title: Indication of peritonectomy for peritoneal dissemination.
abstract: A total of 521 patients with peritoneal carcinomatosis (PC) were treated by peritonectomy and perioperative chemotherapy. Each of the 95, 58, 316, 31, 10 and 11 patients were from gastric, colorectal, appendiceal, ovarian, small bowel cancer and mesothelioma, respectively. The distribution and volume of PC are recorded by the Sugarbaker peritoneal carcinomatosis index (PCI). Peritonectomy was performed with a radical resection of the primary tumor and all gross PC with involved organs, peritoneum, or tissue that was deemed technically feasible and safe for the patient. The postoperative major complication of grade 3 was found in 14%, and total 30-day mortality was 2.7%. The survival of gastric cancer patients with a PCI score ≤ 6 was significantly better than those with a PCI score ≥ 7. In appendiceal neoplasm, patients with PCI score less than 28 showed significantly better survival than those with PCI score greater than 29. The survival of colorectal cancer patients with a PCI score ≥ 11 was significantly poorer than those with a PCI score ≤ 10. Among the various prognostic factors in appendiceal neoplasm and gastric cancer patients, CC-0 complete cytoreduction was the most important independent prognostic factor. Peritonectomy is done to remove macroscopic disease and perioperative intraperitoneal chemotherapy to eradicate microscopic residual disease aiming to remove disease completely with a single procedure. Peritonectomy combined with perioperative chemotherapy may achieve long-term survival in a selected group of patients with PC. The higher mortality rate underlines this necessarily strict selection that should be reserved to experienced institutions.
authors.affiliation: NPO Organization to Support Peritoneal Dissemination Treatment.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yonemura
authors.forename: Goro
authors.initials: G
authors.lastname: Tsukiyama
authors.forename: Ryuwa
authors.initials: R
authors.lastname: Miyata
authors.forename: Souzou
authors.initials: S
authors.lastname: Sako
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Endou
authors.forename: Masamitu
authors.initials: M
authors.lastname: Hirano
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Mizumoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsuda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takao
authors.forename: Masumi
authors.initials: M
authors.lastname: Ichinose
authors.forename: Masahiro
authors.initials: M
authors.lastname: Miura
authors.forename: Akeo
authors.initials: A
authors.lastname: Hagiwara
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
mesh_terms: D000368:Aged; D001063:Appendiceal Neoplasms / Q000188:drug therapy / Q000601:surgery; D002277:Carcinoma / Q000188:drug therapy / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome