Cytoreduction and intraperitoneal chemotherapy for the management of peritoneal carcinomatosis, sarcomatosis and mesothelioma

• Published in: European journal of surgical oncology Vol. 28; no. 1; pp. 80 - 87
• Main Authors: Begossi, G, Gonzalez-Moreno, S, Ortega-Perez, G, Fon, L.J, Sugarbaker, P.H
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.02.2002; Elsevier
• Subjects: 5-fluorouracil; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biological and medical sciences; cancer seeding; Carcinoma - drug therapy; Carcinoma - surgery; Cholecystectomy - methods; Colectomy - methods; Combined Modality Therapy; Electrosurgery; Gastroenterology. Liver. Pancreas. Abdomen; Humans; hyperthemia; Hyperthermia, Induced; intraperitoneal chemotherapy; Medical sciences; Mesothelioma - drug therapy; Mesothelioma - surgery; mitomycin C; Peritoneal Lavage; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - surgery; Peritoneum - surgery; Postoperative Complications; Reoperation; Sarcoma - drug therapy; Sarcoma - surgery; Splenectomy - methods; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; surgical oncology; Tumors; 5-fluorouracil; mitomycin C; electrosurgery; intraperitoneal chemotherapy; hyperthemia; cancer seeding; surgical oncology; Antineoplastic agent; Human; Intraperitoneal administration; Carcinosis; Mesothelioma; Electrosurgery; Malignant tumor; Gastrointestinal; Chemotherapy; Treatment; Surgery; Digestive diseases; Intestinal disease; Complication; Evolution; Technique; Therapeutic protocol; Hyperthermia; Gastric disease
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1053/ejso.2001.1152

Despite new developments in multi-modality treatments, complete resection remains as an absolute requirement for cure of gastrointestinal cancer. We have reported benefits from combined treatment with complete cytoreduction and intraperitoneal chemotherapy. This has been achieved with low morbidity and mortality. Success in the surgical management of peritoneal surface malignancy depends on the surgeon's ability to complete complex cytoreductive procedures so that only microscopic residual disease remains. This paper describes the current strategy that the surgical oncologist should pursue in the treatment of patients with peritoneal carcinomatosis, sarcomatosis and mesothelioma. Technical details required for this surgery include patient position, incision and exposure, complete lysis of adhesion, electroevaporative dissection with irrigation and suction to preserve the translucent quality of tissues, peritonectomy procedures, proper positioning of tubes and drains for intraperitoneal chemotherapy, and reconstructive surgery. Understanding the treatment and mastery of surgical skills to manage the peritoneal surface spread of cancer has led to long-term survival of selected patients. Combination of this treatment strategy with proper patient selection has reduced the mortality and morbidity. The success of cytoreductive surgery and perioperative intraperitoneal chemotherapy depends on a long-term dedication to achieve the full potential of a curative outcome. Our unit has continued to achieve good results over two decades as improved results of treatment have evolved.