Peritoneal carcinomatosis is a way of dissemination of intraabdominal malignancies (gastrointestinal or gynaecologic tumors, primary peritoneal tumors or sarcomas). Traditionally considered as incurable, recent studies have shown that som patients can clearly benefit form radical surgical approach combined with different kinds of chemotherapy.
Peritoneal carcinomatosis is a form of intra-abdominal dissemination of the malignant gastrointestinal and gynecological tumors and abdominopelvic sarcomas, with or without evidences of systemic metastasis.
There is a wide variety of this type of carcinomatosis depending on the peritoneal involvement, from small and superficial nodes near the primary tumor to a complete occupation of the abdominal cavity by big invasive tumor deposits.
Traditionally, the peritoneal carcinomatosis has been considered as a later incurable stage of the neoplastic injury, subsidiary of palliative systemic chemotherapy only, with or without reduction surgery of the tumoral mass (debulking).However, the studies carried out in the 1980s suggest that peritoneal carcinomatosis should be faced as a locoregional stage, and that a limited peritoneal seeding can be cured (40% in gastrointestinal origin cases) using a combination of debulking surgery and intraperitoneal perioperative chemotherapy.
The radical treatment for Peritoneal carcinomatosis includes debulking and intraoperative hiperthermic intraperitoneal chemotherapy.
Those patients that only have one controlled or controllable primary tumor located in the peritoneum can benefit from a treatment with a curative intention of the resection if it is complete or almost complete from a macroscopic perspective.
The invasive or non-invasive nature of the tumor on the surface of the peritoneum is also a defining feature when treating peritoneal carcinomatosis.
Thus, non-invasive tumors such as pseudomyxoma peritonei, stage I sarcoma or a slightly invasive peritoneal mesothelioma can be debulked entirely, even though they might appear in form of big masses and high peritoneal cancer index. On the other hand, the prognosis will be dismal in the case of invasive tumors with low peritoneal cancer index, but with infiltrations in relevant anatomic locations with difficult resections, such as the small bowel or the biliary tree.
The peritoneal carcinomatosis tumors that can be dealt with thanks to a combined radical treatment are the following, depending on evidences seen nowadays:
- Epithelial ovarian carcinoma
- Colorectal cancer
- Gastric cancer
- Diffuse peritoneal mesothelioma
- Pseudomyxoma peritonei
- Peritoneal sarcomatosis
It is necessary to apply intraperitoneal chemotherapy in the following cases, after expected mechanisms of tumoral cell implantation in the peritoneum:
- Intraoperative neoplastic cell contamination
- Involvement of the lymph nodes in resection limits
- Positive resection margins
- Perforated cancer
- Peritoneal Implants confirmed with biopsy
- Ovarian involvement
- Invasion of nearby organs or structures