Dr. María Clara Arroyave

Five W’s after surgery

In the postoperative phase of the surgery, the patient can develop some problems and complications. The main one is fever, and as surgeons, we must identify its source from a long list of possibilities. First, it is important to rule out the emergency setting; if the source of the fever is still unknown, that is when the “5 Ws” apply: wind, water, wound, walking and wonder drug. Each of the “Ws” is discussed, talking about the specific diagnosis, treatment and prevention. Special attention is given to “wounds”, as this is the reason for Surgical Site Infections. For wounds, the SENIX index risk is used to assess the patient’s chance of developing an SSI depending on their previous conditions. However, as nothing can be done about these risk factors, other prevention, intraoperative, and postoperative factors to treat SSI are discussed. A diagram is given showing the steps to decrease the incidence of SSI, and a paper on the use of antibiotics in the postoperative period is discussed.

With Johnson & Johnson MedTech

Review and Discussion of the Prodige 7 Trial

Peritoneal metastases are associated with reduced overall survival, as well as with significantly worse prognosis compared with non-peritoneal metastases. Systemic chemotherapeutic regimens have not achieved major benefits in OS. In patients with potentially resectable disease, surgical management of peritoneal metastases of colorectal origin has evolved profoundly in the past 15 years. HIPEC has sound theoretical benefits and its usefulness has been proven by retrospective trials and in comparison with systemic chemotherapy. The main goal of the trial was to assess the specific benefit of adding HIPEC to cytoreductive surgery in patients with colorectal peritoneal metastasis. We aim to review and discuss the results and implications of the trial in clinical practice.

CRS + HIPEC for the Treatment of Ovarian Cancer

In this presentation we show the advantages of CRS + HIPEC vs CRS alone for the treatment of stage III ovarian cancer. Ovarian cancer is one of the most prevalent malignancies worldwide, presenting with advanced disease and peritoneal spread in a significant number of cases. Disease burden and quality of life impairment are significant in a huge proportion of women around the world. Primary treatment with Cytoreductive Surgery plus HIPEC is emerging as the best treatment option as supported by well conducted studies which we present.

5 Things you should know about Cytoreductive Surgery and HIPEC in peritoneal carcinomatosis from peritoneal Mesothelioma: Current Evidence

Diffuse Malignant Peritoneal Mesotheliomas are aggressive and rare neoplasms that require extensive treatment in highly specialized centers to achieve maximal survival benefits and an acceptable morbidity and mortality rate. In this SOC we explore the natural history of DMPM, its Clinical presentation and Diagnosis, relevant Histopathologic features, treatment modalities and an overview of CRS and HIPEC.

Cytoreduction and Intraperitoneal Hyperthermic Chemotherapy in a case of high volume Intraperitoneal Pseudomyxoma

Clinical Case In high-volume cases like the one presented in this video, a sound surgical technique is mandatory for the entire team, including mastery of multiple organ resections, reconstructions and peritonectomies. Our program has had a strong impact as regards several diseases. including pseudomyxoma peritonei and other secondary peritoneal carcinomatosis, achieving significant improvement in overall survival, disease free survival and quality of life in patients previously treated with palliative intent only.

Implementation of a Peritoneal Surface Malignancy Program

Our program had succeeded to impact several diseases including pseudomyxoma peritonei and other secondary peritoneal carcinomatosis, achieving an important improvement in overall survival, disease free survival and quality of life in patients previously treated with only palliative intent. Our institution protocol includes a treatment plan combining the benefits of CRS and HIPEC with systemic perioperative chemotherapy. Challenges and barriers in our country are considerable, but our team is convinced of the benefits of the procedure and we will persevere in our goal to propitiate that more patients receive the appropriate treatment for this disease. Strong and qualified leadership is mandatory to achieve the preparation, education and development of a very well- trained and reliable team. All participants have to be aware of their functions and be able to feed back themselves and colleagues. Proper protocol construction adjusted both to literature standards and local particularities and requirements is highly advised.