1. Need for guidance : a multidisciplinary survey on surgical emergencies in peritoneal surface malignanciesPaola Fugazzola, Niccolò Allievi, Andrea Celotti, Enrico Cicuttin, Lorenzo Cobianchi, Andrea Dagnoni, Francesca Dal Mas, Simone Frassini, Ahmed Ghaly, Stefano Magnone, 2026, izvirni znanstveni članek Povzetek: Introduction: Advances in systemic chemotherapy, cytoreductive surgery, and intraperitoneal treatment have improved long-term outcomes in peritoneal carcinomatosis (PC), yet acute complications such as obstruction, perforation, and strangulation remain poorly standardized in their surgical management. This study investigated current clinical attitudes and decision-making strategies in PC emergencies. Materials and methods: A 76-item web-based survey was sent out via the World Society of Emergency Surgery (WSES) and the Italian Society of Surgical Oncologists (SICO) from October 2023 to January 2024. Questions addressed diagnostic approaches, surgical indications, treatment strategies, and referral pathways. Respondents were stratified by specialty (Emergency vs. Oncologic Surgery) and institutional experience with peritoneal procedures (>30 cases). Data were analyzed using descriptive statistics and the Mann–Whitney U test for subgroup comparisons. Results: Six hundred twenty-two surgeons completed the survey. A strong consensus emerged on the significant impact of emergencies on long-term outcomes and the need for international guidelines. However, 75% of survey items exhibited standard deviation (SD) > 0.84, and 58% showed SD > 1.0, indicating substantial heterogeneity. Peritoneal surgery specialists were more likely to support active surgical management, post-operative intensive care unit (ICU) admission, early nutritional assessment, and referral to high-volume centres (all p < 0.05). Conclusions: This international survey reveals marked variability in the emergency surgical management of PC and underscores the urgent need for standardized, evidence-based recommendations. These findings will inform a consensus effort by WSES, the Peritoneal Surface Oncology Group International (PSOGI), and SICO to harmonize care and improve outcomes in peritoneal carcinomatosis emergencies.
Ključne besede: peritoneal carcinomatosis, peritoneal metastasis, malignant bowel obstruction, emergency surgery, clinical decision-making, survey research, practice variability
Objavljeno v DiRROS: 20.08.2026; Ogledov: 192; Prenosov: 116
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2. Solitary ovarian cancer cells in the peritoneum : what happens below the surface?Laura M.C. Vos, Willemien J. van Driel, Gabe S. Sonke, Juliette O. A. M. van Baal, Koen K. van de Vijver, Cornelis J. F. van Noorden, Christianne A. R. Lok, 2022, izvirni znanstveni članek Povzetek: Background
In advanced epithelial ovarian cancer (EOC), the peritoneum is the primary site of disease recurrence which occurs in >75% of patients despite complete cytoreductive surgery (CRS) and chemotherapy. Macroscopically undetectable remaining cancer cells are deemed to be a source for recurrent disease. We investigated characteristics of occult disease in biopsies of macroscopically normal peritoneum during CRS.
Materials and methods
We included 14 patients with advanced stage high grade serous ovarian cancer (HGSOC). Eleven patients had received neoadjuvant chemotherapy (NACT) and three patients were chemotherapy naïve. Each patient underwent three study-related peritoneal biopsies: 1) of a metastasis, 2) adjacent to a metastasis and 3) at distance from metastases. Cryostat sections were immunohistochemically stained for PAX8 and PanCK as markers of EOC cells and for CD31 as a marker for vascular and lymphatic endothelium. The sections were analyzed semi-quantitatively.
Results
Macroscopically normal peritoneum showed solitary PAX8-positive cells adjacent to and at distance from metastases in all patients. Thirteen percent of these PAX8-positive cells were found to be attached to the mesothelium and are presumably spread through intra-abdominal fluid. Eighty-seven percent of the solitary PAX8-positive cells were found in the stroma underneath the mesothelium, of which 59% were firmly attached to endothelium and 33% were found in the stroma. In most cases, no sign of proliferation of the solitary cells was observed. Only a few clusters of PAX8-positive cells were found. Chemotherapy did not affect these results.
Conclusions
Solitary PAX8-positive cells are present in the macroscopically healthy-looking peritoneum of all EOC patients investigated, irrespective of the distance to macroscopically-visible metastases and of previous treatment. The majority of these solitary cancer cells were attached to endothelium of capillaries, venules or lymphatic vessels. Their solitary character and lack of proliferation suggests a dormant state, which could explain why these cells are unaffected by neo-adjuvant chemotherapy.
Ključne besede: ovarian cancer, peritoneal metastasis, translational medical research, human pathology, PAX8, cancer recurrence
Objavljeno v DiRROS: 26.02.2025; Ogledov: 1125; Prenosov: 744
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