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Peritoneal surface malignancy spread reoperations after cytoreductive surgery + HIPEC.
Summary
Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is effective for peritoneal carcinomatosis. Repeated CRS + HIPEC, second-look operations, and prophylactic HIPEC can improve outcomes, even after disease recurrence.
Area of Science:
- Surgical Oncology
- Medical Oncology
- Gastroenterology
Background:
- Peritoneal malignancies (PM) affect 10-30% of patients with gastrointestinal cancers.
- PM can arise during initial surgery or as metachronous metastases from recurrence.
Purpose of the Study:
- To review factors influencing tumor recurrence after CRS + HIPEC.
- To evaluate the efficacy of repeat CRS + HIPEC, second-look operations, and prophylactic HIPEC.
Main Methods:
- Literature review (PubMed-Medline, last 5 years) and analysis of institutional experience.
- Focus on cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).
Main Results:
- CRS + HIPEC is the standard for pseudomyxoma peritonei and mesothelioma, improving survival in colorectal, ovarian, and primary peritoneal cancers.
- Recurrence rates vary: 25-44% for pseudomyxoma peritonei, 40-82% for mesothelioma and colorectal cancer.
- Repeated CRS + HIPEC, second-look operations, and prophylactic HIPEC show potential benefits.
Conclusions:
- CRS + HIPEC offers effective treatment for peritoneal carcinomatosis, including recurrent disease.
- Second-look operations and prophylactic HIPEC may enhance prognosis following complete tumor removal (R0 resection).
