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III Convegno Congiunto delle Società Lombarda e Triveneta di Chirurgia La carcinosi peritoneale da ca colorettale.

III Convegno Congiunto delle Società Lombarda e Triveneta di Chirurgia La carcinosi peritoneale da ca colorettale. Storia naturale, scenari clinici ed impatto prognostico D.Foschi Dipartimento di Scienze Cliniche L.Sacco Università di Milano Desenzano 12 maggio 2012.

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III Convegno Congiunto delle Società Lombarda e Triveneta di Chirurgia La carcinosi peritoneale da ca colorettale.

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  1. III Convegno Congiunto delle Società Lombarda e Triveneta di Chirurgia La carcinosi peritoneale da ca colorettale. Storia naturale, scenari clinici ed impatto prognostico D.Foschi Dipartimento di Scienze Cliniche L.Sacco Università di Milano Desenzano 12 maggio 2012

  2. Pathogenesis of peritoneal minimal residual disease D WP Ceelen, 2009

  3. Disease progression and metastatic spread K.L. Sodek, 2012

  4. Incidence of synchronous peritoneal carcinomatosis Author N. Patients P.C. Russell (1984) 94 5 % Minsky (1988) 294 4 % Jayne (2002) 2756 7.7 % Lemmens (2010)* 18.738 4.8 % Mulsow (2011) 3138 4.8 %

  5. Synchronous Peritoneal Carcinomatosis and Colorectal cancer 4.8% 43.6% 56.4% Anni 1995-2008 W.E. Lemmens, Int J Cancer, 2011

  6. General characteristics of patients with synchronous P.C. 0.1% 0.3% 3.4% 21% W.E. Lemmens, Int J Cancer, 2011

  7. Risk of P.C. : Multivariable logistic regression W.E. Lemmens, Int J Cancer, 2011

  8. Meta-analysis of overall and local recurrence for – vs + preresection PFCC Rekhraj S,2008

  9. Meta-analysis of overall and local recurrence for – vs + postresection PFCC Rekhraj S,2008

  10. B.Sadeghi, 2000 Cancer

  11. Prognostic factors in metachronous ascites M:6 mnt DZJ Chu, Cancer, 1989

  12. Crude survival of synchronous peritoneal carcinomatosis V.E. Lemmens,2010

  13. Incidence of metachronous peritoneal carcinomatosis Author year N.Patients Met.P.C. Cass 1976 280 28% Malcom 1981 285 13% Mendenhall 1983 140 12% Gilbert 1984 31 3% Tong 1984 64 44% Gunderson 1985 91 21% Jayne 2002 2756 4.8% ________________________________________________ Gilbert(autopsy ser.) 1984 45 40% Russell (autopsy ser.) 1985 53 36% ________________________________________________ Mulsow (CRC-PC) 2011 31 74% Matsuda (CRC-PC) 2012 31 77%

  14. Logistic regression analysis for metachronous peritoneal carcinomatosis Odds ratio P Clinical Liver metastasis 2.84 (1.7 – 4.6) <0.001 Histological Tumor stage 2.74(1.6-4.5) <0.001 Nodal stage 2.47(1.6-3.8) <0.001 Venous invasion 2.07(1.1-2.3) <0.012 Perineural invasion 1.57(1-2.3) <0.032 Jayne DG, 2002

  15. Risk factors for metachronous P.C. pT4 Positive peritoneal cytology Peritoneal seeding Ovarian Involvement Perforation of the tumor Rupture of a necrotic tumor mass Intraoperative tumor spill

  16. Risk factors for metachronous P.C. N.Patients Synchronous P.C. Ovarian Metastase Perforated tumor Tot n:41 n:25 n: 8 n:8 % + P.C. 15(60%) 5 (62%) 3 (37%) PCI 9±6 7±5 5±2 D. Elias, 2011

  17. Risk of local recurrence after inadvertent rectal perforation M.T. Eriksen, 2004

  18. Risk of metachronous carcinomatosis after CRC-PC resection Synchronouscolorectal PC N:153 Non complete resection N:122 Complete resection N:31 Allrecurrences N:24 (77%) 1° site of recurrence Intra-peritoneal alone N. 8 (25.8%) P.C. – extraperitoneal N:1 (3.2%) Extra-peritoneal alone N:15 (48.4%) Matsuda, 2012

  19. Pathophysiology of ascites accumulation ROS MIF TGF-α bFGF TGF-β TNF-α IL-1, -6, -8, -10 K.L. Sodek, 2012

  20. SurvivaL of P.C. after standard treatment or CRS-HIPEC

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