Peritoneal surface oncology: review of a personal experience with colorectal and appendiceal malignancy

Abstract

Peritoneal surface malignancy usually results from implantation of gastrointestinal cancer. In the past, this clinical situation was treated with palliative intent. A definitive approach to peritoneal surface malignancy involves peritonectomy procedures, visceral resections, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The quantitative prognostic indicators necessary for valid clinical judgements include the cancer histopathology (invasive vs. expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment. In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 45% with selected patients. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit. The definitive prognostic indicator was the complete cytoreduction. Oncologists must seek new knowledge regarding the management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in large phase II studies; in contrast all historical controls show 0% long-term survival. Additional adjuvant phase III studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.

Factors influencing outcome after surgery for stage IV colorectal cancer

“…However, aggressive surgery, including subtotal peritonectomy, has been reported to improve survival, 9,10 although complete resection of the tumor is necessary. 9 Therefore, appropriate patient selection is important to achieve a survival benefi t. 11 To evaluate the grade of peritoneal dissemination of CRC, Sugarbaker 9 used the Peritoneal Cancer Index, which incorporates the size of the lesion and the distribution of metastases. Patients with a relatively low Peritoneal Cancer Index had signifi cantly better survival after surgery than patients with a higher Peritoneal Cancer Index.…”

Guidelines on the Use of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Surface Malignancy Arising from Colorectal or Appendiceal Neoplasms

“…Outcomes that should be measured include complications 79,80 , overall survival 2,11,28,44,57,62,69,[82][83][84][85] , disease-free survival, quality of life 86,87 , and costeffectiveness 88 .…”

Postoperative Infections in Cytoreductive Surgery With Hyperthermic Intraperitoneal Intraoperative Chemotherapy for Peritoneal Carcinomatosis

“…Appendiceal tumors with peritoneal seeding are the paradigm for success of this surgical procedure with an 85% long-term survival in selected patients [6]; for patients affected by colorectal cancer and treated with complete cytoreduction the median survival reaches 32.4 months and the 5-year survival rate is 31% [11].…”

“…Peritonectomy treatment of carcinomatosis from colon cancer has now an overall 5-year survival of 45% with selective patients [6].…”

“…Because of the encouraging results of this new combined procedure in terms of long-term survival [6][7][8][9][10][11][12], in the last years there has been a renewed interest in the surgical treatment of peritoneal carcinomatosis. Appendiceal tumors with peritoneal seeding are the paradigm for success of this surgical procedure with an 85% long-term survival in selected patients [6]; for patients affected by colorectal cancer and treated with complete cytoreduction the median survival reaches 32.4 months and the 5-year survival rate is 31% [11].…”