Carcinomatosis: Cytoreduction and Heated Intraperitoneal Chemotherapy (HIPEC) Versus Palliation

Abstract

Peritoneal surface malignancy (PSM) is a heterogeneous form of cancer. A paradigm shift has occurred in the past 50 years; operative intervention in selected patients with limited peritoneal carcinomatosis (PC) is now undertaken with curative intent. Approximately 150,000 patients are diagnosed with colorectal cancer (CRC) in 2012 in the USA and one third die from the disease each year. Approximately 8,000 patients in the USA are diagnosed with synchronous PSM; 8 % with CRC have synchronous peritoneal spread of disease at time of primary resection, and up to 25 % of patients with recurrent CRC have disease confined to the peritoneal cavity. In about 30 %, PSM is the main reason for death in CRC patients, and only ~50 % of patients who develop PSM from CRC may have curative treatment by an R0 resection. The multimodal treatment approach for carefully selected patients with good performance status and limited PC consists of cytoreductive surgery (CRS), followed by hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment approach represents a formidable challenge for patients and surgeons alike, as well as members of the multidisciplinary health-care team. In patients undergoing CRS + HIPEC technique not the only aim; a much broader, holistic view of care is imperative. Such an approach is emphasized in this chapter.