Adjuvant intraoperative post-dissectional XXXX bed chemotherapy-A novel approach in treating midgut @entity5 .

@entity1 @entity3329 @entity66 @entity5 @entity532 @entity3 @entity1487
BACKGROUND: Midgut @entity5 ( @entity5 ) @entity1 are often diagnosed at an advanced stage with extensive mesenteric lymph node and liver @entity3 . Even with skillful surgical dissection, macro and microscopic @entity66 at the dissection site remains a possibility. We hypothesize these potential @entity5 residuals in mesenteric lymph node dissection beds can be eliminated safely by a local application of @entity1487 ( @entity1487 ). We describe a novel technique invented by the author to treat these micro and macro residuals. METHODS: Retrospectively, charts of 62 consecutive midgut @entity5 @entity1 with boggy mesenteric @entity3329 who underwent cytoreductive debulking surgeries from 1/2007 to 12/2009 were reviewed. A total of 32 @entity1 received an intraoperative application of @entity1487 saturated gelfoam strips secured into the mesenteric defect following the extensive lymphadenectomy. A total of 30 untreated @entity1 served as a control. RESULTS: The 5-year survival after cytoreductive surgeries was 22/32 (68.8%) for the treated group, vs. 20/30 (66.7%) for the control. Six @entity1 (6/32, 18.8%) among the study group required additional debulking surgeries, vs. 16 @entity1 (16/30, 53.3%) in the control group. Upon reoperation, loco-regional recurrence was noted in 9 of the 16 @entity1 (56.3%) in the control group, vs. only 2/6 (33.3%) of treated @entity1 . Overall, local recurrence rate is 6.25% (2/32) in the treated group vs. 30% (9/30) in the control group. @entity532 rates are similar in the two arms. CONCLUSIONS: Intraoperative application of chemotherapy is a safe and effective adjuvant to reduce local recurrence and the need of reoperation by the tumoricidal or tumorstatic effects of @entity1487 on any potential microscopic @entity66 after extensive cytoreductive surgeries in advanced stage @entity5 @entity1 with mesenteric lymph node @entity3 . It provides @entity1 with sustained, slow releasing, high dose of @entity1487 within the surgical bed with a negligible side effect profile. Further studies are required to evaluate its effect on long term survival.
