Peritoneal surface/HIPEC

Question 1

Dutch trial Verwaal et. al?

Answer 1

• CRC with PM rand to CRS/HIPEC (mitomycin c 90 min) and chemo vs. chemo alone (Only 5-FU)
• OS improved for CC 0 and CC1

Question 2

PRODIGE 7 HIPEC for CRC?

Answer 2

• RCT CRC after 6m nCT (PCI<23)
• Random intraop if able to completely cytoreduce
• 30 min with Oxaliplat
• No overall OS benefit to HIPEC
• Benefit in PCI 11-15

Question 3

HIPECT 4?

Answer 3

• RCT CRS/HIPEC (mitomycin 60 min) vs CRS alone
• T4, N0-2
• Local control improved

Question 4

Types of appendiceal epithelial tumors?

Answer 4

Serrated polyps
LAMN
HAMN
Adenocarcinoma (mucinous, non mucinous, signet ring cell)
Goblet cell adeno

Question 5

LAMN T stage?

Answer 5

Tis- all tumors confined by muscularis
No T1 T2
T3- Subserosa
T4- Serosa, including mesoappendix

Question 6

LAMN M stage?

Answer 6

M1a- Acellular mucin
M1b- Cellular mucin in peritoneum only
M1c- Extraabdominal

Question 7

Completion of cytoreduction grades?

Answer 7

• CC 0- no tumor
• CC 1- < 2.5 mm
• CC 2- 2.5 mm- 2.5 cm
• CC 3 > 2.5 cm

Question 8

PCI?

Answer 8

13 regions
Max 39

Question 9

Lesion size score PCI?

Answer 9

• LS 0- no tumor
• LS 1- up to 0.5cm
• LS 2- 0.5 - 5 cm
• LS 3- > 5 cm
  *LS scores double of CC score

Question 10

Pseudomyxoma peritoneii types?

Answer 10

Acellular mucin
Low grade mucinous carcinoma peritoneii (DPAM)
High grade mucinous carcinoma peritoneii (PMCA)
PMCA-S (with Signet cells)

Question 11

Mesothelioma types?

Answer 11

Epitheloid (75%)
Sarcomatoid (very rare)
Mixed (25%, 10 % of each histology)

Question 12

HAMN?

Answer 12

Single focus of high grade dysplasia adequate to call it HAMN
No Tis (unlike LAMN)
Non invasive
Treat like LAMN

Question 13

Goblet cell adenocarcinoma?

Answer 13

Features of NET and adenoca
More aggressive than NET
Finding of goblet cells and positive mucin stain differentiates from NET
Right colectomy for all

Question 14

Mucinous appendiceal adenoCa?

Answer 14

> 50% mucin
Staged same as colon Ca
Well diff, intermediate and poor
Well diff more likely to present with PMP
T1 and well diff, right colectomy

Question 15

CC grades and LS score relationship?

Answer 15

CC grades half of LS score (mnemonic)

Question 16

Peritoneal mesothelioma staging?

Answer 16

By PCI
T1 – PCI 1-10
T2 – PCI 11-20
T3 – PCI 21-30
T4 – PCI 31-39

Question 17

Mesothelioma poor prognostic factors?

Answer 17

Thrombocytosis
Epitheloid>sarcomatoid
Male > female

Question 18

Mesothelioma chemo?

Answer 18

Pemetrexed/cisplatin systemic
Mitomycin or Cisplatin for HIPEC

Question 19

Gastric CA HIPEC evidence?

Answer 19

Cytochip (CRS vs CRS HIPEC)- improved OS with HIPEC
Yang and Regatta trials
Currently indicated for PCI <6