Anatomy of Peritoneum and Preoperative Assessment of Patients with Peritoneal Surface Malignancies

Abstract

Cytoreductive surgery of peritoneal surface malignancies (PSM) and hypethermic intraperitoneal chemotherapy applications have become a gold standard in pseudomyxoma peritonei, diffuse malign peritoneal mesothelioma, peritoneal metastases of colorectal cancer and primary peritoneal cancers. They have also promising results for peritoneal metastases originated from gastric cancer and ovarian cancer as well as other intraabdominal cancers, sarcomas and stromal tumours. Our group has pioneered aggressive management strategies for the long-term survival of patients with PSM of gastric cancer as well as PSMs originated from other intraabdominal organs. It is essential that surgeons throughly understand the peritoneal spaces and the ligaments and mesenteries that form their boundaries in order to localize disease to a particular peritoneal space and formulate a differential diagnosis on the basis of that location. In this chapter, we describe in detail the normal anatomy of the peritoneal spaces and the appearance of pathologic involvement of the peritoneal spaces, ligaments, and mesenteries at cross-sectional imaging. Then, preoperative assessment of patients with peritoneal surface malignancies with computed tomography, estimation of extent of disease with clinical staging systems, classification of peritoneal surface malignancies and patient selection will be reviewed.