Peritonectomy procedures
and multivisceral exeresis. 
Sugarbaker's Technique.






8.00    Distribution of course documents

8.15    Welcome
          Dr. Jordi Colomer, Ex-Managing Director of the Santa Creu i Sant Pau Hospital of Barcelona
          Dr. Jordi Mauri, Chairman of the Integrated Health Consortium
          Dra. Maria Rotllan, Director of Care for the Integrated Health Consortium
          Dr. Pedro Barrios, Chairman of the Organising Committee

9.00    Keynote speech.
          Peritonectomy procedures: basic principles and technical description.
           VideoChecklist for complete cytoreductive surgery (20´)
           Current and future role of CRS in oncological surgery (20´)
           Discussion (5')
           Paul Sugarbaker

9.45    Current indications and results of CRS (+ HIPEC) in pseudomyxoma peritonei (20´). 
           Discussion 10’
           Jesús Esquivel 

10.15  Video session 1.  CRS in pseudomyxoma peritonei (PP).

           VS 1.1. Unification of peritonectomy procedures in two anatomical abdominal cavities: peritonectomy of the lower
           hemiabdomen, peritonectomy of the upper hemiabdomen
           VS 1.2. CRS in two surgical stages
           1st stage: CRS of upper left quadrant, lower hemiabdomen, extensive intestinal resection
           2nd stage: CRS of upper right quadrant. Total gastrectomy
           VS 1.3. Maximum tumour debulking
           CRS of lower hemiabdomen and upper left quadrant, intestinal resection. Residual tumour upper right quadrant
           VS 1.4. Maximum tumour debulking for PMP peritonitis
           CRS in all abdominal areas. Residual tumour in region II. Digestive reconstruction: ileocolic and ileorectal        

11.30 to 12:00 COFFEE BREAK                                                                                                         

12:00  Video session 2. CRS + hyperthermic intrathoracic perfusion chemotherapy (HITHOC) for mucinous
           pleuropulmonary disease. Session sponsored by ETHICON

           VS 2.1. Mucinous dissemination through the thoracic and pleuropulmonary  wall
           Exeresis of thoracic wall. Parietal and visceral pleurectomy. HITHOC
           VS 2.2. Pleuropulmonary mucinous dissemination
           Parietal pleurectomy. Atypical pulmonary segmentectomy. HITHOC

12:30  Video session 3. Techniques for digestive tract reconstruction after CRS+HIPEC

           VS 3.1. Oesophageal-Roux-en-Y jejunostomy
           VS 3.2. Oesophageal-jejunal intestinal interposition
           VS 3.3. Mechanically reinforced T-L Ileocolic Anastomosis
           VS 3.4. Manual T-L Ileocolic Anastomosis
           VS 3.5. Mechanically reinforced T-L Ileorectal Anastomosis
           VS 3.6. Ileocolic and colorectal anastomosis and biliopancreatic-intestinal reconstruction after cephalic
           VS 3.7. “True” Mechanically reinforced T-T colorectal anastomosis

13:15  Video session 4. Techniques for the slowing of digestive transit with massive resection of the digestive tract.
           Session sponsored by ARAGÓ 
           VS 4.1. CRS associated with extensive intestinal resection. Interpostioning of an antiperistaltic ileal segment
           between the jejunum and the splenic colon
           VS 4.2. CRS associated with extensive intestinal resection. Interpostioning of an antiperistaltic transverse colon
           segment between the jejunum and the rectum
           VS 4.3. CRS associated with extensive intestinal resection. Interpostioning of antiperistaltic cecum between
           the ileum and rectum

14.00-15.30 WORKING LUNCH                                             


15.30  Current indications and results of CRS (+ HIPEC) in ovarian carcinomatosis (20´). 
           Discussion 10’
           Marcello Deraco
16.00  Video session 5. CRS in ovarian carcinomatosis 

           VS 5.1. Pelvic peritonectomy and lymphadenectomy
           VS 5.2. CRS in ovarian PC. All peritonectomy procedures associated with lymphadenectomy

17. 00  Video session 6. Techniques for the reconstruction of the urinary tract in CRS+HIPEC

           VS 6.1. Direct ureterovesical reimplant
           VS 6.2. Psoas hitch ureteral implant
           VS 6.3. Partial cystectomy associated with segmental ureteral resection. Mobilisation of the renal pelvis
           and T-T uretero-ureteral anastomosis
           VS 6.4. Segmental ureteral replacement with appendiceal plasty (uretero-appendix-ureteral interpositioning)
           VS 6.5. Segmental ureteral replacement with tubular vesical plasty
           VS 6.6. Vesical augmentation with cecum plasty
           VS 6.7. Double ureteral diversion to colostomy
           VS 6.8. Ureteral diversion to defunctionalised ileal ansa (Bricker)

18.00-18.30  COFFEE BREAK 

18.30  Current indications and results of CRS (+ HIPEC) in carcinomatosis of gastric origin. (15´)
           Discussion (10’)
           Pedro Barrios

18.45  Video session 7. CRS in carcinomatosis of gastric origin

           VS 7.1. CRS in synchronous gastric PC. Total gastrectomy. Transverse colectomy. Parietal peritonectomies
           VS 7.2. CRS in metachronous gastric PC. Total degastrogastrectomy. Hysterosalpingo-oophorectomy.
           Douglasectomy. Parietal peritonectomies

19.15  Role of the anaesthetist in CRS + HIPEC (15’).
           Elisenda Pujol

19.30  Preparation and application of HIPEC and HITHOC: open technique.
           Video (20´)
           Carmen Roldán




8.00    Sectorization of complex oncological surgery in Catalonia (20´)
           Josep M. Borrás

8:30    Clinical results of the Catalan Programme for Peritoneal Carcinomatosis. Hospital Moisès Broggi. 
           10 years: 1,200 CRS (700 of which associated with HIPEC). (20´)
           Pedro Barrios

9.00    Current indications and results of CRS (+ HIPEC) in colorectal carcinomatosis. (20´). 
           Discussion (10’)
           Pompiliu Piso

9:30    Video session 8. CRS in colorectal and appendiceal (not PP) carcinomatosis

           VS 8.1. CRS associated with extensive intestinal resection, mesenteric lymphadenectomy and nephrectomy.
           VS 8.2. CRS associated with urinary tract repair and hepatic RDF
           VS 8.3. CRS associated with extended pelvic peritonectomy and diaphragmatic resection
           VS 8.4. CRS for synchronous PC of the colon associated with endoluminal prosthesis
           VS 8.5. CRS for multi-occlusive PC of the colon
           VS 8.6. CRS for PC of the colon with localised septic focus

10.30    Surgical management of  Desmoplastic Small Round Cell Tumours in children and young adults.
           Video: Pelvic Cytoreduction and Peritonectomy in Large Pelvic Tumours: Focus on Desmoplastic
           Small Round Cell Tumour
           Andrea Hayes-Jordan

11.00-11.30 COFFEE BREAK 

11.30  Current indications and results of CRS (+ HIPEC) in malignant peritoneal mesothelioma. (20´). 
           Discussion (10’)
           Marcello Deraco

12.00  Video session 9. CRS in malignant peritoneal mesothelioma

           VS 9.1. CRS in epithelioid malignant mesothelioma. Procedures for parietal peritonectomy.
           VS 9.2. CRS in multicystic mesothelioma. Procedures for parietal peritonectomy.
           VS 9.3. Mesenteric peritonectomy

12:45  Video session 10. Techniques for the repair of defects of the wall and of the pelvic floor

           VS 10.1. CRS with extensive exeresis of the abdominal wall
           VS 10.2. Abdominal bipartition with rectus abdominis muscle
           VS 10.3. Repair of pelvic defect after total exenteration with complete plasty of the rectus abdominis muscle
           VS 10.4 Perineal gracilis muscle fill
           VS 10.5 Epiploplasty techniques
           VS 10.6. CRS in multifistulated necrotic tumour with complete digestive reconstruction and abdominal-pelvic
           bipartition with a mesenteric flap and epipoplasty.

13.30  Laparoscopy and peritoneal carcinomatosis. Videos
           Oriol Crusellas

14.00-15.00 WORKING LUNCH 


15.00  Current indications and results of CRS (+ HIPEC) in rare tumours (20´). 
            Discussion 10’
            Isabel Ramos

15:30  Video session 11. CRS in rare tumours

            VS 11.1. CRS in PC from mucinous endocervical tumour. All peritonectomy procedures.
            VS 11.2. CRS in PC from neuroendocrine tumour of the small intestine. All peritonectomy procedures,
            resection of the small intestine, partial diaphragmatic resection. Bicameral hyperthermic chemotherapy: 
            intraperitoneal (HIPEC) and thoracic (HITHOC)
            VS 11.3. CRS in peritoneal sarcomatosis (not GIST)

16:15  Video session 12. CRS (+/- HIPEC) for appendiceal mucinous tumours

            VS 12.1 Appendiceal mucinous tumour with extensive peritoneal dissemination (Pompiliu Piso)
            VS 12.2. Infected mucinous cystadenoma of the ovary and associated tumour of the appendix (not mucinous).
            VS 12.3. Broad base perforated mucinous appendiceal tumour associated with localised acellular
            periappendiceal mucin
            VS 12.4. Perforated mucinous appendiceal tumour associated with pelvic acellular mucin (woman)
            VS 12.5. Perforated mucinous appendiceal tumour associated with mucin in the abdominal cavity
            VS 12.6. Surgical treatment of an appendiceal mucocele

16:45  Panel Session 1. Recommendations to the general surgeon regarding the management of epithelial
            appendiceal tumours (20´).
           Moderator: Pedro Barrios
           Panel members: Paul Sugarbaker, Marcello Deraco, Pompiliu Piso and Isabel Ramos

17:30-18.00 COFFEE BREAK 

18:00  Panel Session 2. Recommendations to the general/gynaecological surgeon concerning the surgical strategy
           to be adopted on unexpectedly finding peritoneal carcinomatosis in mid-operation. (30’)
            Moderator: Pedro Barrios
            Panel members: Paul Sugarbaker, Marcello Deraco, Pompiliu Piso  and Isabel Ramos

18:35  Discussion and final conclusions 
            Paul Sugarbaker / Marcello Deraco / Pedro Barrios