Optimal Techniques for Visceral Cytoreduction Lana Bijelic MD, FACS Washington DC, June 21-22, 2012 Background Peritonectomy procedures as described by Sugarbaker* form the basis for cytoreductive surgery and HIPEC RUQ peritonectomy LUQ peritonectomy Pelvic peritonectomy Lesser omentectomy and stripping of the omental bursa Greater omentectomy w/wo splenectomy Ann Surg 221: 29-42, 1995 Background Performed using wide exposure and traction and high voltage electrosurgery using a ball-tip cautery device Background Performed using wide exposure and traction and high voltage electrosurgery using a ball-tip cautery device Text Text Parietal peritonectomy RUQ peritonectomy Cytoreductive surgery is a series of peritonectomies and visceral resections Visceral involvement Visceral involvement Visceral involvement Visceral involvement Visceral resections performed Number (%) Greater omentectomy 144(98%) Splenectomy 84(57%) Rectosigmoid colon resection 70(48%) Right colon resection 57(39%) Hysterectomy 47(32%) Small bowel resection 29(20%) Transverse colon resection 20(14%) Gastrectomy 4(3%) Visceral involvement Visceral resections performed Number (%) Greater omentectomy 144(98%) Splenectomy 84(57%) Rectosigmoid colon resection 70(48%) Right colon resection 57(39%) Hysterectomy 47(32%) Small bowel resection 29(20%) Transverse colon resection 20(14%) Gastrectomy 4(3%) Visceral involvement ? Ann surg oncol 13:635-644 Cytoreduction of the small bowel Type 1 Non-invasive nodules Type 2 Small invasive nodules of the anti-mesenteric portion of the small bowel Type 3 Moderate size invasive nodules of the antimesenteric portion of the small bowel Type 4 Small invasive nodules at the junction of the small bowel and small bowel mesentery Type 5 Large invasive nodules
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