A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma

Abstract

Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.

Consensuses and controversies on pseudomyxoma peritonei: a review of the published consensus statements and guidelines

“…There have been several different versions of consensuses on PMP customized according to actual situations in different regions. Currently, there are 5 up-to-date consensuses in different regions, coming from PSOGI/EURACAN, CCWG (U.S.A.) [6], CACA (China) [7], LARPD (Latin America) [8], and BSSO (Brazil) [9].…”

Treading the beaten path with old and new obstacles: a report from the Indian HIPEC registry

“…As the number of participating centres increases, it could provide epidemiological information in addition to the treatment-related information. The surgeons participating in the registry can collaborate and form national consensus guidelines as done by other developing countries [33,34]. With a population of over a billion people, even an uncommon disease will have a large number of affected individuals.…”

Comments on: Pharmacokinetics of cisplatin during open and minimally-invasive secondary cytoreductive surgery plus HIPEC in women with platinum-sensitive recurrent ovarian cancer: a prospective study

“…Despite the initial enthusiasm with the findings of women receiving HIPEC through a MI approach reach double CDDP peritoneal tissue levels compared to patients submitted to O-SCS, we would like to add some criticism to this issue in light of previous experiences [234]. Firstly, some results presented for supporting the influence of surgical approach (i.e., O-SCS vs. MI-SCS) over the CDDP pharmacokinetic in women receiving SCS plus HIPEC are not clear.…”

“…Whilst there are no convincing data favoring any technique, the closed technique has been preferred in many centers based on the simplicity of this method and decreased contamination risk [2]. In these settings, a minimum of 4 L (ranging from 4 L to 6 L) of perfusate into the abdominal cavity has also been advocated in order to counterbalance the theoretical drawbacks of closed techniques in comparison to the open approach, since a maximal distention of the abdomen enhances the thermal homogeneity throughout the peritoneal cavity and facilitates drug distribution into the whole abdomen, ensuring that every site of the diffuse peritoneal disease receives the optimal treatment [234]. Despite a perfusate volume of 2 L/m 2 have proved to be appropriated for the open abdominal technique (Coliseum technique) [6], we are afraid it is not a good technical parameter for the closed approach, and thus the value of HIPEC could be underestimated in the HORSE trial, mainly in patients that underwent O-SCS.…”

“…Herein, a started point of discussion is performing HIPEC as a closed or open abdominal (coliseum) technique. Whilst there are no convincing data favoring any technique, the closed technique has been preferred in many centers based on the simplicity of this method and decreased contamination risk [2]. In these settings, a minimum of 4 L (ranging from 4 L to 6 L) of perfusate into the abdominal cavity has also been advocated in order to counterbalance the theoretical drawbacks of closed techniques in comparison to the open approach, since a maximal distention of the abdomen enhances the thermal homogeneity throughout the peritoneal cavity and facilitates drug distribution into the whole abdomen, ensuring that every site of the diffuse peritoneal disease receives the optimal treatment [2][3][4].…”