43 to 72 years, the control group was represented by a sample of 31 people without cancer. Results. The incidence of advanced CRC in the presence of GSPT1 Val/Val (aa) polymorphism is statistically significantly higher than in the presence of Ile/Ile (AA) and Ile/Val (Aa) GSPT1 polymorphism. Conclusions. Among people with GSTP1 Val/Val (aa) polymorphism, primary CRC is 4.4 times more likely than among people with GSPT1 Ile/Ile (AA) and Ile/Val (Aa) polymorphisms, which are statistically significant (p<0.05). The obtained results indicate the possibility of conducting a genetic study of GSTP1 polymorphism to form groups of potential risk of CRC

Optimal Surgical Treatment Tactics in Patients with Synchronous Metastatic Colorectal Cancer

The aim of the study is to choose the optimal tactics of surgical treatment in patients with colorectal cancer (CRC) with synchronous intra-abdominal metastases. Materials and methods: The study included 74 patients with CRC with synchronous intra-abdominal metastases (peritoneal carcinomatosis and/or liver metastases), which were divided into 3 groups: I group (25 patients)-Intestinal stoma + neoadjuvant chemotherapy + Cytoreductive Surgery (CRS) + Adjuvant Chemotherapy (ACT); II group (18 patients)-Colon/rectal resection + ACT + CRS + ACT; III group (31 patients)-CRS + ACT. Results: The best oncological results were obtained in III group (median overall survival 46 months vs 27m. in I group and 31m. in II group). In contrast, a higher incidence of postoperative complications was observed also in this group (29%). There is no significant difference in overall survival (p>0.05 according to Log-Rank test) and the rate of postoperative complications between all groups of patients. The mean length of hospital stay was shorter in III group-9.8 days (p<0.01). Conclusions: All three options could be selected for the treatment of synchronous metastatic CRC. Therefore, the main goal remains the achievement of complete cytoreduction. So, it is necessary to focus on its possibility when choosing the sequence of stages of treatment in such patients. However, if it is possible to achieve complete cytoreduction and in the setting of the oncological center it is recommended cytoreductive surgery as the first step followed by adjuvant chemotherapy as the best treatment tactics for patients with synchronous metastatic CRC

The interval between the primary cytoreductive surgery and adjuvant chemotherapy in patients with advanced ovarian cancer

Aim of the study was to establish the effect of the time interval between the initial optimal cytoreductive surgery and the initiation of adjuvant chemotherapeutic treatment (ACT) on the overall survival (OS) of patients with advanced ovarian adenocarcinoma. Materials and methods. Clinical cases of 60 patients with advanced ovarian adenocarcinoma (FIGO IIIC-IV), with the average age of 61 years, who underwent primary cytoreductive surgery (PDS) with the completeness of cytoreduction (CC) – 0 score according to Shugarbaker and adjuvant chemotherapeutic treatment according to the standard frst-line regimen were examined. Patients were categorized depending on the time between surgery and chemotherapeutic treatment into two groups: I – delay of chemotherapy for no more than one month (30 patients), II – from two to six months (30 patients). The OS data of the patients obtained from the national cancer registry were analyzed. Results. The results demonstrate an increase in OS of patients who underwent CC-0 PDS at the early initiation of ACT. Conclusions. Delaying the onset of ACT is an independent predictor of the worse OS after performing PDS. According to the data obtained, patients should start ACT within 1 month after the surgery. However, the fndings are proved if CC-0 is achieved during the operation

Synchronous multiple primary malignant neoplasms: a case report of malignant peritoneal mesothelioma and neuroendocrine rectal tumor

The aim of the research was to discuss a rare case of synchronous malignant peritoneal mesothelioma of the biphasic histological type and neuroendocrine tumor (NET) of the rectum without history of asbestos exposure and to analyze the outcomes of the performed treatment. Materials and methods. The 48-year-old patient with synchronous malignant peritoneal mesothelioma of the biphasic histological type and neuroendocrine tumor (NET) of the rectum was analyzed for oncological and clinical outcomes. Case presentation. During 2 years since manifestation of the disease the patient underwent 3 cytoreductive surgeries (CRS): removal of the tumor of the sigmoid mesentery, resection of the rectosigmoid junction completeness of cytoreduction (CC) 0 (2017), omentectomy and partial parietal peritonectomy CC-0 (2017), atypical resection of S2, S4, S5 liver, the removal of the abdominal tumor with left-sided en-block hemicolectomy, partial parietal peritonectomy, argon-plasma coagulation of tumor foci on the mesentery of the small intestine CC-2 (2018) and Transanal Minimally Invasive Surgery-removal of neuroendocrine rectal tumor (2017). The patient underwent hyperthermic intraperitoneal chemotherapy (HIPEC) twice (during 2nd and 3rd CRS). Different regimens of HIPEC were performed: cisplatin + doxorubicin (2017) and metamycin C (2018). The patient received 4 courses of adjuvant chemotherapy with cisplatin plus pemetrexed in 2017 and 3 courses of the chemotherapy with gemcitabine and carboplatin plus bevacizumab in 2018. Results. The patient survived 21 months after the detection of malignant peritoneal mesothelioma in 2017 and died 4 months after the last cytoreductive surgery from the progression of the disease. Conclusions. Histological subtype of MPMP remains important factor in the prognosis of the disease even on the early stages though patient had received the most aggressive variant of special treatment. Minimally invasive treatment tactics of NET demonstrated clinical effectiveness

The impact of hyperthermic intraperitoneal chemotherapy and cytoreductive surgery on clinical outcomes and quality of life of patients with peritoneal carcinomatosis

Aim of the study: To investigate the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) on the clinical and oncological outcomes and quality of life (QOL) of patients with peritoneal carcinomatosis (PC). Material and methods: The study involved 304 patients with PC of different origin, who were divided into 2 groups: Group I – cytoreductive surgery (CRS) + adjuvant chemotherapy (ACT) – 247 patients; Group II – CRS + HIPEC + ACT – 57 patients. Intraoperative characteristics and postoperative complications were compared. Patients’ QOL was assessed at all phases of treatment using the international scales the Short Form-36 Health Survey (SF-36) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Breast Cancer Core 30 (EORTC QLQ-C30). Results: No statistically significant differences were observed between the 2 groups comparing the average blood loss and the total rate of postoperative complications, although the rates of hyperthermia and acute renal failure in the early postoperative period were higher in the HIPEC group. The use of HIPEC significantly contributed to the worse restoration of intestinal function in the postoperative period and to prolonged hospital stay. Assessment of the QOL of patients in Group II using SF-36 showed no significant difference between the physical and psychological components of health compared with the control group. The analysis of EORTC data showed a significant deterioration in the QOL of patients in Group II due to increased scales of pain, nausea and vomiting, and constipation in the early postoperative period. No difference in QOL was observed in the subsequent phases of treatment and after its completion. Overall survival and disease-free survival of patients with ovarian cancer who underwent HIPEC were significantly better compared with CRS + ACT alone. Conclusions: The proposed HIPEC technique has demonstrated its clinical safety in the treatment of PC, no long-term negative impact on the QOL of patients, and better oncological results for ovarian cancer

Implementation of the enhanced recovery after surgery protocol for patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion

Aim of the study – to investigate the feasibility of enhanced recovery after surgery (ERAS) protocol for patients with primary peritoneal carcinomatosis (PC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC) based on the length of hospital stay (LOS), return of bowel function, the incidence of postoperative complications, and quality of life (QLQ) analysis. Material and methods: The study included a total of 37 patients with primary PC of different origin, who underwent cytoreductive surgery plus HIPEC. Patients were divided into 2 groups: Group I (nonERAS) – 20 patients and Group II (ERAS) – 17 patients. Results: The median LOS in Group I (nonERAS) (12.35 ± 3.9) was longer than in Group II (ERAS) (6.8 ± 1.9) (p < 0.01). The use of the ERAS protocol significantly contributed to the faster return of bowel function (peristalsis and stool) in the postoperative period (p < 0.01). There was no statistically significant difference in the incidence of postoperative complications between the ERAS and nonERAS groups, which supports its clinical safety. Improved QLQ according to the obtained data has also been achieved due to the introduction of the principles of the ERAS protocol. Conclusions: The obtained results prove the expediency and feasibility of the implementation of the ERAS protocol among patients undergoing cytoreductive surgery in combination with HIPEC