Is Intraperitoneal Chemotherapy After Cytoreductive Surgery Efficient? Knowing Whether It Is or Not Appears Secondary!

Abstract

The concept of treating peritoneal carcinomatosis (PC) with a curative intent by combining complete cytoreductive surgery (CCRS) resecting all visible disease plus hyperthermic intraperitoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) to eradicate the remaining nonvisible disease is logical and seems to be efficient. Described for the first time for 1 patient in 1980 by Spratt et al., it was extensively developed by Sugarbaker et al. during the following years. At the present time, numerous publications consider that this curative combined approach is efficient, mainly for the treatment of peritoneal pseudomyxomas, malignant mesotheliomas, and colorectal PC. However, if you examine all the current data in the literature, an important question subsists: What is the specific role of HIPEC itself in this ‘‘package’’? A few randomized experimental trials in animals clearly consider that IP chemotherapy after CCRS exerts a positive impact, but they are limited by 2 weak points: the wide variability of the procedures tested and the difficulty of transposing the results of experimental procedures to humans. Finally, we have numerous, nonrandomized studies that enable us to attempt to evaluate whether IP alone, with or without hyperthermia, can efficiently cure nonvisible disease. Now, these data are currently astonishing and lead us to wonder about the role of IP chemotherapy following CCRS.