Treatment of peritoneal carcinomatosis with intent to cure.
OBJECTIVE
Low-grade malignant tumors arise in the abdomen, do not infiltrate, and "redistribute" on the peritoneum with no extraregional spreading. In these cases, aggressive surgery combined with localized chemotherapy may provide cure.


METHODS
After removing the tumor with the regional peritoneum en bloc, intraabdominal hyperthermic chemoperfusion was performed throughout the abdominopelvic cavity. Alternatively, early intraabdominal chemotherapy, starting on the first postoperative day, was administered for 5 days.


RESULTS
Forty patients affected with extensive peritoneal carcinomatosis underwent peritonectomy, with no residual macroscopic disease except in four cases. Seventy-five percent of the patients underwent locoregional chemotherapy. Major complications were observed in 40% of the patients and led to death in five; there was a direct correlation to the duration of surgery (P = 0.03). At a mean follow-up of 20 months, the overall 2-year survival was 61.4%, with a median survival of 30 months.


CONCLUSIONS
After a learning curve of 18 months, the feasibility of the integrated treatment increased to greater than 90%, and mortality dramatically decreased. The combined treatment resulted in a high survival rate in patients with extensive carcinomatosis who were no longer responsive to traditional therapies.
Cavaliere
F
F
First Department of Surgical Oncology, Regina Elena National Cancer Institute, Rome, Italy. cavaliere@crs.ifo.it
Perri
P
P
Di Filippo
F
F
Giannarelli
D
D
Botti
C
C
Cosimelli
M
M
Tedesco
M
M
Principi
F
F
Laurenzi
L
L
Cavaliere
R
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D002945:Cisplatin / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D010051:Ovarian Neoplasms / Q000473:pathology; D010477:Perfusion; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications; D015996:Survival Rate
D016685:Mitomycin; D002945:Cisplatin