OBJECTIVE: Describe the case of echinococcal disease in gynecological practice and point out the complications of its diagnosis. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Faculty Hospital Trenčín, Slovakia. CASE REPORT: The case is presented in an immunosuppressed patient with peritoneal carcinomatosis, mild Ca 125 elevation and increased CRP presenting as a finding of gynecological etiology with histopathological outcome and conclusion of parasitic disease - echinococcosis (hydatidosis). CONCLUSION: In the differential diagnosis of peritoneal carcinomatosis and ascites, especially in immunosuppressed patients with a positive social (or epidemiological) history, the possibility of rare parasitic diseases such as echinococcosis, which resembles malignant tumors, should be considered.

• Klíčová slova
• Ascites, Ca 125, echinococcosis, peritoneal carcinomatosis,
• MeSH
• antigen CA-125 krev   MeSH
• ascites diagnóza   MeSH
• C-reaktivní protein MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• echinokokóza krev   diagnóza   parazitologie   MeSH
• lidé MeSH
• peptidové fragmenty krev   MeSH
• peritoneální nádory diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Geografické názvy
• Slovenská republika MeSH
• Názvy látek
• antigen CA-125 MeSH
• C-reactive protein (164-173) MeSH Prohlížeč
• C-reaktivní protein MeSH
• peptidové fragmenty MeSH

BACKGROUND: Peritoneal carcinomatosis of gastric origin is challenging to diagnose and treat. This disease is often misdiagnosed in the early stages using a non-invasive technique. Conventional surgery is unsuitable for treatment of patients with peritoneal seeding and positive peritoneal cytology. Peritoneal recurrence is the most frequent cause of therapeutic failure. The effectiveness of chemotherapy is low due to the plasma-peritoneal barrier. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment for pseudomyxoma peritonei and mesothelioma and improves overall survival and disease-free survival. This approach is also widely used to prevent and treat peritoneal carcinomatosis of gastric origin. PURPOSE: This article aims to provide a short summary of the contemporary role of cytoreductive surgery and HIPEC for treatment of gastric cancer patients. Theoretically, there are four possible applications and indications. First, palliative application to improve quality of life without prolongation of overall survival. This application mainly affects malignant ascites. Second, therapeutic application using a combination of gastrectomy/cytoreductive surgery and HIPEC to treat advanced disease including peritoneal metastases. Localized peritoneal seeding is the only indication for this application (maximum peritoneal cancer index of 10-12 or Cy+). Third, adjuvant/prophylactic application in patients at high risk of peritoneal recurrence, typically those with T3, T4, N+ disease (without peritoneal seeding). Fourth, neoadjuvant application using a combination of repeated HIPEC and chemotherapy with the aim of decreasing peritoneal seeding and enabling radical surgery. In this indication, HIPEC is often replaced by pressurized intraperitoneal aerosol chemotherapy.

• Klíčová slova
• cytoreductive surgery, gastric cancer, hyperthermic intraperitoneal chemotherapy, peritoneal metastases,
• MeSH
• cytoredukční chirurgie * MeSH
• gastrektomie MeSH
• indukovaná hypertermie * MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• nádory žaludku patologie   terapie   MeSH
• peritoneální nádory sekundární   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Peritoneal carcinomatosis (PK) of colorectal origin is a malignant tumour of the peritoneum caused by spreading of colorectal carcinoma (KRK) over the peritoneal surface of the abdominal cavity and its organs. PK occurs as a synchronous tumour in 1520% of patients, and as metachronous disease in 2550% of patients. METHODS: A group of 66 patients operated on for PK was retrospectively evaluated; 18 patients were excluded due to insufficient data. We evaluated 48 patients in total (22 men and 26 women) with mean age of 58 and 53 years, respectively; 12 patients (25%) were aged over 65 years. The patients were operated on between 2000 and 2019 using the Sugarbaker´s method of maximal cytoreduction (CRS) + HIPEC (Hyperthermic Intraoperative Peritoneal Chemotherapy). We evaluated the length, median survival, the incidence of complications and lethality in relation to the Peritoneal Carcinoma Index (PCI) and the Completeness of Cytoreduction (CC) score. The patients were divided into two subgroups according to the PCI score (012 and >12, respectively) and the CC score (CC 01 and CC 23, respectively). RESULTS: The mean survival was 26.3 months in the group with PCI up to 12 and 21.4 months in patients with PCI above 12 (p=0.02). In the group with CC 01 the mean survival was 27.1 months, while in the patients with the CC 23 it reached 12.6 months (p=0.06). The morbidity rate requiring an intervention was 18.7% and the lethality rate was 6.25% in the entire group. The median survival of the entire group was 22 months (1334 months). CONCLUSION: Literary references and our results are comparable, confirming the high efficiency of this method both in our country and worldwide. The use of CRS and HIPEC, associated with acceptable mortality and morbidity in selected patients with PK of colorectal origin, results in a significant extension of overall survival (OS).

• Klíčová slova
• peritoneal carcinomatosis − peritoneal carcinoma index − cytoreductive surgery − hyperthermic intraperitoneal chemotherapy − HIPEC,
• MeSH
• cytoredukční chirurgie MeSH
• kolorektální nádory * terapie   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• míra přežití MeSH
• nemocnice MeSH
• peritoneální nádory * terapie   MeSH
• peritoneum MeSH
• prognóza MeSH
• protokoly protinádorové kombinované chemoterapie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Peritoneal carcinomatosis represents an advanced stage of tumors within the peritoneal cavity. Once considered an incurable terminal cancer metastasis, contemporary medicine is on the hunt for certain potentially curative options alongside the present day's palliative disease management. However, for most patients, peritoneal carcinomatosis continues to pose a fatal late-stage prognosis with a grim future outlook. Over the past two decades, non-coding RNAs have garnered significant attention due to their undeniable significance in regulating cellular processes across all levels. Disruption of the intricate regulation led by non-coding RNAs has been demonstrated to have a substantial impact on various human diseases, particularly in cancer, including solid tumors originating from the organs of the peritoneal cavity. This review aims to offer a comprehensive overview of the current state of knowledge in the under-researched field of peritoneal carcinomatosis, focusing specifically on the role of non-coding RNAs in the development of this condition and delineating potential avenues for future research.

• Klíčová slova
• ascites, exosomes, miRNA, non-coding RNA, peritoneal carcinomatosis,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Epithelial ovarian cancer is one of the most common causes of cancer-related death in women. More than half of patients are diagnosed at an advanced stage, usually due to locoregional spread of peritoneal carcinomatosis. A combination of systemic chemotherapy and cytoreductive surgery has been the standard treatment since the mid-1990s. However, conventional chemotherapy is poorly delivered to the peritoneum due to the plasma-peritoneal barrier. Intraperitoneal chemotherapy can improve survival by eliminating residual microscopic disease. A combination of hyperthermic intravenous and intraperitoneal chemotherapy may reduce plasma toxicity and increase therapeutic effectiveness. Several experts are investigating the effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for both primary and recurrent ovarian cancer worldwide. Recent randomized studies indicate that this method prolongs overall patient survival and the disease-free interval. This approach is not yet part of standard guidelines and is the subject of several other clinical trials. However, indications should be considered in women with significant residual disease after neoadjuvant chemotherapy because these patients can benefit from comprehensive surgical resection in combination with hyperthermic intraperitoneal chemotherapy to prevent locoregional relapses.

• Klíčová slova
• cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, ovarian cancer,
• MeSH
• cytoredukční chirurgie * MeSH
• indukovaná hypertermie * MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• nádory vaječníků patologie   terapie   MeSH
• peritoneální nádory sekundární   terapie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

This article provides an introduction to peritoneal tumors, which are the subject of a series of review papers published in Issue 5 (2019) of Klinicka onkologie. Many malignant peritoneal tumors are characterized by production of mucinous and gelatinous masses, multiple peritoneal disability, so-called peritoneal carcinomatosis, and various grades of malignancy depending on their origin, staging, and histological type. Malignant peritoneal tumors are rare and their clinical symptomatology is nonspecific and varies according to the extent of disability. Diagnosis, particularly in the initial asymptomatic stages, is very complicated and often impossible, and tumors are often diagnosed by chance during other operations. Malignant peritoneal tumors were regarded as incurable and lethal for a long time; however, this view has changed over the past three decades. The Sugarbaker method, a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, was introduced in the 1990s. Postoperative cytostatic lavage is usually performed in specific cases. Classifications for the extent of disease and completeness of cytoreduction were established. Studies repeatedly confirmed the efficacy of this treatment for peritoneal malignancy. The combination of an aggressive surgical approach and intraperitoneal chemotherapy not only enhances quality of life, but also prolongs progression-free survival and overall survival in selected patients. Specialized centers for treatment of peritoneal malignancy were established based on results from the Czech Republic and around the world. These centers provide complex care, including specific surgical interventions and follow-up, for selected patients with primary and secondary peritoneal malignancy.

• Klíčová slova
• cytoreductive surgery, intraperitoneal chemotherapy, peritoneal metastases, peritoneal tumors,
• MeSH
• cytoredukční chirurgie MeSH
• indukovaná hypertermie MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• peritoneální nádory * diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• úvodní články MeSH

Stage IV colorectal cancer is associated with high mortality, and the prognosis is significantly worse for patients have peritoneal metastases. Peritoneal carcinomatosis from colorectal cancer was considered incurable with an infaust prognosis. Median survival of untreated patients is about 6 months and palliative systemic chemotherapy can prolonge this time up to 20 months. Patients with this disease were previously only surgically treated if they had severe clinical symptoms or complications. This view has changed dramatically over the past 15 years. Aggressive cytoreductive surgery in combination with intraperitoneal chemotherapy may prolong median survival for more than 40 months in selected patients. The Peritoneal Surface Oncology Group International (PSOGI), the international authority on the treatment of peritoneal tumors, recommends cytoreduction with intraperitoneal chemotherapy as the standard of care for selected patients with moderate-to-small volume peritoneal metastases secondary to colorectal cancer. Macroscopic cytoreduction appears to be essential; however, the role of hyperthermic intraperitoneal chemotherapy and the optimal chemotherapeutic agent for intraperitoneal lavage to treat peritoneal metastases from colorectal cancer remain unclear. The results of ongoing and future clinical trials are eagerly awaited.

• Klíčová slova
• colorectal cancer, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, peritoneal carcinomatosis,
• MeSH
• cytoredukční chirurgie * MeSH
• indukovaná hypertermie * MeSH
• kolorektální nádory patologie   terapie   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• peritoneální nádory prevence a kontrola   sekundární   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Peritoneal malignancies (PM) are observed in about 1030% of patients suffering from gastrointestinal malignant diseases, both in connection with the primary surgical management or as metachronous metastases due to cancer recurrence. METHODS: In the 1980s a new method of cytoreductive surgery (CRS) + HIPEC (hyperthermic intraperitoneal chemotherapy) was introduced. Today, we consider this method to be the gold standard for treatment of pseudomyxoma peritonei and peritoneal mesothelioma. The method increases overall survival (OS) of patients diagnosed with colorectal cancer, primary peritoneal and ovarian cancers. However, the disease recurs after this demanding treatment in the certain group of patients, approximately in 2544% of patients treated for pseudomyxoma peritonei, and in 40% and up to 82% of those treated for mesothelioma and colorectal cancer, respectively. Based on literary data (PubMed-Medline, last 5 years) and our own experience we present the basic factors associated with tumor recurrence, possibility of treatment using repeated CRS + HIPEC, data regarding second-look operations, and as applicable, prophylactic HIPEC. CONCLUSION: The method CRS + HIPEC provides an effective treatment of peritoneal carcinomatosis even in cases of recurrence. The second-look operations and prophylactic HIPEC may favorably affect the prognosis after primary R0 resections.

• Klíčová slova
• HIPEC − recurrence after CRS − second-look operations, peritoneal carcinomatosis − cytoreductive surgery,
• MeSH
• cytoredukční chirurgie MeSH
• hypertermická intraperitoneální peroperační chemoterapie MeSH
• indukovaná hypertermie * MeSH
• kolorektální nádory * terapie   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• lokální recidiva nádoru chirurgie   MeSH
• míra přežití MeSH
• peritoneální nádory * terapie   MeSH
• protokoly protinádorové kombinované chemoterapie MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The peritoneal membrane, formed by a single layer of mesothelial cells, lines the largest cavity of the human body. Anatomic structures of the peritoneal cavity, along with resident leukocyte populations, play an important role in the defense against microorganisms invading by breaching the gut integrity or ascending through the female genital tract. Local immune mechanisms in the peritoneal cavity are also important in patients undergoing peritoneal dialysis and in women with endometriosis. There is now extensive evidence demonstrating the significance of peritoneal immune mechanisms in the control of metastatic spread. Leukocytes belonging to both the innate and adaptive immune systems are present in the peritoneal cavity of normal subjects as well as in patients with intra-abdominal cancer. There is now increased understanding of the mechanisms that not only allow the tumor cells to escape the detection and destruction by the host immune system, but also to use the inflammatory mechanisms to promote tumor growth and spread inside the peritoneal cavity. Malignant ascites represents a model for the study of the interaction between tumor cells and the host immune system as well for the analysis of the tumor microenviroment. The peritoneal immune system may be stimulated by intraperitoneal administration of biologic agents. This peritoneal immunotherapy may be used for palliation of malignant ascites, or as a consolidation strategy in patients with minimal residual disease.

• MeSH
• lidé MeSH
• peritoneální dutina * MeSH
• peritoneální nádory imunologie   MeSH
• peritoneum imunologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

Malignant mesothelioma is a highly malignant disease that most often occurs in the pleura of the thoracic cavity, followed by the peritoneum, pericardium, or tinea vaginalis testis. Malignant peritoneal mesothelioma (MPM) accounts for 10-15% of all mesotheliomas. The most significant risk factor for MPM is exposure to asbestos. There is no specific symptomatology, and imaging (computed tomography) and histopathology are crucial for diagnosis. There are no generally accepted guidelines for radical treatment of MPM. Previously, the prognosis of MPM patients was poor, with survival of up to 1 year. However, median survival of patients who are suitable candidates for radical therapy is currently 3-5 years. A combination of cytoreductive surgery (CRS) and hyperthermic perioperative chemotherapy (HIPEC) is recommended in selected patients, while chemotherapy alone has insufficient efficacy. Systemic chemotherapy remains the only treatment option for patients who are unsuitable for CRS and HIPEC. In selected patients scheduled for or currently undergoing CRS and HIPEC, surgery may be performed in combination with systemic chemotherapy in the neoadjuvant or adjuvant setting; however, the benefit is unclear. There are no recommendations for follow-up of MPM patients after radical surgery. Existing guidelines for the pleural form (e.g., those issued by the European Society for Medical Oncology) do not specify the frequency or method of investigation. In the absence of specific serum markers, only CA 125 and mesothelin are generally available. Imaging methods include ultrasonography, computed tomography, and magnetic resonance imaging.

• Klíčová slova
• cytoreductive surgery, intraperitoneal chemotherapy, mesothelioma,
• MeSH
• cytoredukční chirurgie * MeSH
• indukovaná hypertermie * MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• mezoteliom diagnóza   epidemiologie   terapie   MeSH
• peritoneální nádory diagnóza   epidemiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH