PubMed Health⌕ Search

Biomedical subjects

P H Sugarbaker

Publications and source records attributed to P H Sugarbaker.

At least 19 recordsLinked to original sources
PubMed1995

Treatment of pseudomyxoma peritonei in a geriatric patient population.

Pseudomyxoma peritonei of appendiceal origin is a disease characterized by the progressive accumulation of mucus ascites within the abdomen and pelvis. Metastatic disease outside the peritoneal cavity is unusual. Gastrointestinal function is lost from external compression of stomach, small bowel, and large bowel. New surgical and regional chemotherapy treatments were used to provide palliation of two patients aged 88 and 85 years. The selection criteria and methodologies for treatment of geriatric patients with pseudomyxoma peritonei are presented.

Aged↗
PubMed1995

Pharmacokinetic studies of intraaortic stop-flow infusion with 14C-labeled mitomycin C.

This pharmacokinetic study attempted to improve the exposure of gastrointestinal tract tissues to chemotherapy by increasing the transit time of a first pass of a drug through the vascular system. Bolus infusion of 9 mg mitomycin (MMC) mixed with 1 mg of MMC labeled by 50 microCi of 14C was performed in 18 mongrel dogs. Pharmacokinetics of MMC in peripheral, portal, and aortic blood were studied under different types of major vessel occlusion. Three dogs with intravenous infusion constituted a control group. In 15 dogs MMC was infused intraaortically with the catheter's tip at the level of the celiac and superior mesenteric artery. Vascular flow was controlled in four different ways for 30 min: Type I-Type IV. In Type IV the abdominal aorta and vena cava inferior were occluded after surgical exclusion of all nongastrointestinal branches of aorta. Blood samples were obtained during a 90-min period. After solubilizing the samples, 14C-labeled MMC activity was counted by a scintillation counter. For stop-flow infusion Type I, II, III, and IV, area under the curve (AUC) ratios for portal blood versus systemic circulation were 1.6:1, 2.9:1, 2.9:1, and 8.8:1, respectively (statistically significant for Types II, III, and IV). The highest value of AUC, peak MMC concentration, and lowest clearance in portal blood were achieved in SFI Type IV. Exposure to MMC was the greatest with SFI Type IV, making this type of aortic stop-flow infusion the most favorable mode of drug administration from a pharmacokinetic perspective.

Animals↗
PubMed1995

Cancer recurrence following laparoscopic colectomy. Report of two patients treated with heated intraperitoneal chemotherapy.

PURPOSE: Use of laparoscopic techniques for resection of colon and rectal cancer has raised considerable controversy. There is increasing concern that wound recurrence and peritoneal dissemination may represent a potentially fatal complication of this technique. METHODS: The surgical literature was reviewed, and clinical course of two patients is presented. RESULTS: Our two patients had tumor recurrence in the laparoscopy port sites within one year after laparoscopic assisted colectomy for Dukes B adenocarcinoma of the colon. At laparotomy, diffuse peritoneal carcinomatosis without lymph node or liver metastases were found in both patients. They were treated by surgical resection of recurrent disease combined with heated intraoperative intraperitoneal mitomycin C chemotherapy and five days of early postoperative intraperitoneal 5-fluorouracil. These patients are clinically free of disease at 1.5 years after treatment of peritoneal implants. CONCLUSIONS: Cancer recurrence in abdominal wall incisions after laparoscopic colectomy has been reported in an increasing number of patients. It is possible that this technique should be abandoned. Cytoreductive surgery combined with intraperitoneal chemotherapy may represent the most adequate treatment of recurrent cancer that occurs following laparoscopic colectomy.

Adenocarcinoma↗
PubMed1995

Intraaortic stop-flow infusion: pharmacokinetic feasibility study of regional chemotherapy for unresectable gastrointestinal cancers.

BACKGROUND: This study attempted to increase the exposure of gastrointestinal tract tissues to chemotherapy by prolonging the first pass of intraaortically administered drug by temporary occlusion of vascular structures. METHODS: Bolus infusion of 14C-labeled mitomycin C (MMC) mixed with unlabeled MMC was performed in dogs. Distribution of MMC in gastrointestinal tract tissues was studied under different types of major vessel occlusion. Three dogs with intravenous infusion constituted the control group. Vascular flow was controlled in four ways for 30 min: type I--stop-flow infusion (SFI) with clamping of the abdominal aorta above the celiac and below inferior mesenteric artery; type II--with additional clamping of the inferior vena cava above the diaphragm; type III with additional clamping of the portal vein in the hepatoduodenal ligament; and type IV--with surgical exclusion of nongastrointestinal branches of the aorta in addition to type II clamping. RESULTS: Type II and IV produced a 3-10-fold increase in exposure to MMC of major gastrointestinal tissues as compared with intravenous infusion. Area under the curve ratios with type IV were most prominent in the following tissues: stomach, pancreas, liver, and mesenteric lymph node. CONCLUSION: Access of MMC to several gastrointestinal tissues was increased through SFI. Type IV infusion was the most effective. Tissue exposure to MMC was especially advantageous for stomach, pancreas, liver, and mesenteric lymph node.

Animals↗
PubMed1995

Pseudomyxoma peritonei in women: a clinicopathologic analysis of 30 cases with emphasis on site of origin, prognosis, and relationship to ovarian mucinous tumors of low malignant potential.

Pseudomyxoma peritonei (PMP) is a poorly understood condition characterized by the accumulation of abundant mucinous material within the peritoneal cavity and associated with a mucinous tumor of the gastrointestinal tract or ovaries. Recently there has been considerable debate over the primary site of origin of the tumor associated with PMP in women. Some investigators have proposed a primary site in the ovaries, whereas others favor the gastrointestinal tract or the peritoneum. Another confusing issue has been the nature of the ovarian mucinous tumors associated with PMP. Although these neoplasms may be frankly malignant, more often they show minimal cytologic atypia and epithelial proliferation and have been classified as borderline or low malignant potential tumors. In order to address the issues of site of origin and nature of the associated ovarian mucinous tumors, we studied 68 cases of PMP in women, 30 of whom had mucinous tumors involving the ovaries. All 30 of these cases had an associated mucinous appendiceal or intestinal tumor. The PMP cases with ovarian tumors were compared with 30 ovarian mucinous tumors of low malignant potential (LMP). Based on the analysis of the primary ovarian mucinous LMP tumors, a set of criteria was formulated and used to determine the probable site of origin of PMP in the 30 women with mucinous tumors involving the ovaries. The following gross and microscopic features of the ovarian tumor were considered to be inconsistent with a primary ovarian origin: (1) surface involvement with or without superficial stromal involvement only; (2) adenocarcinoma with signet ring cell differentiation, with a previously diagnosed or concurrent appendiceal tumor of similar morphology; (3) bilateral adenocarcinoma consistent with colonic or appendiceal morphology; and (4) unilateral adenocarcinoma consistent with colonic or appendiceal morphology with a history of a colonic or appendiceal adenocarcinoma. When any one of these features was present the ovarian tumor was diagnosed as secondary. The following additional features also were considered to be more typical of secondary ovarian involvement: (1) normal or only slightly enlarged ovaries; (2) bilateral ovarian involvement; (3) simple or only focally proliferative mucinous epithelium with abundant extracellular mucin in cases with predominantly surface involvement of the ovaries, with or without a history of/or concurrent appendiceal adenoma; (4) multifocal or extensive pseudomyxoma ovarii in cases with stromal involvement, with or without a history of/or concurrent appendiceal adenoma; (5) ruptured appendiceal adenoma and unruptured ovarian tumor of similar histology; and (6) presence of an associated mucinous intestinal tumor.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Repeat liver resections from colorectal metastasis. Repeat Hepatic Metastases Registry.

BACKGROUND: A retrospective multiinstitutional study was performed to assess survival benefits of patients undergoing repeat liver resection for colorectal metastasis. An updated report is presented here. METHODS: The series comprised 170 patients from 20 different institutions around the world. Mean age of patients was 58 years (range, 28 to 84 years). The mean and median follow-up were 29 and 25 months, respectively. RESULTS: Three- and 5-year overall survival rates were 45% and 32%, respectively. The Dukes' stage of the primary tumor showed a 34% 5-year survival rate for those patients with negative nodes and 30% if nodes were positive (p = 0.42). The disease-free interval between liver resections showed a better outcome for those who had undergone repeated liver resections less than 1 year from the first liver resection (42% versus 23% 5-year survival rates); the difference was not significant (p = 0.58). The number of metastases found and resected at second procedures did not show significant differences in survival and was probably due to selection criteria. Anatomic resections reached a better 5-year survival rate (39%) than wedge resections (21%). The difference was not statistically significant (p = 0.2). The presence of extrahepatic disease and residual liver tumor left behind when repeat liver resection was performed were the most important prognostic variables in survival. Patients with extrahepatic disease had 19% 5-year survival rate, whereas those without disease outside the liver had 36% 5-year survival rate (p = 0.09). Patients with complete resections and those with residual liver disease after repeat resections had 36% and 17% 5-year survival rates, respectively (p = 0.01). Presence of postoperative morbidity after second liver resections did not show a significant negative impact in survival (p = 0.70). Adjuvant therapies were not widely used after liver resections and did not seem to improve prognosis of patients who were treated (39% versus 29% 5-year survival rates, p = 0.9). CONCLUSIONS: Repeat liver resections for colorectal metastasis is a justified approach because surgery remains the only potentially curative treatment. These procedures are relatively safe with low morbidity and mortality rates. Long-term survival (32%) can only be achieved in selected patients.

Adenocarcinoma↗
PubMed1995

Prognostic implications of chemoresistance-sensitivity assays for colorectal and appendiceal cancer.

A major problem with pharmacologic treatments for cancer is the unpredictable nature of the clinical response. Therefore, many patients are treated but few benefit from chemotherapy. Selection of patients for drug treatment would greatly benefit both responders and nonresponders. Mitomycin C (MMC) and 5-fluorouracil (5-FU) are important drugs widely used in the treatment of patients with gastrointestinal malignancies. In a prospective study, an in vitro chemoresistance-sensitivity assay (CR-SA) was performed for 95 patients at the time of surgery for peritoneal carcinomatosis from colorectal and appendiceal cancer. Following cytoreductive surgery, all of these patients had minimal-to-moderate residual disease. All patients were treated with the same chemotherapy regimen regardless of the results of the in vitro assay in the postoperative period. Clinical status of patients was correlated to the assay predictions, and the results were statistically evaluated. When resistance was correlated with outcome, there was no statistical difference. In addition, the mean percentage of growth inhibition was not increased when responders and nonresponders were compared. Finally, more patients who had > or = 95% in vitro growth inhibition of cancer did not survive than did those with < or = 95% growth inhibition. The in vitro test did not predict sensitivity or resistance to cancer when regional chemotherapy was administered in a clinical setting of peritoneal carcinomatosis.

Adult↗
PubMed1995

Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to "pseudomyxoma peritonei".

Pseudomyxoma peritonei (PMP) is a poorly understood condition characterized by mucinous ascites and mucinous implants diffusely involving the peritoneal surfaces. There is considerable debate regarding the definition, pathology, site of origin, and prognosis of PMP. We analyzed the clinicopathologic features of 109 cases of multifocal peritoneal mucinous tumors to develop a pathologic definition of cases characterized by the clinical condition PMP. Cases were separated into two diagnostic categories: disseminated peritoneal adenomucinosis (DPAM) and peritoneal mucinous carcinomatosis (PMCA). Cases classified as DPAM were characterized by peritoneal lesions composed of abundant extracellular mucin containing scant simple to focally proliferative mucinous epithelium with little cytologic atypia or mitotic activity, with or without an associated appendiceal mucinous adenoma. Cases classified as PMCA were characterized by peritoneal lesions composed of more abundant mucinous epithelium with the architectural and cytologic features of carcinoma, with or without an associated primary mucinous adenocarcinoma. Sixty-five of the 109 cases (59.6%) were classified as DPAM consistent with origin from an appendiceal mucinous adenoma. Thirty-seven of the 65 cases (56.9%) had a documented appendiceal mucinous adenoma. Thirty cases (27.5%) were classified as PMCA consistent with origin from an appendiceal or intestinal mucinous adenocarcinoma. Fourteen cases (12.8%) were classified as PMCA with features intermediate between DPAM and PMCA or with discordant features based on the finding of at least focal areas of carcinoma in the peritoneal lesions, whether or not the primary site demonstrated carcinoma. The cases with intermediate features were derived from well-differentiated appendiceal or intestinal mucinous adenocarcinomas and had peritoneal lesions displaying features of DPAM as well as focal areas of mucinous carcinoma. The cases with discordant features were derived from atypical appendiceal adenomas with little or no histologic evidence of a transition from adenoma to carcinoma and had peritoneal lesions uniformly composed of mucinous carcinoma. There was a statistically significant difference in survival between cases classified as DPAM, those classified as PMCA with intermediate or discordant features, and those classified as PMCA (p < 0.0001). The age-adjusted 5-year survival rates were 84% for patients with DPAM, 37.6% for patients with PMCA with intermediate or discordant features, and 6.7% for patients with PMCA. The term DPAM should be used to diagnose the histologically benign peritoneal lesions associated with ruptured appendiceal mucinous adenomas and those that are pathologically identical but lack a demonstrable appendiceal adenoma. Cases with the pathologic features of adenocarcinoma should be designated PMCA because they have recognizably different pathologic features and a significantly worse prognosis.

Adenocarcinoma, Mucinous↗
PubMed1995

Peritonectomy procedures.

OBJECTIVE: New surgical procedures designed to assist in the treatment of peritoneal surface malignancy were sought. BACKGROUND: Decisions regarding the treatment of cancer depend on the anatomic location of the malignancy and the biologic aggressiveness of the disease. Some patients may have isolated intra-abdominal seeding of malignancy of limited extent or of low biologic grade. In the past, these clinical situations have been regarded as lethal. METHODS: The cytoreductive approach may require six peritonectomy procedures to resect or strip cancer from all intra-abdominal surfaces. RESULTS: These are greater omentectomy-splenectomy; left upper quadrant peritonectomy; right upper quadrant peritonectomy; lesser omentectomy-cholecystectomy with stripping of the omental bursa; pelvic peritonectomy with sleeve resection of the sigmoid colon; and antrectomy. CONCLUSIONS: Peritonectomy procedures and preparation of the abdomen for early postoperative intraperitoneal chemotherapy were described. The author has used the cytoreductive approach to achieve long-term, disease-free survival in selected patients with peritoneal carcinomatosis, peritoneal sarcomatosis or mesothelioma.

Humans↗
PubMed1995

Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy.

OBJECTIVE: A treatment plan to be used in patients with peritoneal carcinomatosis was devised and tested as a Phase II study. BACKGROUND: Peritoneal carcinomatosis from appendical or colorectal cancer has been regarded as a fatal clinical entity. Treatment protocols have not been reported previously. METHODS: The authors used cytoreductive surgery and intraperitoneal chemotherapy to treat 181 consecutive patients with peritoneal carcinomatosis. There were 51 patients with colorectal cancer and 130 patients with appendiceal cancer. Mean follow-up is 24 months, with a range of 0 to 149 months. RESULTS: Clinical features that showed prognostic significance included appendiceal versus colorectal primary tumors (p = 0.0001), grade 1 versus grades 2 and 3 histopathology (p = 0.0003), complete versus incomplete cytoreductions (p = 0.0001), lymph node-negative versus lymph node-positive primary tumors (p = 0.0001), and volume of peritoneal carcinomatosis present preoperatively for colon cancer (p = 0.0006). Features with no statistical prognostic significance included preoperative tumor volume for appendiceal cancer, age, sex, number of cycles of chemotherapy, operative time, complications, blood loss, and institution providing treatment. From these prognostic features, four prognostic groups were identified, and 3-year survival was estimated by the product-limit survival method. Group I patients (n = 76) were those with grade 1 histology, no lymph node metastases, and complete cytoreductions (survival at 3 years = 99%). Group II patients (n = 23) were those with grade 2 or 3 histology, no lymph node metastases, and complete cytoreductions (65%). Group III patients (n = 24) had any histology, lymph node metastases, and complete cytoreductions (66%). Group IV patients (n = 58) had incomplete cytoreductions (20%).

Adenocarcinoma↗
PubMed1995

Abdominal computed tomographic scan in the selection of patients with mucinous peritoneal carcinomatosis for cytoreductive surgery.

BACKGROUND: Cytoreductive surgery and intraperitoneal chemotherapy have been used to treat peritoneal carcinomatosis. A complete surgical resection is required for optimal results to be achieved. This study evaluated the preoperative computed tomographic (CT) findings in patients with mucinous peritoneal carcinomatosis in order to predict the probability of a complete resection. STUDY DESIGN: Computed tomographic scans of the abdomen and pelvis were reviewed retrospectively in 45 patients with a diagnosis of mucinous peritoneal carcinomatosis who were treated with surgery and intraperitoneal chemotherapy. According to the completeness of cytoreduction, patients were divided into two groups. Patients in the first group (n = 25) had complete cytoreduction (CR) with no tumor deposits 2.5 mm in diameter or larger left behind. The surgical resection of tumor was incomplete in the second group of patients (n = 20). Sixteen CT parameters were initially examined in each group of patients and statistically evaluated according to the completeness of the cytoreductive surgical procedure. RESULTS: The incidences of six CT findings were significantly different in the two groups of patients. These findings were: tumor volume in small bowel mesentery (p < 0.001), tumor volume in proximal jejunum (p = 0.003), tumor volume in distal jejunum (p = 0.002), tumor volume in proximal ileum (p = 0.003), mesentery configuration (p < 0.001), and obstruction of bowel segments by tumor (p < 0.001). A statistical approach using a tree-structured diagram showed that patients with both obstruction of bowel segments by tumor and tumor diameter greater than 0.5 cm on small bowel surfaces exclusive of distal ileum on preoperative CT scan, had an 88 percent probability of incomplete resection. Patients without these two CT findings had a 92 percent probability of complete resection. CONCLUSIONS: This study shows that selection criteria for patients with mucinous peritoneal carcinomatosis are available on a preoperative CT scan of the abdomen and pelvis. Patients whose scans show obstruction of bowel segments by tumor and tumor diameter greater than 0.5 cm on small bowel surfaces exclusive of distal ileum are unlikely to be candidates for cytoreductive surgery for the treatment of peritoneal carcinomatosis.

Adenocarcinoma, Mucinous↗
PubMed1994

Sarcomas involving the head and neck, trunk and breast.

Sarcomas of the head, neck, trunk and breast are biologically similar to and behave like the soft tissue tumors found in other anatomic areas. In the past and still today, radical surgical resection with negative margins is the only reliable treatment for these sarcomas. The opportunity to use chemotherapy, surgery, and radiation therapy in selected patients as a multimodality approach may improve the likelihood of long-term, disease-free survival. Added experience with radiologic evaluation of patients to accurately define the anatomic location of the tumor, more definitive pathology to assess the biologic aggressiveness of the lesion, and more conservative wide excisions have allowed patients to retain function and cosmesis. In addition, the development of new surgical techniques has made it feasible to reconstruct large surgical defects.

Breast Neoplasms↗
PubMed1994

Intraperitoneal chemotherapy for treatment and prevention of peritoneal carcinomatosis and sarcomatosis.

PURPOSE: The treatment of peritoneal carcinomatosis and sarcomatosis has been associated with long-term disease-free survival. Recently, new intraperitoneal chemotherapy regimens used in patients with small volume peritoneal implants have shown benefits. METHODS: After removal of all but minimal residual disease, the abdominal cavity is flooded with a large volume of fluid containing full systemic doses of chemotherapy. Adenocarcinoma patients receive mitomycin C and 5-fluorouracil; sarcoma patients receive cisplatin and doxorubicin. RESULTS: Long-term disease-free survival is seen in patients with low-grade malignancy, no lymph node or liver metastases, and a complete cytoreduction. CONCLUSIONS: If patients can be treated early when the volume of peritoneal surface cancer is low or if the patient can be made disease free by surgery, then intraperitoneal chemotherapy may be expected to achieve long-term disease-free survival in a majority of selected patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Evaluation of computed tomography in patients with peritoneal carcinomatosis.

BACKGROUND: Radiologic tests to determine the size and location of cancer on peritoneal surfaces are needed for patient management and for clinical research activity. METHODS: Computed tomography (CT) of the abdomen and pelvis were obtained on 45 patients with a diagnosis of peritoneal carcinomatosis before implementation of a complete exploratory laparotomy with biopsy or resection of all tissues suspicious of malignancy. CT findings and surgical findings were recorded and the data analyzed by dividing the abdomen into 9 regions or into 15 anatomic sites. RESULTS: In an overall patient analysis, the sensitivity was 79%. In the nine different abdominal regions, sensitivity was greater than 80% in the right flank, left flank, and right lower and left lower abdominal regions. Sensitivity was lowest in the pelvis (60%). Negative predictive value in the pelvis was 20%. The volume of tumor present within an abdominal region or anatomic site greatly influenced the sensitivity. A sensitivity of only 28% was recorded when tumor nodules were less than 0.5 cm in thickness. This increased to 90% when nodule thickness was greater than 5 cm. CONCLUSIONS: CT is not a reliable diagnostic test for low volume tumor on peritoneal surfaces, and the greatest inaccuracies were recorded in the pelvis. Its diagnostic value increased as tumor volume increased.

Abdomen↗