Publications by authors named "Jesus Esquivel"

64 Publications

A Multi-institutional Study of Peritoneal Recurrence Following Resection of Low-grade Appendiceal Mucinous Neoplasms.

Ann Surg Oncol 2021 Jan 7. Epub 2021 Jan 7.

Department of Surgery, University of California San Diego, La Jolla, CA, USA.

Background: Peritoneal dissemination of low-grade appendiceal mucinous neoplasms (LAMNs), sometimes referred to as pseudomyxoma peritonei, can result in significant morbidity and mortality. Little is known about the natural history of localized (non-disseminated) LAMNs.

Objective: The goal of this study was to evaluate the risk of peritoneal recurrence in patients with localized LAMNs.

Methods: We performed a multi-institutional retrospective review of patients with pathologically confirmed localized LAMNs. Baseline characteristics, pathology, and follow-up data were collected. The primary endpoint was the rate of peritoneal recurrence.

Results: We identified 217 patients with localized LAMNs. Median age was 59 years (11-95) and 131 (60%) patients were female. Surgical management included appendectomy for 124 (57.1%) patients, appendectomy with partial cecectomy for 26 (12.0%) patients, and colectomy for 67 (30.9%) patients. Pathology revealed perforation in 46 patients (37.7% of 122 patients with perforation status mentioned in the report), extra-appendiceal acellular mucin (EAM) in 49 (22.6%) patients, and extra-appendiceal neoplastic cells (EAC) in 13 (6.0%) patients. Median follow-up was 51.1 months (0-271). Seven (3.2%) patients developed a peritoneal recurrence, with a median time to recurrence of 14.4 months (2.5-47.0). Seven (15.2%) patients with histologic evidence of perforation had recurrence, versus no patients (0%) without perforation (p < 0.001); five (10.2%) patients with EAM versus two (1.2%) patients without EAM (p = 0.007), and one (7.7%) patient with EAC versus six (2.9%) patients without EAC (p = 0.355) had recurrence.

Conclusions: This multi-institutional study represents the largest reported series of patients with localized LAMNs. In the absence of perforation or extra-appendiceal mucin or cells, recurrence was extremely rare; however, patients with any of these pathologic findings require careful follow-up.
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http://dx.doi.org/10.1245/s10434-020-09499-yDOI Listing
January 2021

Management of Low-Grade Appendiceal Mucinous Neoplasms (LAMN): An International Survey of Surgeons Performing CRS and HIPEC.

Ann Surg Oncol 2021 Jan 3. Epub 2021 Jan 3.

Department of Surgery, Johns Hopkins University, Baltimore, MD, 21287, USA.

Background: Low-grade appendiceal mucinous neoplasms (LAMN) are commonly managed by community surgeons at diagnosis. There is variability in the treatment of LAMN, both by community and specialist providers. We assessed current management practices for LAMN across surgeons with expertise in peritoneal surface malignancies (PSM).

Methods: An online survey was sent to 106 international surgeons specializing in PSM. The survey assessed demographics, favored pre-referral management, and definitive management practices for LAMN.

Results: The response rate was 40% (67% USA, 33% international). Respondents had performed a median of 18 (interquartile range [IQR] 7.75-29) HIPEC cases in the last year, of which 10 (IQR 4-20) were for LAMN. Ninety-three percent reported more than half of LAMN referrals had already undergone surgery-an estimated 50% appendectomy and 20% right hemicolectomy (RH). No surgeon respondents supported performing right hemicolectomy before referral. For LAMN confined to the appendix, 86% of respondents would definitively treat with appendectomy. In the presence of mucinous implants, 24% would observe after appendectomy and 76% would proceed with HIPEC. All would perform HIPEC if implants contained tumor cells. When LAMN involved the appendiceal base, 67% of respondents would proceed with partial cecectomy, while 33% favored RH.

Conclusions: Pre-referral management of LAMN is not standardized and 20% of patients were referred to a surgeon who performs CRS/HIPEC after a right hemicolectomy that would not have been recommended. Management of LAMN by surgeons who treat PSM is also variable. Long-term data and identification of prognostic features are necessary to generate consensus on the optimal management of these complex patients.
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http://dx.doi.org/10.1245/s10434-020-09312-wDOI Listing
January 2021

Retention of Pantoea agglomerans Sc1R across stadia of the southern green stink bug, Nezara viridula (L.) (Hemiptera: Pentatomidae).

PLoS One 2020 3;15(12):e0242988. Epub 2020 Dec 3.

Insect Control & Cotton Disease Research Unit, Plains Area, Agricultural Research Service, United States Department of Agriculture, College Station, Texas, United States of America.

Southern green stink bug [Nezara viridula (L.)] adults and other pentatomid pests can transmit pathogens (e.g., the bacterium Pantoea agglomerans) that cause disease in cotton (Gossypium hirsutum L.) and other high-value cash crops worldwide. First instars of N. viridula were recently shown to ingest P. agglomerans strain Sc1R with rifampicin-resistance, and to retain the pathogen to the 2nd instar. The objective of this study was to determine the acquisition of P. agglomerans Sc1R by early instars of N. viridula and determine persistence of P. agglomerans Sc1R across subsequent stadia. In three trials, early instars (1st and 2nd) were exposed to P. agglomerans Sc1R and subsequently maintained to adulthood; cohorts were sampled at 3rd and 5th instars, as well as adults. In every trial, P. agglomerans Sc1R was detected in all stadia, including adults, but significantly higher frequencies of infection than expected were observed at the initial stage of infection (either 1st or 2nd instar). Higher densities of P. agglomerans Sc1R were detected in 1st and 2nd instars, and lower densities were observed in subsequent stadia. Densities of innate microbiota were generally lower when the initial stage of exposure was at 1st instar than when the initial stage of exposure was at the 2nd instar. Overall, half of the adults possessed P. agglomerans Sc1R. These findings demonstrated that N. viridula nymphs can acquire P. agglomerans Sc1R and retain the pathogen to adulthood. Potential avenues of research to further elucidate the implications of nymphs harboring pathogens to adulthood are discussed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242988PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714169PMC
February 2021

Diapause Response of the Boll Weevil (Coleoptera: Curculionidae) to Feeding Period Duration and Cotton Square Size.

J Insect Sci 2018 Sep 1;18(5). Epub 2018 Sep 1.

Insect Control and Cotton Disease Research Unit, USDA, ARS, College Station, TX.

Distribution of the boll weevil, Anthonomus grandis grandis Boheman (Coleoptera: Curculionidae), in the United States has been greatly reduced by eradication efforts. Still, it remains a key pest of cotton (Gossypium spp., [Malvales: Malvaceae]) in the New World, and has proven difficult to eliminate from Mexico and from southern Texas. In those regions, improved knowledge of boll weevil overwintering ecology may benefit efforts by eradication and management programs. Adult diapause in the boll weevil is well documented, but influences of the feeding period duration between adult eclosion and assessment of diapause remain unstudied. We examined diapause incidence and associated survival for weevils fed for 7, 14, or 21 d after adult eclosion. Diapause incidence of females was less influenced by feeding duration compared with males. For males, highest diapause incidence occurred after 14 d of feeding compared with 7 or 21 d. Host-free survival tended to be higher after 14 d of feeding compared with 7 or 21 d, although many weevils were long-lived (≥80 d) after each feeding period duration. Males exhibited higher survival compared with females, and survival was higher for weevils fed large flower buds (squares) compared with smaller squares. Survival was most influenced by temperature; longevity increased with decreasing temperature except at the lowest temperature (12.8°C). These results suggest an optimal feeding period for induction of diapause and maximized host-free longevity. These findings may permit improved timing of late-season insecticide treatments aimed at reducing overwintering populations, and thereby improve effectiveness of eradication and management programs.
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http://dx.doi.org/10.1093/jisesa/iey084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117904PMC
September 2018

2017 Update on Ovarian Cancer Peritoneal Carcinomatosis Multimodal-Treatment Considerations.

Gastroenterol Res Pract 2018 5;2018:5284814. Epub 2018 Apr 5.

American Society of Peritoneal Surface Malignancies (ASPSM), Clarkesville, MD, USA.

Ovarian cancer peritoneal carcinomatosis requires a multimodal-treatment approach. Current treatment considerations are analyzed in this update and include the management of recurrent malignant ascites and the understanding of its pathophysiology, the role of peritoneal washing cytology in detecting peritoneal metastases, capsular invasion and ovarian cancer histologic type, interpretation of pretreatment Ca-125 levels at different time points of ovarian cancer therapeutic management, characteristics of 10-year survivors of high-grade ovarian cancer, and the role of lymphadenectomy in ovarian cancer peritoneal carcinomatosis. This update also includes current considerations on the role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer peritoneal carcinomatosis as well as relevant ongoing phase III randomized controlled trial protocols.
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http://dx.doi.org/10.1155/2018/5284814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907426PMC
April 2018

Clinicopathological Features and Management of Appendiceal Mucoceles: A Systematic Review.

Am Surg 2018 Feb;84(2):273-281

Appendiceal mucoceles (AMs) are rare mucin-containing neoplasms with malignant potential. Lack of evidence-based data exists defining clinicopathological features for management. MEDLINE search between 1995 and 2015 was performed using search criteria "Appendix mucocele." Systematic review of patient-, pathologic-, and treatment-related characteristics was performed and data analyzed. Among 276 cases of non-perforated AMs, 163 (59%) patients were female, with variable and nonspecific presentation. Patients were treated with appendectomy (52.1%), right hemicolectomy (17.6%), partial cecectomy (17.2%), and ileocecetomy (13.1%). Pathologic evaluation revealed the following: cystadenoma/low-grade appendiceal mucinous neoplasm (54%), unspecified/benign (25%), retention cyst (14.1%), cystadenocarcinoma (4.2%), and mucosal hyperplasia (2.9%). All 11 (4.2%) patients with cystadenocarcinoma were female (P = 0.004), odds ratio for malignancy 1.07 times higher for women. Synchronous colonic malignancy was reported in three patients (27%) with cystadenocarcinoma (P = 0.007), odds ratio of 12.1. AMs have low risk for malignancy. Treatment should begin with appendectomy-only and subsequently guided by pathologic diagnosis.
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February 2018

Clinical studies in CRS and HIPEC: Trials, tribulations, and future directions-A systematic review.

J Surg Oncol 2018 Feb 9;117(2):245-259. Epub 2017 Nov 9.

Department of Surgery, Frederick Memorial Hospital, Frederick, Maryland.

Background: The field of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has suffered from a lack of clinical trials to validate its expanding use.

Objective: To evaluate published and ongoing clinical trials seeking to better define role of CRS/HIPEC in the treatment of peritoneal surface malignancies.

Methods: Systematic review by PubMed search was performed using terms "Clinical trial," "intraperitoneal chemotherapy," and "HIPEC." ClinicalTrials.gov and EudraCT registries were searched for active clinical trials. Eligibility included CRS/HIPEC trials investigating adult patient populations from published clinical reports and/or trials currently accruing or at completion.

Results: Thirteen published trials and 57 active clinical trials were included for review.

Conclusions: Published and ongoing U.S. and international clinical trials for CRS and HIPEC are defining important parameters that include improving patient selection, strategic sequences of treatment, cytoreductive strategies, chemotherapeutics, optimal hyperthermic temperature and timing, and toxicity profiles. Main barriers or limitations to trial development remain patient enrollment, trial design, and oncologic community collaboration. Overall progress is positive with increasing number of clinical trials throughout the world. Collaboration between surgeons and the wider oncologic community will be crucial to validate this important treatment strategy.
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http://dx.doi.org/10.1002/jso.24813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692902PMC
February 2018

Current Delivery of Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery (CS/HIPEC) and Perioperative Practices: An International Survey of High-Volume Surgeons.

Ann Surg Oncol 2017 Apr 29;24(4):923-930. Epub 2016 Nov 29.

Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.

Background: Cytoreductive surgery and heated intraperitoneal chemotherapy (CS/HIPEC) is performed for selected indications at a limited number of specialized centers worldwide. Currently there is no standardized approach to the perioperative care process. We sought to capture current practices in the perioperative management of patients who undergo CS/HIPEC at high-volume centers.

Methods: Surgeon members of the American Society of Peritoneal Surface Malignancies working at high-volume CS/HIPEC centers (>10 cases/year) were invited to complete an online survey. The survey included questions relating to preoperative preparation of patients, intraoperative practices, and postoperative care.

Results: Ninety-seven surgeons from five continents completed the survey (response rate 55%). The majority (80%) practiced in academic environments. Most respondents (68%) indicated that a formal preoperative preparatory pathway for CS/HIPEC surgery existed at their centers, but few (26%) had used enhanced recovery protocols in this group of patients. Whereas the intraoperative technical practices of the CS/HIPEC procedure were relatively consistent across respondents, there was little agreement on pre- and postoperative care practices, including use of mechanical bowel preparation, nutritional supplementation, methods of perioperative analgesia, timing of physical therapy and ambulation, nasogastric tube and Foley removal, intravenous fluids, blood transfusion parameters, and postoperative use of deep-vein thrombosis prophylaxis and antibiotics.

Conclusions: Perioperative care practices for CS/HIPEC are widely variable nationally and internationally. Standardization of such practices offers an opportunity to incorporate evidence-based interventions and may enhance patient outcomes and improve care standards across all centers that offer this procedure.
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http://dx.doi.org/10.1245/s10434-016-5692-3DOI Listing
April 2017

The American Society of Peritoneal Surface Malignancies Multi-Institution evaluation of 1,051 advanced ovarian cancer patients undergoing cytoreductive surgery and HIPEC: An introduction of the peritoneal surface disease severity score.

J Surg Oncol 2016 12;114(7):779-784

Department of Surgical Oncology, St. Agnes Hospital, Baltimore, Maryland.

Background: Standard treatment for ovarian epithelial cancer (OEC) consists of cytoreductive surgery (CRS) and a platinum-taxane chemotherapy combination. There is increasing interest in evaluating hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with stage IIIC/IV disease. The peritoneal surface disease severity score (PSDSS) was introduced as a basis to improve patient selection for this therapy in OEC.

Methods: The charts of 1,051 patients with advanced OEC who underwent CRS/HIPEC were retrospectively evaluated using the following preoperatively obtained criteria: symptoms, peritoneal dissemination, and tumor histology. Overall survival was analyzed according to PSDSS as well as the timings and agents used during CRS/HIPEC.

Results: Median survival for all 1,051 patients was 73.4 months. PSDSS information was available for 553 patients. Survival correlated negatively with PSDSS (P < 0.001). Furthermore, combining PSDSS scores into I/II and III/IV described two distinct patient populations with vastly different outcomes, 100 versus 55 months, respectively (P < 0.001). Multivariate analysis failed to describe any differences between timings of HIPEC or chemotherapy agents used.

Conclusion: PSDSS was capable of identifying a better surviving patient population in advanced-stage OEC. While randomized trials to evaluate the benefit of HIPEC are needed, the PSDSS may be a useful tool for selecting and stratifying OEC patients in clinical trials. J. Surg. Oncol. 2016;114:779-784. © 2016 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jso.24406DOI Listing
December 2016

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered via a modified perfusion system for peritoneal carcinomatosis of colorectal origin.

Surg Today 2016 Aug 30;46(8):979-84. Epub 2016 Apr 30.

Peritoneal Surface Malignancy Program, GI Surgical Oncology, St. Agnes Health Care, Baltimore, MD, USA.

Background And Purpose: The long-term survival of patients with peritoneal carcinomatosis of colorectal origin has been achieved with cytoreductive surgery, which removes all macroscopic implants, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The current technology for administering intraperitoneal heated chemotherapy is expensive and, for some institutions, unaffordable. We conducted this study to assess the temperature stability provided by a modified, inexpensive system, to offer a simple and low cost alternative to the standard HIPEC delivery equipment.

Methods: Ten patients with histologically diagnosed peritoneal metastases of adenocarcinoma or pseudomyxoma peritonei underwent cytoreductive surgery and received HIPEC with 5-fluorouracil for 90 min, delivered via our modified system. The temperature was recorded from two probes: one in the inflow catheter and one in the outflow catheter. The intra-abdominal temperature was monitored meticulously to maintain it at between 41 and 42 °C.

Results: All patients underwent cytoreductive surgery and HIPEC using our modified delivery system. Temperature stability was achieved in all patients, with a mean of 41.4°. There were no thermal injuries associated with any of the ten perfusions. The mean hospital stay was 15 days and the median survival was 30 months.

Conclusion: Analysis of this data demonstrates that the uniform delivery of HIPEC at 41° with this modified system is feasible and safe. The outcome of the patients treated with cytoreductive surgery and HIPEC with this modified system compares favorably to other published series. Its low cost and simple design will give more patients with peritoneal carcinomatosis access to this treatment.
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http://dx.doi.org/10.1007/s00595-016-1335-3DOI Listing
August 2016

Poultry litter and the environment: Physiochemical properties of litter and soil during successive flock rotations and after remote site deposition.

Sci Total Environ 2016 May 22;553:650-661. Epub 2016 Mar 22.

USDA-ARS-PA-NRRC, Office of the Director, 2150 Centre Avenue, Building D, Suite 300, Fort Collins, CO 80526, USA.

The U.S. broiler meat market has grown over the past 16 years and destinations for U.S. broiler meat exports expanded to over 150 countries. This market opportunity has spurred a corresponding increase in industrialized poultry production, which due to the confined space in which high numbers of animals are housed, risks accumulating nutrients and pollutants. The purpose of this research was to determine the level of pollutants within poultry litter and the underlying soil within a production facility; and to explore the impact of spent litter deposition into the environment. The study follows a production facility for the first 2.5 years of production. It monitors the effects of successive flocks and management practices on 15 physiochemical parameters: Ca, Cu, electrical conductivity, Fe, K, Mg, Mn, moisture, Na, NO3(-)/N, organic matter, P, pH, S, and Zn. Litter samples were collected in-house, after clean-outs and during stockpiling. The soil before house placement, after the clean-outs and following litter stockpiling was monitored. Management practices markedly altered the physiochemical profiles of the litter in-house. A canonical discriminant analysis was used to describe the relationship between the parameters and sampling times. The litter profiles grouped into five clusters corresponding to time and management practices. The soil in-house exhibited mean increases in all physiochemical parameters (2-297 fold) except Fe, Mg, %M, and pH. The spent litter was followed after deposition onto a field for use as fertilizer. After 20 weeks, the soil beneath the litter exhibited increases in EC, Cu, K, Na, NO3(-)/N, %OM, P, S and Zn; while %M decreased. Understanding the impacts of industrialized poultry farms on the environment is vital as the cumulative ecological impact of this land usage could be substantial if not properly managed to reduce the risk of potential pollutant infiltration into the environment.
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http://dx.doi.org/10.1016/j.scitotenv.2016.02.077DOI Listing
May 2016

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: survival outcomes and patient selection.

Authors:
Jesus Esquivel

J Gastrointest Oncol 2016 Feb;7(1):72-8

Department of Surgical Oncology, Cancer Treatment Centers of America, Philadelphia, PA 19124, USA.

Background: Chemotherapy hyperthermic intraperitoneal chemotherapy (HIPEC) is playing an ever increasing role in the management of colorectal cancer (CRC) with peritoneal metastases (PM) as results approach those of surgical resection of liver metastases. Selection criteria for treatment type, sequence and timing of currently available therapies remain ill-defined.

Methods: We review the current published literature analyzing outcomes by treatments with surgery, systemic chemotherapy, cytoreductive surgery (CRS) and HIPEC, and ongoing clinical trials. A clinical pathway that incorporates all currently available therapies, determining the timing and sequence of such therapies was constructed.

Results: Most of the literature on outcome data comes from studies reporting the results of CRS and HIPEC with large series showing a median survival of 32-47 months. Meanwhile, the vast majority of patients, over 90% in the United States, are being treated with palliative systemic therapies following the NCCN guidelines.

Conclusions: Cooperation between medical and surgical oncologists represents an unmet need in oncology when it comes to patients with CRC with PM. The presented clinical pathway constitutes a feasible and much needed first step to start this cooperation.
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http://dx.doi.org/10.3978/j.issn.2078-6891.2015.114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754309PMC
February 2016

Gossypolhemiquinone, a dimeric sesquiterpenoid identified in cotton (Gossypium).

Phytochemistry 2016 Feb 22;122:165-171. Epub 2015 Dec 22.

USDA, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX 77845, United States.

The report that the cotton leaf perforator, Bucculatrix thurberiella, is one of the few insect herbivores to attack Gossypium thurberi prompted an investigation of the terpenoids present in the leaves of this wild species of cotton. Members of Gossypium produce subepidermal pigment glands in their leaves that contain the dimeric sesquiterpenoid gossypol as well as other biosynthetically related terpenoids. In addition to gossypol, a previously unknown dimeric sesquiterpenoid, gossypolhemiquinone (GHQ), was identified in trace amounts in G. thurberi, a member of the D genome. Other members of the D genome of Gossypium were subsequently found to contain this compound, but GHQ was not detected in commercial cotton cultivars. When fed to Helicoverpa zea in an artificial diet, GHQ delayed days-to-pupation, reduced pupal weights, and survival to adulthood to a lesser or equal extent than gossypol in comparison to the control diet. However, GHQ had a synergistic effect on survival and days-to-pupation when combined with gossypol at the highest dosage tested (0.18%; 15.5:84.5 GHQ:gossypol). Because gossypol exhibits anti-cancer activity, GHQ was also evaluated for its anti-cancer activity against the National Cancer Institute's 60-Human Tumor Cell Line Screen. Significant inhibitory activity against most of these cell lines was not observed, but the results may offer some promise against leukemia cancer cell lines.
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http://dx.doi.org/10.1016/j.phytochem.2015.12.009DOI Listing
February 2016

Relationship Between Piercing-Sucking Insect Control and Internal Lint and Seed Rot in Southeastern Cotton (Gossypium hirsutum L.).

J Econ Entomol 2015 Aug 11;108(4):1540-4. Epub 2015 Jun 11.

USDA, ARS, SPARC, 2765 F&B Rd., College Station, TX 77845.

In 1999, crop consultants scouting for stink bugs (Hemiptera spp.) in South Carolina discovered a formerly unobserved seed rot of cotton that caused yield losses ranging from 10 to 15% in certain fields. The disease has subsequently been reported in fields throughout the southeastern Cotton Belt. Externally, diseased bolls appeared undamaged; internally, green fruit contain pink to dark brown, damp, deformed lint, and necrotic seeds. In greenhouse experiments, we demonstrated transmission of the opportunistic bacterium Pantoea agglomerans by the southern green stink bug, Nezara viridula (L.). Here, green bolls were sampled from stink bug management plots (insecticide protected or nontreated) from four South Atlantic coast states (North Carolina, South Carolina, Georgia, and Florida) to determine disease incidence in the field and its association with piercing-sucking insects feeding. A logistic regression analysis of the boll damage data revealed that disease was 24 times more likely to occur (P = 0.004) in bolls collected from plots in Florida, where evidence of pest pressure was highest, than in bolls harvested in NC with the lowest detected insect pressure. Fruit from plots treated with insecticide, a treatment which reduced transmission agent numbers, were 4 times less likely to be diseased than bolls from unprotected sites (P = 0.002). Overall, punctured bolls were 125 times more likely to also have disease symptoms than nonpunctured bolls, irrespective of whether or not plots were protected with insecticides (P = 0.0001). Much of the damage to cotton bolls that is commonly attributed to stink bug feeding is likely the resulting effect of vectored pathogens.
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http://dx.doi.org/10.1093/jee/tov156DOI Listing
August 2015

Colorectal cancer with peritoneal metastases: Progress, not perfection.

Authors:
Jesus Esquivel

J Surg Oncol 2015 Jul 7;112(1):115. Epub 2015 Jul 7.

Department of Surgical Oncology, Cancer Treatment Centers of America, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1002/jso.23954DOI Listing
July 2015

The American Society of Peritoneal Surface Malignancies evaluation of HIPEC with Mitomycin C versus Oxaliplatin in 539 patients with colon cancer undergoing a complete cytoreductive surgery.

J Surg Oncol 2014 Dec 2;110(7):779-85. Epub 2014 Aug 2.

Deaprtment of General Surgery, Hospital Infanta Cristina, Cordoba, Spain.

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are gaining acceptance as treatment for selected patients with colorectal cancer with peritoneal carcinomatosis (CRCPC). Tremendous variations exist in the HIPEC delivery.

Methods: The American Society of Peritoneal Surface Malignancies (ASPSM) examined the overall survival in patients with CRCPC who underwent a complete cytoreduction and HIPEC with Oxaliplatin vs. Mitomycin C (MMC), stratifying them by the Peritoneal Surface Disease Severity Score (PSDSS).

Results: Median overall survival (OS) of 539 patients with complete cytoreduction was 32.6 months, 32.7 months for the MMC group and 31.4 months for the Oxaliplatin group (P = 0.925). However, when stratified by PSDSS, median OS rates in PSDSS I/II patients were 54.3 months in those receiving MMC vs. 28.2 months in those receiving oxaliplatin (P = 0.012), whereas in PSDSS III/IV patients, median OS rates were 19.4 months in those receiving MMC vs. 30.4 months in those receiving Oxaliplatin (P = 0.427).

Conclusion: These data suggest that MMC might be a better agent for HIPEC delivery than Oxaliplatin in patients with CRCPC, favorable histologies and low burden of disease (PSDSS I/II) undergoing complete cytoreduction. Prospective studies are warranted, which stratify patients by their PSDSS and randomize them to HIPEC with MMC vs. Oxaliplatin.
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http://dx.doi.org/10.1002/jso.23728DOI Listing
December 2014

Evaluation of a new staging classification and a Peritoneal Surface Disease Severity Score (PSDSS) in 229 patients with mucinous appendiceal neoplasms with or without peritoneal dissemination.

J Surg Oncol 2014 Nov 5;110(6):656-60. Epub 2014 Jun 5.

St. Agnes Hospital, Baltimore, Maryland.

Introduction: Most classifications of mucinous appendiceal neoplasms (MAN) do not take into consideration the type of primary tumor or the burden of peritoneal disease.

Materials And Methods: We conducted a retrospective evaluation of 229 patients with MAN. The severity of their disease was analyzed with the Peritoneal Surface Disease Severity Score (PSDSS) on a five-point scale that included: (1) the primary appendiceal tumor, (2) the type of peritoneal dissemination, and (3) the burden of disease. Overall survival was analyzed according to five tiers of estimated disease severity based on the above parameters.

Results: There were 19, 67, 59, 43, and 41 patients with PSDSS 0, I, II, III, and IV, respectively. One hundred seventy-three patients underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Overall survival was 80.0 months in this group with 5-year survival of 100%, 79.2%, 23.3%, and 6.9% in patients with PSDSS I, II, III, and IV, respectively (P < 0.001). On multivariate analysis, sex and PSDSS stage were identified as independent predictors of survival.

Conclusions: The PSDSS appears to be an important prognostic indicator in patients with MANs with or without peritoneal dissemination and may improve selection of patients for appropriate therapy from the time of diagnosis.
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http://dx.doi.org/10.1002/jso.23679DOI Listing
November 2014

The American Society of Peritoneal Surface Malignancies (ASPSM) Multiinstitution Evaluation of the Peritoneal Surface Disease Severity Score (PSDSS) in 1,013 Patients with Colorectal Cancer with Peritoneal Carcinomatosis.

Ann Surg Oncol 2014 Dec 23;21(13):4195-201. Epub 2014 May 23.

Department of Surgical Oncology, Cancer Treatment Centers of America, Philadelphia, PA, USA,

Background: Extensive clinical experience suggests that hyperthermic intraperitoneal chemotherapy (HIPEC) may play an important role in the management of colorectal cancer patients with peritoneal carcinomatosis (CRCPC). However, there remains no established nonsurgical process to rationally select patients for this management, either for inclusion/stratification in clinical trials or as a component of standard of care. The Peritoneal Surface Disease Severity Score (PSDSS) was introduced as a basis to improve patient selection.

Methods: The American Society of Peritoneal Surface Malignancies conducted a retrospective review of 1,013 CRCPC patients. The PSDSS was evaluated on 3 specific criteria obtained before surgery (symptoms, extent of peritoneal dissemination, and primary tumor histology). Overall survival was analyzed according to four tiers of disease severity, and a comparison was made between patients who underwent cytoreductive surgery + HIPEC and those who did not.

Results: The PSDSS was calculated on 884 patients (87 %). The median survival of 275 patients not undergoing CRS/HIPEC based on their PSDSS-I (n = 8), II (n = 80), III (n = 55), and IV (n = 132)-was 45, 19, 8, and 6 months, respectively. The median survival of 609 patients who underwent CRS/HIPEC based on their PSDSS-I (n = 75), II (n = 317), III (n = 82), and IV (n = 135)-was 86, 43, 29, and 28 months, respectively.

Conclusions: These data support that the PSDSS, undertaken before surgery, is capable of defining CRCPC populations who have a statistically defined high or considerably lower likelihood of long-term survival after CRS/HIPEC. The PSDSS can be quite useful in the decision to enter CRCPC patients into, and their stratification within, clinical trials.
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http://dx.doi.org/10.1245/s10434-014-3798-zDOI Listing
December 2014

Treatment of peritoneal surface malignancies.

Authors:
Jesus Esquivel

Surg Oncol Clin N Am 2012 Oct 28;21(4):xv-xviii. Epub 2012 Jul 28.

Peritoneal Surface Malignancy Program, St. Agnes Hospital, Baltimore, MD 21229, USA.

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http://dx.doi.org/10.1016/j.soc.2012.07.006DOI Listing
October 2012

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: initial experience in Oaxaca, Mexico.

Am Surg 2012 Sep;78(9):942-6

Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca, México.

Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multimodality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at "Hospital Regional de Alta Especialidad de Oaxaca," Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.
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September 2012

Summary of current therapeutic options for peritoneal metastases from colorectal cancer.

J Surg Oncol 2013 May 11;107(6):566-73. Epub 2012 Jun 11.

Hepatobiliary and Surgical Oncology Unit, Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia.

Background: Peritoneal metastases remain an under addressed problem for which this review serves to investigate the efficacy of systemic chemotherapy and radical surgical treatments in this disease entity.

Methods: The literature between 1995 and June 2009 was surveyed systematically through a review of published studies on the treatment outcomes of metastatic colorectal cancer to the peritoneum on the Medline and PubMed databases.

Results: A total of 2,492 patients from 19 studies were reviewed. One thousand and eighty-four patients treated with complete cytoreductive surgery (CCS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and 1,408 patients were treated with palliative surgery and/or systemic chemotherapy. For CCS HIPEC, the overall survival ranged between 20 and 63 (median 33) months, and 5-year survival ranged between 17% and 51% (median 40%). For palliative surgery and/or systemic chemotherapy, the overall survival ranged between 5 and 24 (median 12.5) months, and 5-year survival ranged between 13% and 22% (median 13%).

Conclusion: Systemic therapies have not proved effective and randomised clinical trials have not sufficiently addressed patient subpopulations with metastatic disease of this entity. Current evidence have demonstrated the efficacy associated with CCS HIPEC for which should now be embraced as the standard of care.
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http://dx.doi.org/10.1002/jso.23189DOI Listing
May 2013

Laparoscopic Cytoreductive Surgery and HIPEC in Patients with Limited Pseudomyxoma Peritonei of Appendiceal Origin.

Gastroenterol Res Pract 2012 11;2012:981245. Epub 2012 Apr 11.

Department of Surgical Oncology, St. Agnes Hospital, Baltimore, MD 21229, USA.

Introduction. Increasing numbers of patients with pseudomyxoma peritonei (PMP) of appendiceal origin are being evaluated with a low tumor burden. We explored a minimally invasive approach for this group of patients. Materials and Methods. We designed a protocol in which patients with a PMP diagnosis would have a diagnostic laparoscopy. If limited carcinomatosis (PCI ≤ 10) is identified, the procedure will continue laparoscopically. If extensive carcinomatosis (PCI > 10) is found, then the procedure will be converted to an open approach. Results. From December 2008 to December 2011, 19 patients had a complete cytoreduction and HIPEC: 18 of them (95%) were done laparoscopically and 1 of them (5%) was converted to an open procedure. Mean PCI was 4.2. Grade 3 morbidity was 0, and one patient (5%) experienced a grade 4 complication, needing a reoperation for an internal hernia. There were no mortalities. Mean length of hospital stay was 5.3 days. At a mean follow-up of 17 months (1-37) all 19 patients are alive and free of disease. Conclusion. This study demonstrates that cytoreductive surgery and HIPEC via the laparoscopic route is feasible and safe and should be offered to patients with limited pseudomyxoma peritonei of appendiceal origin.
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http://dx.doi.org/10.1155/2012/981245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3332170PMC
August 2012

Peritoneal carcinomatosis: cytoreductive surgery and HIPEC--overview and basics.

Cancer Invest 2012 Mar;30(3):209-24

Surgical Oncology, Department of Surgery, Tübingen Comprehensive Cancer Center, University of Tübingen, Germany.

Tumor involvement of the peritoneum-peritoneal carcinomatosis-is a heterogeneous form of cancer that had been generally regarded as a sign of systemic tumor disease and as a terminal condition. The multimodal treatment approach for patients with peritoneal carcinomatosis, which had been conceived and developed, consists of what is known as cytoreductive surgery, followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Depending on the tumor mass as assessed intraoperatively and the histopathological differentiation, patients who undergo cytoreductive surgery and HIPEC have a significant survival benefit. Mean increases in the survival period ranging from six months to up to four years have now been reported. In view of the substantial logistic effort and the extent of the surgery involved, this treatment approach represents a major challenge both for patients and for surgical oncologists, as well as for the members of the overall interdisciplinary structure required, which includes oncology, anesthesiology and intensive care, psycho-oncology, and patient management. The surgical procedures alone may take 8-14 hr. The present paper provides an overview of the basis for the approach and the use of specialized classifications and quantitative prognostic indicators.
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http://dx.doi.org/10.3109/07357907.2012.654871DOI Listing
March 2012

Minimally invasive evaluation and treatment of colorectal liver metastases.

Int J Surg Oncol 2011 7;2011:686030. Epub 2011 Jul 7.

Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, Mailbox no. 207, Baltimore, MD 21229, USA.

Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs) include ultrasonography (US), computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs), to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR) and minimally invasive LR (MILR). Although there are no randomized trials comparing OLR and MILR, nonrandomized data suggest that MILR compares favorably with OLR regarding morbidity, mortality, LOS, and cost, although significant selection bias exists. The future of MILR will likely include expanding criteria for resectability of CRLM and should include both a patient registry and a formalized process for surgeon training and credentialing.
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http://dx.doi.org/10.1155/2011/686030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263653PMC
August 2012

Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with limited peritoneal surface malignancies: feasibility, morbidity and outcome in an early experience.

Ann Surg 2011 Apr;253(4):764-8

St. Agnes Hospital, Baltimore, Maryland 21229, USA.

Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are being widely used in the treatment of patients with peritoneal surface malignancies. The open procedure has been associated with high grade III and IV morbidity and prolonged hospitalization.

Methods: Patients with peritoneal surface malignancies and no gross evidence of carcinomatosis on the computed tomographic scan were enrolled to undergo laparoscopic CRS and HIPEC. We aimed to assess the feasibility, safety, and outcome of this procedure. Postoperative complications were reported according to the National Cancer Institute Common Toxicity Criteria.

Results: From October 2008 to January 2010, 14 patients were enrolled into the protocol. Amongst these 14 patients, one patient was found with extensive carcinomatosis at the time of laparoscopy and had no surgical procedure. Thirteen patients had a complete cytoreduction and HIPEC, 10 (77%) laparoscopically and 3 (23%) were converted to an open procedure. There was one grade 3 morbidity (10%) and one patient (10%) in the laparoscopy group experienced a grade 4 complication, needing a reoperation for an internal hernia. Mean length of hospital stay was 6 days for those completed laparoscopically, 8 days for those converted to an open procedure and 8 days for a matched cohort of patients with an upfront open procedure.

Conclusions: This initial investigative stage demonstrates the feasibility and safety of cytoreductive surgery and HIPEC via the laparoscopic route in selected patients with low-tumor volume and no small bowel involvement mainly from appendiceal malignancies. Longer follow-up and additional studies are required to evaluate its long-term efficacy.
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http://dx.doi.org/10.1097/SLA.0b013e31820784dfDOI Listing
April 2011

Development of a Bayesian Belief Network Model for personalized prognostic risk assessment in colon carcinomatosis.

Am Surg 2011 Feb;77(2):221-30

Department of Surgery, Division of Surgical Oncology, Walter Reed Army Medical Center, Washington, DC, USA.

Multimodality therapy in selected patients with peritoneal carcinomatosis is gaining acceptance. Treatment-directing decision support tools are needed to individualize care and select patients best suited for cytoreductive surgery +/- hyperthermic intraperitoneal chemotherapy (CRS +/- HIPEC). The purpose of this study is to develop a predictive model that could support surgical decisions in patients with colon carcinomatosis. Fifty-three patients were enrolled in a prospective study collecting 31 clinical-pathological, treatment-related, and outcome data. The population was characterized by disease presentation, performance status, extent of peritoneal cancer (Peritoneal Cancer Index, PCI), primary tumor histology, and nodal staging. These preoperative parameters were analyzed using step-wise machine-learned Bayesian Belief Networks (BBN) to develop a predictive model for overall survival (OS) in patients considered for CRS +/- HIPEC. Area-under-the-curve from receiver-operating-characteristics curves of OS predictions was calculated to determine the model's positive and negative predictive value. Model structure defined three predictors of OS: severity of symptoms (performance status), PCI, and ability to undergo CRS +/- HIPEC. Patients with PCI < 10, resectable disease, and excellent performance status who underwent CRS +/- HIPEC had 89 per cent probability of survival compared with 4 per cent for those with poor performance status, PCI > 20, who were not considered surgical candidates. Cross validation of the BBN model robustly classified OS (area-under-the-curve = 0.71). The model's positive predictive value and negative predictive value are 63.3 per cent and 68.3 per cent, respectively. This exploratory study supports the utility of Bayesian classification for developing decision support tools, which assess case-specific relative risk for a given patient for oncological outcomes based on clinically relevant classifiers of survival. Further prospective studies to validate the BBN model-derived prognostic assessment tool are warranted.
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February 2011