Pelvic peritonectomy without intraperitoneal chemotherapy for localized peritoneal carcinomatosis

This study assessed the feasibility of pelvic peritonectomy for carcinomatosis localized in the pelvic cavity. The survival and clinical benefits were examined, especially in colorectal cancer.

Seventeen patients underwent pelvic peritoneal resection for peritoneal dissemination localized in the pelvis (10 colorectal, six ovarian, one cervical cancer). The male/female ratio was 5/12. The age range was 31-83 (median=63) years. The peritoneal cancer index was 2-16 (median=4). Perioperative intraperitoneal chemotherapy was not performed.

For all 17 cases, pelvic exenteration significantly increased invasiveness in the treatment of pelvic peritoneal carcinomatosis (p<0.05). Additionally, pelvic exenteration did not improve prognosis. In all cases, the serum carcinoembryonic antigen (CEA) levels decreased significantly from a mean of 15.1 (range=0.8-55.7) to 2.4 (range= 0.5-7.4) ng/ml (paired t-test, p<0.05). For colorectal cancer, serum CEA decreased significantly from 19.3 (range=1.2-55.7) to 2.7 (range=0.5-7.4) ng/ml (paired t-test, p<0.05). In the colorectal cancer series, cumulative 1- and 3-year overall survival rates were 89% and 71%, respectively. One- and 3-year recurrence-free survival rates were 78% and 67%, respectively.

The cytoreductive effect of this method is feasible and excellent for pelvic carcinomatosis. Pelvic peritonectomy without perioperative intraperitoneal chemotherapy is a safe, effective procedure for peritoneal carcinomatosis from colorectal cancer localized in the pelvis.