Peritoneal carcinomatosis 2011; it's about time for chemosurgery
J D Spiliotis1, E A Halkia, E Efstathiou
1; Metaxa Cancer Hospital, Piraeus, Greece. jspil@in.gr
Summary
Cytoreductive surgery combined with hyperthermic intraoperative intraperitoneal chemotherapy offers a new standard of care for peritoneal carcinomatosis (PC). This aggressive approach improves outcomes for select patients with specific cancers, moving beyond palliative options.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Peritoneal carcinomatosis (PC) traditionally has a poor prognosis, with systemic chemotherapy offering limited palliative benefit and median survival under 6 months.
- Peritoneal surface malignancies were historically considered end-stage, managed solely with palliative systemic chemotherapy.
- Current management paradigms are shifting away from purely palliative approaches for PC.
Purpose of the Study:
- To review the current management strategies for peritoneal carcinomatosis (PC) originating from various primary cancers.
- To highlight the emerging role of cytoreductive surgery (CRS) combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in treating PC.
- To discuss the evolving consensus and future directions in PC management.
Main Methods:
- Review of existing literature and phase III studies on the combined CRS and HIPEC approach for PC.
- Analysis of treatment outcomes in well-selected patients achieving sufficient cytoreduction.
- Synthesis of current global consensus among surgical teams regarding this combined strategy.
Main Results:
- The combination of CRS and HIPEC represents a novel treatment concept for PC, aiming to eliminate microscopic residual disease.
- Phase III studies support the efficacy of CRS + HIPEC in selected PC patients where adequate cytoreduction is feasible.
- A growing international consensus recognizes CRS + HIPEC as a standard of care for specific PC types, including pseudomyxoma peritonei, peritoneal mesothelioma, and colorectal cancer.
Conclusions:
- The combination of aggressive cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy is a promising treatment for peritoneal carcinomatosis.
- While further high-quality phase III studies are needed, this combined modality is increasingly accepted as a standard of care for specific malignancies.
- This approach offers a more effective alternative to traditional palliative chemotherapy for select patients with peritoneal carcinomatosis.
