Introduction: Pseudomyxoma peritonei (PMP) is a rare disease characterized by the progressive accumulation of mucinous ascites and peritoneal implants. The optimal treatment for PMP includes the association of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). For patients with a large burdensome disease, the completeness of cytoreduction sometimes requires maximal effort surgery. The aim of this article is to provide proof of concept for two stage cytoreductive surgery (CRS) in this category of patients. Methods and materials: A two stage CRS and HIPEC with oxaliplatin was proposed for patients with bulky PMP including important involvement of the serosal surfaces of the bowel or colon who had an impaired nutritional status. The residual disease at the end of the first stage was less than 5 mm of thickness on several implants. Clinical, surgical and histopathological variables were analyzed. Results: All eight patients completed the two-stage strategy. Mortality was nil. One Clavien Dindo grade 3 event occurred in each stage. After a median follow up of 29.5 months, all patients were alive and free of recurrence. All of the patients had histopathological complete response on the specimens obtained from the residual sites during the second stage surgery. Conclusions: Two-stage surgical strategy is feasible for bulky PMP patients and it is associated with little high-grade morbidity and enhanced visceral sparing.

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Objectives To assess the risk perception and the uptake of measures preventing environment-related risks in the operating room (OR) during hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). Methods A multicentric, international survey among OR teams in high-volume HIPEC and PIPAC centers: Surgeons (Surg), Scrub nurses (ScrubN), Anesthesiologists (Anest), Anesthesiology nurses (AnesthN), and OR Cleaning staff (CleanS). Scores extended from 0–10 (maximum). Results Ten centers in six countries participated in the study (response rate 100%). Two hundred and eleven responses from 68 Surg (32%), 49 ScrubN (23%), 45 Anest (21%), 31 AnesthN (15%), and 18 CleanS (9%) were gathered. Individual uptake of protection measures was 51.4%, similar among professions and between HIPEC and PIPAC. Perceived levels of protection were 7.57 vs. 7.17 for PIPAC and HIPEC, respectively (p<0.05), with Anesth scoring the lowest (6.81). Perceived contamination risk was 4.19 for HIPEC vs. 3.5 for PIPAC (p<0.01). Information level was lower for CleanS and Anesth for HIPEC and PIPAC procedures compared to all other responders (6.48 vs. 4.86, and 6.48 vs. 5.67, p<0.01). Willingness to obtain more information was 86%, the highest among CleanS (94%). Conclusions Experience with the current practice of safety protocols was similar during HIPEC and PIPAC. The individual uptake of protection measures was rather low. The safety perception was better for PIPAC, but the perceived level of protection remained relatively low. The willingness to obtain more information was high. Intensified, standardized training of all OR team members involved in HIPEC and PIPAC is meaningful.

[Formula: see text] injection into subsurface reservoirs leads to pressure and saturation changes. Furthermore, [Formula: see text]-brine-minerals interaction could result in dissolution or reprecipitation of rock frame-forming minerals. Observed time-lapse seismic associated with [Formula: see text] injection into poorly consolidated sandstone at the Frio [Formula: see text] injection site (Texas, USA) could not be predicted using classical rock-physics models (i.e., models involving elastic changes in the rock frame due to saturations and/or pressures changes only, and assuming no changes in the rock microstructure). That, and the changes in the fluid chemistry after [Formula: see text] injection, suggests that the assumption of a constant rock microstructure might be violated. Using high-resolution time-lapse crosswell data, we have developed a methodology for estimating changes in the rock frame by quantifying the rock-frame drained moduli before and after [Formula: see text] injection. Based on rock microstructure diagnostics, we found that the changes in the drained frame elastic properties are due to the changes in the grain contact-cement percentage. The reduction in contact-cement percent is found to be variable throughout the reservoir, with a maximum near the injection well, down to 0.01% from the initial 0.1% contact cement; this results in more than 40% reduction in the drained frame shear and bulk moduli. [Formula: see text] saturation was estimated using this model for uniform and patchy saturation cases. Our rock-physics analysis may allow improved interpretation of time-lapse seismic for [Formula: see text] saturation in the context of other poorly consolidated sandstones with similar geomechanical properties. Having the P- and S-wave velocity time-lapse data is key to improve saturation estimates with this analysis method.