Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin-C in patients with peritoneal carcinomatosis of colorectal origin

Pharmacologic rationale for treatments of peritoneal surface malignancy from colorectal cancer

“…In colorectal cancer with PC, overall survival rates between 25% and 47% are reported [12][13][14][15][16][17] . These reports, from many different institutions, stand in strong contrast with historical control groups and patients treated with systemic chemotherapy, where the mean and median overall survival were 6.0 and 3.1 mo, respectively [4] .…”

“…The cytoreduction needs to resect all tumor deposits greater than 1-2 mm for the subsequent intraperitoneal chemotherapy to be effective. Clinical data to support this pharmacologic prediction is strong; in univariate and multivariate analysis, complete cytoreduction (cancer nodules ≤ 2.5 mm) is the single most important prognostic factor [15][16][17][18][19] . To describe the pharmacology of both intravenous and intraperitoneal chemotherapy used after cytoreduction to treat PC, a revised theoretical model is needed.…”

Abdominal Advanced Oncologic Surgery

“…Results are encouraging with a 5-ys-OS ranging from 62.5 to 100% for low grade PMP and from 0 to 65% for high grade disease . This differentiation is crucial for the evolution of disease; low grade tumours are slow growing and indolent differently from those high grade, fast growing and aggressive (Sugarbaker and Chang, 1999;Witkamp et al, 2001;Güner et al, 2005;Moran et al, 2008;Moran and Cecil, 2003;Murphy et al, 2007;Baratti et al, 2008;Elias et al, 2008;Loungnarath et al, 2005;Smeenk et al, 2007;Stewart et al, 2005;Yan et al, 2006). The goal of the surgical cytoreduction is to remove all the visible tumor by the following procedures: right subdiaphragmatic and parietal peritonectomy, left subdiaphragmatic and parietal peritonectomy,greater omentectomy with splenectomy, lesser omentectomy and stripping of the omental bursa, andpelvic peritonectomy with salpingo-oophorectomy in women.…”

Peritoneal carcinomatosis of colorectal origin: is it really an end-stage disease?

“…There is mounting evidence for a local spread theory [1]. Peritoneal tumor implantation occurs due to multiple mechanisms including serosal invasion, leakage of malignant cells through the lymphatics, or as a result of imprudent dissection [2].…”