Management of peritoneal metastases - Basic concepts.

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Cytoreductive surgery (CRS) combined with hyperthermic perioperative chemotherapy (HIPEC) is a complex treatment for peritoneal metastases.
• Optimal implementation requires careful consideration of patient, methodologic, and pharmacologic variables.

Purpose of the Study:

• To outline principles for optimizing the management of peritoneal metastases using CRS and HIPEC.
• To emphasize the integration of various chemotherapy strategies for sustained response.

Main Methods:

• Focus on achieving complete cytoreduction through surgical techniques like peritonectomy and visceral resections.
• Mechanical removal of cancer cells via irrigation prior to HIPEC.
• Utilizing chemotherapy to eradicate residual disease post-cytoreduction.

Main Results:

• Complete cytoreduction is crucial, with benefits maximized at a low peritoneal cancer index (PCI).
• Current perioperative chemotherapy often fails to maintain surgical response in high-grade peritoneal metastases.
• Modified chemotherapy regimens including HIPEC, EPIC, and long-term NIPEC are essential.

Conclusions:

• A comprehensive management strategy integrating surgical and chemotherapeutic principles is vital for treating peritoneal metastases.
• Long-term NIPEC is important for preserving surgical complete response.
• Optimized perioperative chemotherapy, including HIPEC, EPIC, and NIPEC, is key to improving treatment for gastrointestinal and gynecologic malignancies with peritoneal spread.