title: Peritoneal carcinomatosis of gastrointestinal tumors: where are we now?
abstract: The peritoneal stromal tissue which provides a rich source of growth factors and chemokines is a favorable environment for tumor proliferation. The pathophysiological mechanism of peritoneal carcinomatosis is an individual sequence consisting of genetic and environmental factors and remains controversial. The natural history of the disease reveals a poor median prognosis of approximately 6 mo; however aggressive surgery and multimodal treatment options can improve oncologic outcomes. Considering peritoneal carcinomatosis as though it is a locoregional disease but not a metastatic process, cytoreductive surgery and and intraperitoneal chemotherapy has been a curative option during recent years. Cytoreductive surgery implies a series of visceral resections and peritonectomy procedures. Although the aim of cytoreductive surgery is to eliminate all macroscopic disease, viable tumor cells may remain in the peritoneal cavity. At that point, intraperitoneal chemotherapy can extend the macroscopic disease elimination to microscopic disease elimination. The successful treatment of peritoneal carcinomatosis requires a comprehensive management plan including proper patient selection, complete resection of all visible disease, perioperative intraperitoneal chemotherapy and postoperative systemic chemotherapy. Surgical and oncologic outcomes are strictly associated with extent of the tumor, completeness of cytoreduction and patient-related factors as well as multidisciplinary management and experience of the surgical team. In this review, pathophysiology and current management of peritoneal carcinomatosis originating from gastrointestinal tumors are discussed according to the latest literature.
authors.affiliation: Cem Terzi, Naciye Cigdem Arslan, Aras Emre Canda, Department of Colorectal and Pelvic Surgery, Dokuz Eylul University School of Medicine, Inciraltı, Izmir 35340, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Terzi
authors.affiliation: Cem Terzi, Naciye Cigdem Arslan, Aras Emre Canda, Department of Colorectal and Pelvic Surgery, Dokuz Eylul University School of Medicine, Inciraltı, Izmir 35340, Turkey.
authors.forename: Naciye Cigdem
authors.initials: NC
authors.lastname: Arslan
authors.affiliation: Cem Terzi, Naciye Cigdem Arslan, Aras Emre Canda, Department of Colorectal and Pelvic Surgery, Dokuz Eylul University School of Medicine, Inciraltı, Izmir 35340, Turkey.
authors.forename: Aras Emre
authors.initials: AE
authors.lastname: Canda
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects / Q000401:mortality; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D011183:Postoperative Complications; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Cytoreductive surgery; Gastrointestinal tumors; Intraperitoneal chemotherapy; Oncologic surgery; Peritoneal carcinomatosis