Joannie Neveu

Developing a hyperthermic intraperitoneal chemotherapy (HIPEC) gynecologic oncology program: a Canadian experience

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for epithelial ovarian cancer following cytoreductive surgery. The intraperitoneal spread of the disease makes the peritoneal cavity an ideal target for drug delivery. HIPEC has shown promising results in improving overall survival in epithelial ovarian cancer patients when performed during interval cytoreductive surgery. Recent studies have provided level 1 evidence supporting increased overall survival in stage III ovarian cancer patients treated with HIPEC during interval cytoreduction. Meta-analyses have further confirmed the survival improvement in women receiving HIPEC. Despite its inclusion in guidelines, many centers have been hesitant to implement HIPEC programs due to perceived obstacles, such as increased morbidity, cost, and resource requirements. Studies have shown that morbidity rates are acceptable in selected patients, and the addition of HIPEC to cytoreductive surgery is cost effective. Therefore, the main barrier to implementing HIPEC programs is related to resource requirements and logistics, but with proper preparation, these challenges can be overcome. Establishing a successful HIPEC program requires institutional support, a knowledgeable and dedicated team, adequate resources and equipment, and proper training and audit. This review aims to provide evidence based information to guide the development of successful HIPEC programs, including preoperative, anesthetic, and surgical considerations. It also reviews the different equipment and protocols for the perfusion and common postoperative events.

Laparoscopic bariatric surgery with hysterectomy for endometrial cancer to improve long-term outcomes: A review article

Endometrial cancer is the most common gynecologic malignant disease in Canada, and women with an elevated body mass index carry an increased lifetime risk of developing this disease. As rates of obesity have risen, the rates of endometrial cancer have seen a similar rise. Given this association, women diagnosed with endometrial cancer often suffer from several obesity-related co-morbidities, including type 2 diabetes, hypertension, and cardiovascular disease. Studies have suggested that women with early-stage endometrial cancer have a higher potential to die of obesity-related complications than recurrence and that weight reduction would be beneficial for these patients to improve quality-of-life and long-term obesity-related morbidity and mortality. Bariatric surgery is currently the only treatment modality to result in sustained long-term weight loss for this cohort of patients. Early evidence has suggested that combining bariatric surgery with total laparoscopic hysterectomy may improve the underlying metabolic disease, the patients' quality of life, and the long-term obesity-related morbidity and mortality. Additionally, the inclusion of bariatric surgery in treatment of patients with obesity and endometrial cancer may decrease the projected lifetime health care cost when compared to hysterectomy alone. This narrative review aims to examine the evidence surrounding endometrial cancer and its link to obesity. Further, we hope to explore current treatments for the aforementioned conditions and the possible benefits and feasibility of a combined intervention of vertical sleeve gastrectomy and total laparoscopic hysterectomy for patients with obesity and endometrial cancer.