Surgical oncology clinics of North America
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Surg. Oncol. Clin. N. Am. · Oct 2001
ReviewIntraperitoneal chemohyperthermia: rationale, technique, indications, and results.
Intraperitoneal chemohyperthermia (IPCH) is a loco-regional treatment for intraperitoneal malignancies. This ultra-radical treatment combines complete cytoreduction of macroscopic peritoneal disease preceding perioperative intraperitoneal perfusion of a chemotherapeutic drug heated to 42 degrees to 44 degrees to treat microscopic residual disease. ⋯ In selected patients, IPCH may lead to 27% five-year overall survival in cases of PC, and as high as 86% five-year survival in cases of pseudomyxoma peritonei. In the near future, this approach will become the standard treatment for selected cases of PC.
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Surg. Oncol. Clin. N. Am. · Jul 2001
ReviewThe immunologic consequences of laparoscopy in oncology.
The last decade has seen the publication of many studies regarding the impact of both traditional open methods and minimally invasive techniques on a variety of immune function parameters. Clearly, major surgery results in period of cell-mediated immunosuppression that can have an impact on the patient's recovery that would best be avoided. Although there are conflicting data among studies regarding some immune parameters there is general agreement in regards to other variables. ⋯ This work also has suggested novel means to avoid postoperative immunosuppression. Minimally invasive methods may be associated with oncologic advantages that go well beyond less pain, a quicker recovery, and a shorter length of stay. More basic science and human studies are needed to shed more light on this intriguing area.
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Two types of procedure may be indicated in incurable patients. The first is palliative, in which the goal of intervention is relief of symptoms. ⋯ Procedures are categorized by the type of symptom the procedure is intended to relieve. This article emphasizes the principles involved in patient selection and outcome assessment in order to identify areas where more research is needed.
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Because most cancer pain involves multiple anatomic sites, invasive techniques are intended to be analgesic adjuvants and not serve as the definitive treatment. These procedures often allow patients to reduce their dosages in their current drug regimens or to derive greater pain relief from their present doses in order to improve their quality of life. Medical care of the suffering pain patient requires a multimodality, multispecialty approach combining psychotherapy, social support, and pain management to provide the best possible quality of life or quality of dying.
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In the area of end-of-life bioethical issues, patients, families, and health care providers do not understand basic principles, often leading to anguish, guilt, and anger. Providers lack communication skills, concepts, and practical bedside information. ⋯ Clinicians need to learn how to balance the benefits and burdens of medications and treatments, control symptoms, and orchestrate withdrawal of treatment. Finally, all need to learn more about the dying process to benefit society, their own families, and themselves.