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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 April;12(2):87-92
Integrated treatment of peritoneal carcinomatosis
Cavaliere F., Di Filippo F., Consolo S., Cairella G., Cosimelli M., Di Lauro L., Callopoli A., Botti C., Anzà M., Di Angelo P., Giunta S., Laurenzi L., Cavaliere R.
Background. The transparietal diffusion of low-aggressive endoabdominal malignancy may develop into a massive peritoneal carcinomatosis without hematogenic and lymphatic metastatization. The lack of infiltration attitude lead to the cancer ''redistribution'' on the peritoneum as an effect of gravity, intestinal peristalsis and peritoneal fluid riabsorption. Traditional target has often been palliation while the surgical intent should be the complete tumor cytoreduction removing peritoneum ''en-bloc'' with the neoplastic implants. Intraoperative hyperthermic-antiblastic perfusion provides a direct contact between the drug and microscopic residual disease when they are entirely exposed. In the experience of Sugarbaker on 64 patients affected by peritoneal carcinomatosis from primary colorectal malignancy, the association of peritonectomy and regional chemotherapy led to a 3 years survival of 37%.
Methods. Personal experience is reported of 31 patients affected by extensive peritoneal carcinomatosis, mostly from ovarian and primary colorectal malignancy, prospectively studied and with a median follow-up of 16 months. Programmed treatment was peritonectomy associated to hyperthermic-antiblastic perfusion with CDDP 25 mg/m2/Lt of perfusate and MMC 3.3 mg/m2/Lt of perfusate (gastrointestinal malignancy only) at 41,5 °C for 90 minutes. After peritonectomy the patients spend the first post-operative day at the Intensive Care Unit.
Results. After the learning curve, operative time and blood loss have decreased and no mortality has been recorded in the last 15 months, with a feasibility for the integrated treatment that actually is of 100%. Median time of recurrence is 16 months with a two-years survival of 59%.
Conclusions. The integrated treatment is feasible and offers new chances of cure to patients not responsive to conventional treatments.