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.
Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. Brazil does not have an official well established program for screening colorectal cancer. The aim of this study was to compare Guaiac Based Fecal Occult Blood Test (G-FOBT) to a kind of an Immunochemical Fecal Occult Blood Test (I-FOBT), in search of cancer or advanced adenoma. Methods: Prospective and cross-sectional study. Asymptomatic and average-risk individuals (n = 1500) aged from 50 to 75 years old were invited to participate in the study. The primary endpoint was positivity rate and the secondary endpoints were adherence rate and significant endoscopic findings. All participants received both tests with follow-up colonoscopy if either test was positive.Results: Adherence rate of G-FOBT was 756/1500 (50.4%) while for I-FOBT it was 960/1500(64%). The positivity ratio in the I-FOBT was 94/960 (9.8%) and in the G-FOBT was 20/771 (2.6%). The Positive Predict Value (PPV) for the I-FOBT counted 16/77 (21.0%) while for the G-FOBT it was 6/18 (33.0%), considering significant lesions. Regarding the colorectal cancer findings, the detection in the colonoscopy guided from the positivity of fecal occult blood tests was 5/77 (6.5%) in I-FOBT and 2/18 (11.1%) on the G-FOBT. Conclusions: The positivity, the adherence rate and the capacity to detect significant lesions were higher in I-FOBT. Considering the findings of the study we could conclude that I-FOBT was superior to G-FOBT.
Solitary bone metastasis from testicular tumor is rare. In literature, only few cases of isolated bone metastasis at first presentation have been reported, and none of them have been treated with extended surgery of the pelvic bone. Case Presentation: We report the case of a 33-year-old man with an iliac bone osteolytic metastasis as the first presentation of a non-seminomatous germ-cell testis tumor (NSGCT), treated with post-chemotherapy en bloc resection of residual tumor in the left iliac bone (Type I + II internal hemipelvectomy). After a 72-month follow-up, the patient has been asymptomatic, with no signs of local recurrence or metastasis and negative serum tumor markers. Conclusions: In selected cases, testicular NSGCT with iliac bone metastasis and normal or normalizing tumor markers can be treated, in association with chemotherapy, by extended surgery, including bone resection, to obtain gain in survival and maintain limb function.
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