Selection of patients and staging of peritoneal surface malignancies

Abstract

Peritoneal carcinomatosis (PC) is a common evolution of cancer of the gastrointestinal tract, and has been traditionally regarded as a terminal disease with short median survival. During the last 20 years, thanks to its favourable oncologic results, a new loco-regional therapeutic approach, combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), has an important development. Due to its significant, but acceptable, morbidity and mortality, and high cost, this comprehensive management plan requires knowledgeable patient selection. Quantitative prognostic indicators are required to assess a patient's eligibility. Large multicenter studies have identified several prognostic factors, which can be used for a better selection of patients who would benefit from the combination of cytoreductive surgery with HIPEC.

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

“…Together, these trials as well as several systematic reviews of the literature indicate that i) cytoreduction in combination with HIPEC prolongs median survival of patients with CRC and peritoneal carcinomatosis up to 29 months and the 5-year survival rates up to 19%; ii) survival rates are even higher if the patients undergo complete surgical cytoreduction (median survival 28-60 months, and 5-year survival 22-49%); and iii) the overall treatment-associated morbidity and mortality rates are relatively high (23-44% and 0-12%, respectively) [90,91,92]. The success of this treatment strategy substantially depends on a careful patient selection [85,93]. Candidates should be younger than 70 years with a physiological age of less than 65 years.…”

“…Candidates should be younger than 70 years with a physiological age of less than 65 years. Severe cardiorespiratory disease, renal failure, untreated malignant neoplasm or a World Health Organization Index > 2 are considered contraindications for cytoreduction + HIPEC [93]. Furthermore, all patients selected for cytoreduction with curative intent should not present with progressive disease while on chemotherapy.…”

Cytoreductive Surgery and Peritonectomy Procedures

“…2 or more sites of segmental small bowel obstruction, patients requiring a total gastrectomy with a total colectomy & Involvement of pancreas head, bladder triagone, porta hepatis. & Massive or diffuse involvement of pleural space [49] Technique of CRS and HIPEC…”

Role of Imaging in Peritoneal Surface Malignancies

“…& Massive or diffuse involvement of pleural space. [84] In peritoneal mesothelioma, there are 2 crucial sites of disease involvement which preclude a complete CRS. Large tumours in the epigastric region may preclude a lesser omentectomy because of involvement of the right or left gastric vascular arcade.…”