Paul H Sugarbaker

PSOGI General Secretary

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ In this group of patients, the only treatment that adds survival time and quality of life is surgery. Usually, they do profit from an aggressive surgical approach to the disease.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ This patient had a large tumor burden. She also has an aggressive tumor biology. In the absence of a response to systemic chemo, her prognosis is extremely guarded.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ Usually, the stent from below goes into the free peritoneal cavity with the delayed leak from the ureter. That means a nephrostomy and a rendezvous procedure at a later time. Urine is well tolerated if drained from the peritoneal space. Rarely, is a surgical procedure required.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ If she has tolerated the surgery well, 5 days of EPIC paclitaxel would be used.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ I think, but the data is scanty, that this patient can profit from HIPEC. I would not use HIPEC cisplatin. She is not a platinum responder. The drug of choice for me would be Gemzar (500 mg/m2) for 90 minutes.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ With a transection of the mid-rectum, the second layer of sutures would be placed and no ileostomy would be necessary.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ In my opinion, this is palliative surgery. I would do everything possible to avoid a stoma. If an obstructed patient comes to the OR with the colon filled by stool, we would perform an "on the table" irrigation of the bowel. It would be a complete bowel prep.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ Any disease that is easily resectable, I would remove. A diaphragm resection may not be indicated with this palliative surgery.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ I appreciate the extensive CRS performed in this patient. I would have been more conservative. She needs the visceral resections in order to prevent GI obstruction in the near future.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ The patient is symptomatic. She has a large pelvic mass. She needs to go to the operating room now.

[Paul H Sugarbaker @PSugarbaker]

@vivekanandkem @PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ Of course, Bev is the worst. Yes, perforation and fistulization is not uncommon in these patients who are going to have a palliative surgery.

[Paul H Sugarbaker @PSugarbaker]

@vivekanandkem @PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ @writeslkpushkin Dr. Sharma, these additional chemo regimens come with added surgical complications. Our morbidity/mortality data clearly shows the extent of preoperative chemo increases the class 3 and 4 adverse events.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ CT shows a large pelvic mass which needs to be removed. It will be symptomatic in the near future. Fortunately to this point in time no gastrointestinal or urinary tract obstructions have occurred.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ Is the best assessment of response tumor marker? If so, the patient has markedly progressed. Did the patient improve in her symptoms? This is an important assessment of the chemo activity.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ At this point I have a major problem. What is the reliable indicator of a response to the neoadjuvant chemo? Is it radiologic? If so, the chemo may have had some value.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @gyncsm @ovarcome @OvarianCancerUK @indepso @IJGConline @Bhandoria @rubigupta16feb @vivekanandkem @DrFloresAyala @ajierros @BisginTayfun @FarazKh65499316 @Dr_Jamie_Murphy @FaekJ Giving neoadjuvant chemo can help in selecting the chemo used in an adjuvant setting. If there is no response to cisplatin, other regimens could be considered. One reason to use chemo first in this group of patients.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @indepso @vivekanandkem @IJGConline @FarazKh65499316 @gyncsm @IJGCfellows @agz_eriksson @Bhandoria @DrFloresAyala @anik0411 @DrSGlezMoreno @CashinPtr @cirugiacancer @DrSuneelKaushik @BisginTayfun @CelestinoGutirr @KurtSpeeten @kturaga @MufaddalKazi Perhaps there should be a "global review" of the patients' condition prior to any intervention. Some improved management for peritoneal mesothelioma needs to occur but hasn't progressed.

[Paul H Sugarbaker @PSugarbaker]

@PSOGI_EC @indepso @vivekanandkem @IJGConline @FarazKh65499316 @gyncsm @IJGCfellows @agz_eriksson @Bhandoria @DrFloresAyala @anik0411 @DrSGlezMoreno @CashinPtr @cirugiacancer @DrSuneelKaushik @BisginTayfun @CelestinoGutirr @KurtSpeeten @kturaga @MufaddalKazi My final comments regarding peritoneal mesothelioma are always the same. Somehow or other this complex and rare disease needs to be treated by surgeons interested in this problem and experienced with its management.