Perioperative Chemotherapy

One reason for failure to cure solid tumors by surgery appears to be the impossibility of controlling metastases that are present but latent at the time of operation. This failure is a common clinical experience with aggressive neoplasms. but it is not always appreciated in tumors with longer survival times. e. g .• breast and colon cancer. In addition. recent evidence indicates that after resection of a primary tumor micrometas tases from it might be enhanced by suppression of immune and reticu loendothelial functions of the host. Other factors, such as increase of coagulability and stress in the perioperative period, can also promote tumor growth. The development of new metastases might be facilitated by cells forced into the circulation during operative manipulations. Such events could be important for the outcome of treatment and it is suggested that preventive measures should be directed to this systemic component of solid tumors. Radical surgery can reduce the number of tumor cells to a subclinical 3 6 stage (10 to 10 cells) in which chemotherapy might be more effective than in advanced stages. Chemotherapy, on the other hand, might aggravate the surgical morbidity by influencing the wound healing pro cess, by decreasing the immune response, and/or by toxicity to the bone marrow and to the gastrointestinal tract, for example.

Despite recent advances in adjuvant therapies of cancer, the regi mens of postoperative adjuvant chemotherapy treatment which are presently available fail to cure the majority of cancer patients. Pre operative (neoadjuvant) chemotherapy represents a new approach in drug scheduling, based on sound theoretical, pharmacokinetic, and experimental principles. The preoperative timing of chemotherapy before definitive sur gery is not a minor change in the therapy of cancer. To be successful, large numbers of practitioners and their patients must participate. Substantial alterations of many aspects of the present management of cancer will have to follow. Therefore, before such therapy can be fully and routinely implemented, results of the novel treatment and its rationale have to be carefully evaluated. In preoperative treatment, other features will likely gain impor tance. For the first time, clinicians have a chance to follow the in vivo response of the tumor exposed to preoperative chemotherapy. The subsequent histological assessment of the tumor sample may likely become an important prognostic guide, permitting more re fined individual approaches to the planning of postoperative adju vant treatment. The value of such a treatment strategy can already be appreciated in the clinical setting, as seen from the therapy of osteosarcoma. Furthermore, preoperative chemotherapy might render previously inoperable tumors operable and hence resectable with a curative intention. The preoperative reduction of tumor bulk may also effectively decrease the need for more radical operations, permitting a more uniform adoption of conservative surgery.

Multimodal treatment strategies - perioperative chemotherapy (CTx) and radical surgery - are currently accepted as treatment standard for locally advanced gastric cancer. However, the role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial. Proceeds from the sale of this book go to support an elderly disabled person.

Prior to the use of the combined treatment of cytoreductive surgery (CRS) and perioperative chemotherapy (POC), peritoneal metastases were uniformly fatal. While the combined treatment of CRS and POC has been practiced for nearly 30 years, the benefits of the treatment are just emerging. This text is for surgical and medical oncologists, and describes the rationale, treatment, and results of treatment of peritoneal metastases, peritoneal mesothelioma, and sarcomatosis. Internationally renowned peritoneal surface oncology teams have authored the chapters. The text is accompanied by surgical video presentations which includes on-camera commentary by the international experts offering his or her own approach to CRS and POC.

More than 80% of patients with cancer will need the services of anesthesiology and perioperative medicine, intensive care medicine, and pain management specialists during their cancer journey for diagnostic, therapeutic, and symptom management needs, as well as for the management of recurrent disease, secondary cancers, and ongoing non-oncologic surgical needs during survivorship. Perioperative Care of the Cancer Patient is today’s most up-to-date, authoritative, comprehensive reference on the acute care of surgical patients with cancer, from a team of international experts in this emerging and dynamic specialty. Covers current clinical practice and perioperative care guidelines during the entire cancer journey for both adult and pediatric patients. Includes a diverse array of topics on cancer care, such as cancer epidemiology, cancer biology, ethics in cancer care delivery, value proposition in cancer care, opportunities and challenges with research programs in perioperative cancer care, application of big data and computational sciences in cancer medicine and care delivery, and the MD Anderson Cancer Center Moon Shots Program®. Discusses newer cancer therapies and their perioperative implications, functional assessment and prehabilitation, enhanced recovery programs in cancer care, challenges with novel cancer therapies in the care of the critically ill cancer patient, chronic and interventional pain management in patients with cancer, and more. An educational resource and clinical reference for surgeons, anesthesia practitioners, hospitalists, internists, pain physicians, intensivists, basic science researchers, and all clinicians involved in the acute care of surgical patients with cancer.

This issue of Surgical Clinics of North America focuses on Surgical Challenges of Foregut Malignancies and is edited by Dr. Sushanth Reddy. Articles will include: Molecular basis of gastric and esophageal tumors; Multidisciplinary therapy of gastric cancers; Management of early stage gastric and esophageal disease; What is the best operation for proximal gastric cancer and distal esophageal cancer?; The difficult esophageal conduit; Managing the Western patient in contrast to the Eastern patient; Complications after esophagectomy; Next generation sequencing in the management of gastric and esophageal cancers; Managing squamous cell esophageal cancer; Esophageal and gastric GISTs; Surgical Challenges of Foregut Malignancies; and more!

The book will explain previously unconnected clinical data such as why mammography works better for women age 50-59 than it does for women age 40-49, why adjuvant chemotherapy works best for premenopausal patients with positive lymph nodes, and it may also explain the racial disparity in outcome. In particular, it points to the perioperative period when systemic inflammation persists for a week or so. This can lead to a variety of mechanisms whereby single cancer cells (perhaps from the marrow) begin division and angiogenesis of dormant avascular micrometastases occurs leading to early relapses. With chapters presented from distinguished scientists and physicians in a variety of specialties that relate to and border the effects we present, this volume can be used as a reference for practicing physicians and as a jumping-off point for researchers to explore new therapeutic opportunities.

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.