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Advanced Colorectal Cancer  Surgery and HIPEC  ,[object Object],[object Object]
Advanced Colorectal Cancer  ,[object Object],[object Object],[object Object]
Locally Advanced Colorectal Cancer without metastatic disease  ,[object Object],[object Object],[object Object]
T4a  ,[object Object],[object Object],[object Object]
Management TNM T4a  ,[object Object],[object Object],[object Object],[object Object]
Case T4 2008 ,[object Object],[object Object],[object Object],[object Object]
CT – “Colonic mass : Possibility Inflammatory and  Duodenal involvement”
MDT Discussion ,[object Object],[object Object],[object Object]
Surgery – Abdominal wall/Right hemi partial duodenal resection
T4b  ,[object Object],[object Object],[object Object],[object Object]
Peritoneal malignancy ,[object Object],[object Object],[object Object]
Colorectal carcinomatosis ,[object Object],[object Object],[object Object]
Peritoneal Carcinomatosis ,[object Object],[object Object],[object Object],[object Object]
Incidence of Peritoneal Carcinomatosis in Colorectal Cancer ,[object Object],[object Object],[object Object]
Colorectal Carcinomatosis – What can be done ? ,[object Object]
Emerging Strategy  ,[object Object],[object Object]
Evolution of Technique For Carcinomatosis ,[object Object],[object Object]
Techniques for pseudomyxoma peritonei Paul Sugarbaker Washington ,[object Object],[object Object],[object Object]
 
Pathophysiology of mucinous tumour distribution ,[object Object],[object Object],[object Object],[object Object]
Redistribution
 
 
 
NICE – NHS in England   ,[object Object],[object Object]
 
 
Traditional Results PMP -1995   (WHC =Washingston, MSK= Memorial Sloan Kettering New York, Mayo Clinic Minneapolis USA)  CRS +  HIPEC
* * * * * * * * *  * ** * * * * * * * * * * * * * * * * * * ** * * * * * ** * * * * * ** * * * * * * *** UK and Ireland National Referral centres for Pseudomyxoma Peritonei of Appendiceal origin since 2000 (pop 80 million) Basingstoke 2000
Pseudomyxoma Peritonei  Complete Cytoreduction
Complete cytoreduction Standard Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Technique- CRS and HIPEC ,[object Object],[object Object],[object Object],[object Object]
 
Post –op mortality 1.4%
 
Question ? ,[object Object]
 
[object Object]
Question ? ,[object Object],[object Object]
Survival Verwaal,Zoetmulder et al RCT Systemic versus HIPEC 2003 Log Rank p = 0.0013 44% versus 24%  at 2 years
 
 
 
 
Glehan et al Cancer PMP Gastric Appendix   Colon
Survival Complete CRS plus HIPEC  appendix colon
What do we know about colorectal carcinomatosis and HIPEC ?
What do we know about colorectal carcinomatosis and HIPEC ? ,[object Object]
What do we know about colorectal carcinomatosis and HIPEC ? ,[object Object],[object Object]
Summary HIPEC for colorectal carcinomatosis (1) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Summary HIPEC for colorectal carcinomatosis (2) ,[object Object],[object Object],[object Object],[object Object]
Thank you

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MCC 2011 - Slide 25