A Curative Approach to Peritoneal Carcinomatosis from Colorectal Cancer

Abstract

The use of radiation therapy and systemic chemotherapy along with surgery continues to improve survival, optimize quality of life, and maximally preserve function. Gastrointestinal cancer management is increasingly complex as a result of the integration of surgery, radiation therapy, and systemic chemotherapy. Over the past two decades, greater knowledge regarding the natural progression of gastrointestinal cancer has been achieved, and an emphasis in clinical research on "anatomic sites of surgical treatment failure" has given oncologists a target for additional laboratory and clinical investigations. One area of treatment failure for gastrointestinal cancer, the peritoneal surface, presents itself as a dominant need for improved understanding and for concentrated research activities. Until recently, peritoneal carcinomatosis has been regarded as a universally fatal condition; however, recent success toward a curative approach is the result of two treatment innovations specifically developed for management of peritoneal carcinomatosis; these include surgical interventions (collectively referred to as peritonectomy), and the use of perioperative intraperitoneal chemotherapy. Because these combined treatment modalities have been investigated in large numbers of patients, the selection factors for acceptable long-term survival combined with a well-defined morbidity and mortality have become established.