So04
management of Suspicious Melanocytic Lesions in General Practice

Abstract

Purpose: Peritoneal carcinomtosis (PC) is uniformly regard ed as a terminal disease with a median survival of 1-6 months and few treatment options. As improved understanding of tumour biology evolved, PC is increasingly recognized as locoregional disease. The aim of this study to report our experience with our 208 consecutive patients with peritoneal carcinomatosis treated by cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC). Methodology: From January 1997 to September 2008, the clinical and treatment-related data of 208 patients with PC were entered into a prospective database. The CRS was performed using peritonectomy procedures and the IPC was performed using Mitomycin C for gastrointestinal tumours with Cisplatin and Doxorubicin added for peritoneal mesothelioma at 42 deg Celsius via the Coliseum technique. Results: The median follow-up period was 36 months (Range: 1-89 months). The hospital mortality was 3%. The overall morbidity rate was 43% with grade 1 and 2 mortality in 75 patients, grade 3 complications in 49 patients and grade 4 complications in 24 patients. The overall median survival was 82 months with 1-, 3-and 5-year actuarial survival of 85%, 70% and 70% respectively. The median survival rates for pseudomxyma peritonei (n = 102), colorectal carcinoma (n = 53) and peritoneal mesothelioma (n = 25) were 82, 30 and 30 months respectively. Conclusion: CRS and IPC for PC can be performed with acceptable mortality and morbidity as for other major gastrointestinal surgeries with satisfactory long term survival results.Purpose: There is an ethnic variation in outcomes for colonic cancer in New Zealand. Whether this disparity is due to cancer biology or inequitable provision of treatment services after diagnosis has not been elucidated. Methodology: National cancer registry data from 1996 to 2003 were obtained. Incidence and mortality rates for the four major ethnic groups were age-adjusted to the new WHO world population. The impact of age, sex, AJCC stage, and site of cancer at diagnosis was compared between ethnic groups using a Cox regression analysis. Results: 11 987 colonic cancer registrations were identified. The overall raw five year mortality was 53.7%. The age-adjusted incidence in Europeans was more than double that of the Maori, Asian, and Pacific populations at 33.0 per 100 000 population/year. Europeans presented older, with more right sided cancers, and at an earlier stage of disease. The opposite was true for Maori. Pacific Islanders and Asians presented younger, but with a similar site, stage, and sex distribution to the rest of the population. There were no significant differences in 5 year mortality after diagnosis when age, sex, stage, and site at presentation were controlled for by Cox regression analysis. Conclusion: These results suggest that age, sex, stage, and site at presentation may be more important than inequality in treatment provision after diagnosis in explaining differences in outcomes between the ethnicities. Efforts need to be focused on identifying reas...