Due to the significantly improved outcome and quality of life of patients with different tumor entities after cytoreductive surgery (CRS) and HIPEC, there is an increasing number of centers performing CRS and HIPEC procedures. As this procedure is technically challenging with potential high morbidity and mortality, respectively, institutional experience also in the anesthetic and intensive care departments is essential for optimal treatment and prevention of adverse events. Clinical pathways have to be developed to achieve also good results in more comorbid patients with border line indications and extensive surgical procedures. The anesthesiologist has deal with relevant fluid, blood and protein losses, increased intraabdominal pressure, systemic hypo-/hyperthermia, and increased metabolic rate in patients undergoing cytoreductive surgery with HIPEC. It is of utmost importance to maintain or restore an adequate volume by aggressive substitution of intravenous fluids, which counteracts the increased fluid loss and venous capacitance during this procedure. Supplementary thoracic epidural analgesia, non-invasive ventilation, and physiotherapy are recommended to guarantee adequate pain therapy and postoperative extubation as well as fast-track concepts. Advanced hemodynamic monitoring is essential to help the anesthesiologist picking up information about the real-time fluid status of the patient. Preoperative preconditioning is mandatory in patients scheduled for HIPEC surgery and will result in improved outcome. Postoperatively, volume status optimization, early nutritional support, sufficient anticoagulation, and point of care coagulation management are essential. This is an extensive update on all relevant topics for anesthetists and intensivists dealing with CRS and HIPEC.

Best practice for perioperative management of patients with cytoreductive surgery and HIPEC.

To analyze the effects of different anaesthetic methods on perioperative cellular immunity and long-term outcome in patients who undergo esophageal cancer surgery. Participants A total of 120 patients with esophageal cancer admitted to Zhengzhou University People's Hospital from January 2016 to January 2017 were recruited and randomly divided into a GA group (general anaesthesia, n = 40), a PG group (paravertebral nerve block with general anaesthesia, n = 40) and an EG group (epidural anaesthesia with general anaesthesia, n = 40). Methods Self-rating anxiety scale and visual analogue scale scores were adopted to compare postoperative anxiety and the degree of pain of patients in the three groups. In addition, the adverse reactions of patients in the three groups were compared. The levels of interleukin-6 (IL-6), IL-4, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and the survival of T-cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+) before operation, at the end of operation, and on postoperative day (POD) 1 and POD 2 were measured by either ELISA or flow cytometry. Results In the PG and EG group, the VAS scores were lower, and fewer opioids and vasoactive agents were used than in the GA group. In both the EG and PG groups, higher CD3+ and CD4+ cell survival and lower levels of Cor, IL-4, and IL-6 were identified at the end of or after the surgery than in the GA group. Moreover, the postoperative survival curves of the PG and EG groups were better than that of the GA group. Conclusions The combination of paravertebral nerve block or epidural anaesthesia and general anaesthesia may improve perioperative immune function and long-term outcome in patients who undergo esophageal cancer surgery.

/pdf/effect-of-different-anaesthesia-methods-on-perioperative-2pw3w13ejh.pdf

Effect of different anaesthesia methods on perioperative cellular immune function and long-term outcome in patients undergoing radical resection of esophageal cancer: a prospective cohort study.

Familial adenomatous polyposis (FAP) is an autosomal dominant disease with a prevalence of about one in 10,000 live births. It is classically characterized by the development of hundreds to thousands of adenomas in the colon and rectum that progress to colorectal cancer (CRC) in almost all individuals if left untreated. It typically presents in early adolescence and without any intervention, 95 % of patients will develop CRC by age 50. Adequate colonoscopy surveillance and prophylactic colectomy have reduced the incidence of CRC cases in FAP. This article examines the epidemiology, clinical presentation, genetic basis, differential diagnosis, endoscopic and surgical management of FAP.

Familial Adenomatous Polyposis

Liang H1*, He J1*, Qiu S1,2#, Chen Z1#, Liu H3#, Liu H3, Lin G2, Zhang Y3, Wu X3 and Liang W1 1Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China 2Guangzhou Medical University, China 3Department of anesthesia, the First Affiliated Hospital of Guangzhou Medical University, China

/pdf/intravenous-anesthesia-offers-a-better-overall-survival-4z8u2dnzs8.pdf

Intravenous Anesthesia Offers a Better Overall Survival Outcomes Than Inhalation Anesthesia of Malignant Tumor After Surgery: A Meta-Analysis

Background: Although significant advances have been made toward understanding the molecular mechanisms underlying the effect of propofol on tumor cell metastasis, less is known regarding how cell membrane and cytoskeletal ultrastructure are affected in this process. Here, we investigated the relationship between cell morphology and cell size, which are features mainly defined by the cytoskeleton. Methods: To confirm the effects of propofol on the migratory ability of human cervical carcinoma cells, cell migration and invasion were examined through scratch wound healing and transwell membrane assays. Furthermore, HeLa cells cultivated with different concentrations of propofol were examined by confocal microscopy and atomic force microscopy (AFM), and the mean optical density and migration ability of these cells were also assessed. In addition, cell membrane morphology was inspected using AFM. Results: The results of the wound healing and transwell membrane assays indicated that propofol decreases the migratory ability of cervical carcinoma cells compared to control cells. A comparative analysis of the test results revealed that short-term (3 h) exposure to propofol induced marked changes in cell membrane microstructure and in the cytoskeleton in a dose-dependent manner. These morphological changes in the cell membrane were accompanied by cytoskeleton (F-actin) derangement. The present findings demonstrate a close relationship between changes in cell membrane ultrastructure and cytoskeletal alterations (F-actin) in propofol-treated HeLa cells. AFM scanning analysis showed that cell membrane ultrastructure was significantly changed, including a clear reduction in membrane roughness. Conclusion: The influence of propofol on the HeLa cell cytoskeleton can be directly reflected by changes in cellular morphology, as assessed by AFM. Moreover, the use of AFM is a good method for investigating propofol-mediated changes within cytoskeletal ultrastructure.

/pdf/effects-of-propofol-on-several-membrane-characteristics-of-1pkit38j49.pdf

Effects of Propofol on Several Membrane Characteristics of Cervical Cancer Cell Lines

The main treatment for most types of malignant tumors is their surgical removal. During the past years there has been a growing interest in the anesthesia effects on long-term surgery results in connection with cancer. Modern clinical and laboratory data indicate that the anesthetic technique may play a role in tumor dissemination and recurrence. The purpose of this study is to review the available literature data on the anesthetic techniques applied in oncology surgery, long-term consequences of anesthesia/analgesia and their relation to tumor progression. We have reviewed the specialized medical literature and have analyzed the effects of anesthesia/analgesia on long-term results of surgical treatment--incidence of local recurrence, metastases and patients' survival. The hypothesis about the influence of the anesthesia type on long-term results after cancer surgery is generated. The use of anesthetics and analgesics with low potential for immunosuppression may reduce the relapse. This is a useful approach for patients with cancer. Further randomized controlled trials are required for extensive research of this problem.

Long-term consequences of anesthetic technique after cancer surgery.

The Peutz-Jeghers syndrome is inherited condition, characterized by hamartomatous gastrointestinal polyposis and with mucocutaneous pigmentation. We have experienced a case with typical clinical features, diagnosed before complication's development. In order to prevent cancer setting it is recommended to perform aggressive screening and high-technological procedures.

Peutz-Jeghers syndrome--a rare case and a literature review.

Abstract The gastrointestinal tract perforation is one of the leading causes of acute abdomen. Mycotic infections have become a significant clinical problem over the last few decades. Despite the advance in diagnostics and treatment of patients with fungal peritonitis, the mortality remains high. Objective. The objective of the study was to determine the type and incidence of causative pathogens of acute peritonitis in patients with gastroduodenal perforation, and to estimate the impact of microbial flora on the disease outcome. Materials and methods. We performed a retrospective study among 83 adult patients with acute peritonitis due to gastroduodenal perforation treated at our centre. Results. A total of 40 mycotic agents were isolated in 39 of the abdominal samples. The primary mycotic isolates were Candida albicans (52.5%) and C. glabrata (64.3%); C. krusei (14.3%) and C. tropicalis (7.1%) predominated among non-albicans Candida species (35.0%). The most common bacterial agents were Escherichia coli (24.0%) and Enterococcus spp. (24.0%). 77.1% of all enrolled patients survived, and 19 of them deceased due to sepsis and multiple organ dysfunction syndrome. Conclusion. Candida albicans is the most common mycotic pathogen in patients with acute peritonitis due to gastroduodenal perforation. It is obligatory to examine the peritoneal fluid samples for bacterial and fungal pathogens with determination of their antimicrobial susceptibility profile. Timely initiation of adequate treatment and multidisciplinary approach is crucial for the outcome of patients with fungal peritonitis.

/pdf/fungal-peritonitis-due-to-gastroduodenal-perforation-3u20eth8mt.pdf

Fungal Peritonitis Due to Gastroduodenal Perforation: Diagnostic and Treatment Challenges

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Long-term consequences of anesthetic technique after cancer surgery.

Peutz-Jeghers syndrome--a rare case and a literature review.

Fungal Peritonitis Due to Gastroduodenal Perforation: Diagnostic and Treatment Challenges