title: Management of Inguinal Involvement of Peritoneal Surface Malignancies by Cytoreduction and HIPEC with Inguinal Perfusion.
abstract: BACKGROUND
  Achieving complete cytoreduction of peritoneal surface malignancies (PSM) can be challenging. In most cases, delivery of heated intra-peritoneal chemotherapy (HIPEC) is straightforward. However, using the closed technique in some cases may be technically challenging; for example, in patients requiring abdominal closure using a large synthetic mesh. In cases where groin hernias are present, it is imperative to resect the hernia sac, since it may contain tumor deposits. In cases with major inguinal involvement where disease may spread out of the hernia sac or in cases where a hernia repair was performed while disease is present, inguinal perfusion should be considered.
  
  
  OBJECTIVE
  To describe our experience with combined intra-peritoneal and inguinal perfusion of HIPEC following cytoreductive surgery.
  
  
  METHODS
  This is a retrospective review of all patients who underwent cytoreductive surgery (CRS) and HIPEC at our institution. A prospectively maintained database containing data of patients treated by CRS and HIPEC (n=122) was reviewed. All patients with macroscopic inguinal involvement by PSM with complete cytoreduction perfused by HIPEC were included.
  
  
  RESULTS
  We identified five cases who underwent CRS and combined intraperitoneal and inguinal perfusion after resection of large inguinal tumor deposits (n=4) or after a recent hernia repair with hernial sac involvement by mucinous adenocarcinoma (n=1). All five patients were successfully perfused using an additional outflow catheter placed in the groin.
  
  
  CONCLUSIONS
  In cases of inguinal involvement by PSM, complete cytoreduction should be achieved and perfusion of the involved groin considered as it is feasible and safe.
authors: 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Yair
authors: Y
authors: Shachar
authors: 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Mohamed
authors: M
authors: Adileh
authors: 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Assaf
authors: A
authors: Keidar
authors: 2. The Department of Anesthesiology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Luminita
authors: L
authors: Eid
authors: 3. The Department of Oncology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Ayalah
authors: A
authors: Hubert
authors: 3. The Department of Oncology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Mark
authors: M
authors: Temper
authors: 3. The Department of Oncology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Salah
authors: S
authors: Azam
authors: 4. The Department of Oncology, Rambam Medical Center, Haifa, Israel;
authors: Alex
authors: A
authors: Beny
authors: 5. The Department of Oncology, Sha'arei Tzedek, Medical Center, Jerusalem, Israel;
authors: Tal
authors: T
authors: Grednader
authors: 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Abed
authors: A
authors: Khalaileh
authors: 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Jonathan B
authors: JB
authors: Yuval
authors: 6. Bon Secours Cancer Institute, Richmond, VA, USA.
authors: Alexander
authors: A
authors: Stojadinovic
authors: 6. Bon Secours Cancer Institute, Richmond, VA, USA.
authors: Itzhak
authors: I
authors: Avital
authors: 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel;
authors: Aviram
authors: A
authors: Nissan
keywords: miR-21; prostate cancer; recurrence