@phdthesis{6374705a-e9a8-4cfb-b6a1-140c695b2a26,
  abstract     = {{Background: Peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is a metastatic condition associated with poor prognosis. Tumor dissemination within the peritoneal cavity is influenced by inflammatory responses, immune activation, and tumor-matrix interactions, particularly following surgical trauma. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment in selected patients, yet recurrence and postoperative morbidity remain major challenges. <br/><br/>Aim: This thesis aimed to investigate cellular mechanisms involved in peritoneal tumor establishment and to evaluate clinical outcomes and complications related to CRS and HIPEC.<br/><br/>Methods: This thesis comprises four studies. One preclinical study used an experimental murine model to examine chemokine signaling and integrin-mediated adhesion in PC following surgical trauma using functional assays, in vivo experiments, and flow cytometry. Three clinical studies used retrospective institutional cohorts and population-based registry data to evaluate oncological outcomes, learning curve, postoperative complications, and preventive strategies.<br/><br/>Results: Experimental studies demonstrated that CXCR2 and αV integrin signaling promote peritoneal tumor adhesion and metastasis after surgical trauma. Clinically, CRS and HIPEC were implemented in a medium-volume center with outcomes comparable to high-volume institutions. Prophylactic sodium thiosulfate (ST) was associated with reduced incidence and severity of acute kidney injury (AKI) following Oxaliplatin-based HIPEC. Adjuvant chemotherapy did not reduce the risk of metachronous peritoneal metastases in patients with radically resected nodenegative T4 colon cancer.<br/><br/>Conclusions: Peritoneal dissemination of CRC is driven by defined cellular mechanisms and is influenced by surgical intervention. CRS and HIPEC can be implemented in a medium-volume center with outcomes comparable to highvolume institutions, without increased morbidity. Prophylactic ST reduces AKI after Oxaliplatin-based HIPEC. Adjuvant chemotherapy does not prevent metachronous peritoneal metastases after radical resection of node-negative T4 colon cancer.}},
  author       = {{Algethami, Nader}},
  isbn         = {{978-91-8021-831-3}},
  issn         = {{1652-8220}},
  keywords     = {{cytoreductive surgery; Hyperthermic intraperiotneal chemotherapy; peritoneal carcinomatosis; CXCR2; Chemokine; learning curve; postoperative complications; acute kidney injury; sodium thiosulfate; adjuvant chemotherapy; colon cancer}},
  language     = {{eng}},
  number       = {{2026:33}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Cellular Response and Clinical Aspects of Peritoneal Carcinomatosis for Colorectal Cancer Patients}},
  url          = {{https://lup.lub.lu.se/search/files/242664389/Avhandling_Nader_Algethami_LUCRIS.pdf}},
  year         = {{2026}},
}