Peritoneal carcinomatosis 2011; it's about time for chemosurgery

The aim of this article was to offer a review on the management of peritoneal carcinomatosis (PC) from cancers of different primary origins. Peritoneal surface malignancies have been traditionally regarded as end-stage conditions amenable to merely palliative options, treated with systemic chemotherapy alone with very poor response and a median survival of less than 6 months. The combination of aggressive cytoreductive surgery (CRS), involving peritonectomy procedures and multivisceral resections with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) to treat microscopic residual disease is a new concept. This method was established with several phase III studies in well selected patients with PC in whom sufficient cytoreduction could be achieved. Despite the need for more high quality phase III studies, there is now a consensus among many surgical teams around the world about the use of this new combination strategy as a standard of care in pseudomyxoma peritonei, peritoneal mesothelioma and colorectal cancer patients. This review summarizes the current status and possible progress in the future.