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World J Gastrointest Oncol. 2010 Jan 15;2(1):31-5. doi: 10.4251/wjgo.v2.i1.31.

Selection of patients and staging of peritoneal surface malignancies.

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  • 1Eddy Cotte, Guillaume Passot, François-Noël Gilly, Olivier Glehen, Department of Digestive Surgery, Lyon-Sud Hospital, F-69495 Pierre Bénite Cédex, France; Équipe Accueil 3738, Claude Bernard Lyon 1 University, Lyon-Sud Faculty, BP12, F-69921 Oullins Cédex, France.

Abstract

Peritoneal carcinomatosis (PC) is a common evolution of cancer of the gastrointestinal tract, and has been traditionally regarded as a terminal disease with short median survival. During the last 20 years, thanks to its favourable oncologic results, a new loco-regional therapeutic approach, combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), has an important development. Due to its significant, but acceptable, morbidity and mortality, and high cost, this comprehensive management plan requires knowledgeable patient selection. Quantitative prognostic indicators are required to assess a patient's eligibility. Large multicenter studies have identified several prognostic factors, which can be used for a better selection of patients who would benefit from the combination of cytoreductive surgery with HIPEC. Indications for treatment of PC with cytoreduction and HIPEC are now validated for several diseases: peritoneal mesothelioma, pseudomyxoma peritonei, PC from the appendix, and colorectal cancer. Indications are still under discussion for gastric and ovarian carcinomatosis. Computed tomography is the best radiological for staging the disease. The extent of peritoneal carcinomatosis is, however, difficult to evaluate preoperatively, and precise evaluation is most often performed during surgical exploration. Cytoreductive surgery associated with HIPEC for the treatment of peritoneal carcinomatosis should be performed for young patients with limited and resectable carcinomatosis, in specialized institutions involved in the management of peritoneal surface malignancies.

KEYWORDS:

Performance status; Peritoneal Cancer Index; Peritoneal carcinomatosis; Selection; Staging

PMID:
21160814
[PubMed]
PMCID:
PMC2999158
Free PMC Article

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