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Title Page | Introduction | Principles of Intraperitoneal Chemotherapy | Current Indications for Cytoreductive Surgery and Intraperitoneal Chemotherapy
Heated Intraoperative Intraperitoneal Chemotherapy by the Coliseum Technique
Immediate Postoperative Abdominal Lavage in Preparation for Early Postoperative Intraperitoneal 5-Fluorouracil
Early Postoperative Intraperitoneal Chemotherapy for Adenocarcinoma | Induction Intraperitoneal Chemotherapy for Debilitating Ascites
Cytoreductive Surgery for Peritoneal Surgacy Malignancy - Pertitonectomy Procedures | Results of Treatment of Peritoneal Surface Malignancy
Conclusions | References

INTRODUCTION

Most cancers that occur within the abdomen or pelvis will disseminate by three different routes. These are: hematogenous metastases, lymphatic metastases, and implants on peritoneal surfaces. In a substantial number of patients, surgical treatment failure that is isolated to the resection site or to peritoneal surfaces may occur. If this is true, elimination of peritoneal surface spread may have an impact on the survival of these cancer patients in whom a prominent cause of death is peritoneal carcinomatosis or sarcomatosis. Prior to the use of intraperitoneal chemotherapy, these conditions were uniformly fatal, eventually resulting in intestinal obstruction over the course of months or years. Occasionally, patients with low-grade malignancies survived long-term, but all end results reporting shows a fatal outcome with progression of intraabdominal cancer.

We have devised techniques that allow the administration of intraperitoneal chemotherapy as an integrated part of a surgical procedure for cancer. This approach involves two conceptual changes in chemotherapy administration. Both the route and timing of chemotherapy administration are changed. The intraperitoneal route assures a high concentration of anticancer therapy at the peritoneal surfaces. The perioperative timing has several advantages. With intraoperative chemotherapy the surgeon will manually manipulate the peritoneal surfaces to uniformly distribute heat and drugs. With early postoperative intraperitoneal chemotherapy the abdominal lavage occurs before wound healing causes adhesions and utilizes a large volume of fluid to contact a majority of the peritoneal surface and irrigate away any old blood or fibrinous debris. The chemotherapy administration is performed so that all of the malignancy except microscopic residual disease is removed surgically before the chemotherapy treatments. This means that the limited penetration of chemotherapy, approximately 1mm into tissues will be adequate to eradicate all tumor cells. Finally, the chemotherapy will be use prior to the construction of any anastomoses, which means that suture line recurrences should also be eliminated.

This manual is designed to acquaint the physician and nurse with methods for treatment and prevention peritoneal carcinomatosis and sarcomatosis developed over the last 15 years.