Abstract
Peritoneal carcinomatosis from gastrointestinal cancer has new treatment options for surgical management. The approach uses cytoreductive surgery which combines peritonectomy and visceral resection in an effort to remove all visible cancer within the abdomen and pelvis. Then the peritoneal cavity is flooded with chemotherapy solution in an attempt to eradicate residual disease. In order to select patients for this approach the quantitative prognostic indicators for carcinomatosis were reviewed, compared and contrasted. Prognostic indicators to be used to select patients for this aggressive approach at the initiation of surgery and after completion of cytoreduction were studied. Four quantitative assessments to be used at the time of abdominal exploration were the Gilly staging, Japanese gastric cancer P score, peritoneal cancer index (PCI), and the simplified peritoneal cancer index (SPCI). All have value with the PCI being the most validated and most precise. Preoperative assessments include the tumor histopathology and the prior surgical score. The completeness of cytoreduction score is an assessment of residual disease after a maximal surgical effort. An opportunity for long-term survival following treatment for carcinomatosis requires a complete cytoreduction in all reports for gastrointestinal cancer. Quantitative prognostic indicators need to be knowledgeably employed when patients with carcinomatosis are being treated. Improved patient selection with greater benefit and reduced morbidity and mortality should result.
Highlights
Peritoneal carcinomatosis has always been regarded as a terminal condition
Recent multicenter phase II and a single phase III study evaluating the usefulness of cytoreductive surgery and perioperative intraperitoneal chemotherapy are promising [4,5]
Patient selection is of utmost importance in optimizing the results of treatment and excluding patients who will not benefit from a high morbidity and potentially life threatening therapy
Summary
Peritoneal carcinomatosis has always been regarded as a terminal condition It is present in 10 to 30% of patients with gastrointestinal cancer at the time of their initial surgery and is a frequent finding in patients who develop recurrent cancer. Patient selection is of utmost importance in optimizing the results of treatment and excluding patients who will not benefit from a high morbidity and potentially life threatening therapy. There are several clinical assessments at many different institutions in use for the evaluation of carcinomatosis (see Table 1). Our goal in this manuscript is to critically discuss these quantitative prognostic indicators. Collaborative studies between institutions would be greatly facilitated with standardized clinical tools for management of carcinomatosis from gastrointestinal cancer
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