Peritoneal Surface Malignancy: Introduction

I. Introduction II.Principles of Management III. Current Methodologies for Delivery of Intraperitoneal Chemotherapy
IV. Clinical Results of Treatment V. Ethical Considerations in Clinical Studies with Peritoneal Surface Malignancy VI. References

I. Introduction

As surgical oncology evolved in the midst of a technological revolution in patient care, this discipline expanded from the resection of primary tumor to include the surgical management of metastatic disease. For gastrointestinal cancer, the earliest success with this new concept was with complete resection of locally recurrent colon and rectal cancer.^(1,2) Then the resection of liver metastases from the same disease was shown to be of benefit to a selected group of patients.⁽³⁾ Extension of the concept of complete eradication of metastatic disease to bring about long-term survival to patients with peritoneal surface malignancy has been pioneered by our group.⁽⁴⁾ The clinical pathways for treatment of a wide variety of abdominal and pelvic malignancies that disseminate to peritoneal surfaces has grown out of extensive experience with appendix cancer. Appendix cancer is the paradigm for successful treatment of peritoneal carcinomatosis.⁽⁵⁾ This review presents the background, the standardized treatments currently in use, and the results of treatment of peritoneal surface malignancy. The selection factors leading to long-term survival with acceptable morbidity and mortality will be a central focus for this work. The peritoneal surface malignancies to be discussed include appendix cancer and pseudomyxoma peritonei, colon cancer with peritoneal carcinomatosis, gastric cancer with peritoneal carcinomatosis, abdominopelvic sarcoma with sarcomatosis, and primary peritoneal surface malignancy including peritoneal mesothelioma, papillary serous cancer, and primary peritoneal adenocarcinoma. A discussion regarding the palliation of debilitating ascites is included.