Laparoscopic intraperitoneal chemohyperthermia (IPCH) for gastrointestinal malignancies: indications and results

Combining cytoreductive surgery (CRS) and intraperitoneal chemohyperthermia (IPCH) is the most promising new treatment for peritoneal carcinomatosis (PC) from colorectal cancer or from gastric cancer. It is not indicated for all patients with PC, and the results achieved by international experts in this field might not be replicated in routine clinical practice. Patients with good performance status, a low volume of peritoneal disease, and no extra-abdominal metastases are more likely to benefit from the combined treatment. Disease extent should be assessed at the time of the primary cancer operation, so that IPCH as an adjuvant treatment for appropriately selected patients can be administered. In this setting, laparoscopy could be interesting. Repeat CRS and IPCH in patients with diffuse peritoneal recurrence should be approached with caution and may be indicated only with effective second-line intraperitoneal chemotherapies. Finally, in some cases of intractable ascitis, patients who are not candidates for CRS, could be treated by merely palliative laparoscopic IPCH. A high level of training, expertise, and infrastructure is needed to optimize safety for both staff and patient. Therefore, concentrating services in a center with experience is likely to increase quality of care for these patients.