Primary Peritoneal Malignancies Research Articles

The role of cytoreductive surgery and HIPEC for the treatment of primary and secondary peritoneal malignancies-experience from a tertiary care center in Germany.

Peritoneal surface malignancies (PSM) are commonly known to have a dismal prognosis. Over the past decades, novel techniques such as cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have been introduced for the treatment of PSM which could improve the overall survival and quality of life of patients with PSM. The decision to proceed with CRS and HIPEC is often challenging due the complexity of the disease, the extent of the procedure, associated side effects, and potential risks. Here, we present our experience with CRS and HIPEC to add to the ongoing discussion about eligibility criteria, technical approach, and expected outcomes and contribute to the evolution of this powerful and promising tool in the multidisciplinary treatment of patients with primary and secondary PSM. A single-center retrospective chart review was conducted and included a total of 40 patients treated with CRS and HIPEC from April 2020 to September 2022 at the University Hospital Münster Department of Surgery. All patients had histologically confirmed primary or secondary peritoneal malignancies of various primary origins. Our study included 22 patients with peritoneal metastases from gastric cancer (55%), 8 with pseudomyxoma peritonei (20%), 4 with mesothelioma of the peritoneum (10%), and 6 patients with PSM originating from other primary tumor locations. Median PCI at time of cytoreduction was 4 (0-25). Completeness of cytoreduction score was 0 in 37 patients (92.5%), 1 in two patients (5%), and 2 in one patient (2.5%). Median overall survival across all patients was 3.69years. Complete cytoreduction during CRS and HIPEC can be achieved for patients with low PCI, for patients with high PCI in low-grade malignancies, and even for patients with initially high PCI in high-grade malignancies following a significant reduction of cancer burden due to extensive preoperative treatment with PIPAC and systemic chemotherapy.

ASO Visual Abstract: Safety and Feasibility of High Pressure/High Dose Pressurized Intraperitoneal Aerosol Chemotherapy (HP/HD-PIPAC) for Primary and Metastatic Peritoneal Surface Malignancies.

ASO Visual Abstract: Safety and Feasibility of High Pressure/High Dose Pressurized Intraperitoneal Aerosol Chemotherapy (HP/HD-PIPAC) for Primary and Metastatic Peritoneal Surface Malignancies.

ASO Author Reflections: Prognosticating the Treatment Outcome for Primary Peritoneal Surface Malignancy: Time for an Overhaul of Scoring Systems?

ASO Author Reflections: Prognosticating the Treatment Outcome for Primary Peritoneal Surface Malignancy: Time for an Overhaul of Scoring Systems?

Diagnosis and treatment of peritoneal carcinomatosis - a comprehensive overview.

Peritoneal carcinomatosis, which is the most common malignant process of the peritoneal cavity, originates mostly from colorectal, gastric, and gynaecological malignancies. The differential diagnosis is broad and covers primary peritoneal malignancies, as well as many benign disorders such as endometriosis, and inflammatory and infectious diseases. Peritoneal implants tend to locate in the areas of the physiological stasis of the peritoneal fluid: pelvic peritoneal reflections, right and left paracolic gutters, superior part of the sigmoid mesocolon, ileocolic area, and the right subdiaphragmatic space. The 3 most common imaging findings are ascites, nodular implants, and infiltration of the peritoneal fatty tissue. Several imaging modalities may be applied in patients with peritoneal carcinomatosis. Ultrasound has low sensitivity and specificity, and therefore plays only a marginal role. Computed tomography is the method of choice, due to its availability, cost-effectiveness, and relatively high sensitivity. The sensitivity of magnetic resonance imaging depends on the size of peritoneal implants - in cases of implants larger than 10 mm is comparable to CT. Some studies suggest that PET/CT may be the most sensitive method, yet its usefulness in everyday practice is controversial. The Peritoneal Carcinomatosis Index (PCI) is a scale used to assess the tumour burden in the peritoneum and may serve as a communication tool between clinicians and radiologists. The imaging findings may influence the surgeon's decision on performing cytoreductive surgery, which may be followed by intraperitoneal chemotherapy (HIPEC or EPIC procedures). The introduction of these therapeutic methods has significantly improved the life expectancy of patients with peritoneal carcinomatosis.

The Landmark Series: Scoring Systems for Primary Peritoneal Surface Malignancy.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) represents an innovative approach to treat or prevent peritoneal metastasis. However, given the morbidity that can be associated with this procedure, adequate patient selection facilitated by scoring systems for primary peritoneal surface malignancy (PSM) is paramount to ensure equitable morbidity as well as acceptable survival outcome. Seminal studies on scoring systems for PSM that have laid the foundation for adequate patient selection and prognostication are spotlighted. Quantitative prognostic indicators have been defined for patients with PSM that enable the surgeon to make sound clinical judgements as to who may or may not benefit from CRS/HIPEC. These prognostic indicators include the histopathology of the tumor, findings on the preoperative abdominal and pelvic computerized axial tomography, the Peritoneal Cancer Index, completeness of cytoreduction score, and prior surgical score. Scoring systems for primary peritoneal surface malignancy reviewed in this article highlight the utility of these systems for patient selection for CRS/HIPEC and prognostication.

Safety and Feasibility of High-Pressure/High-Dose Pressurized Intraperitoneal Aerosol Chemotherapy (HP/HD-PIPAC) for Primary and Metastatic Peritoneal Surface Malignancies.

The aim of this study was to evaluate the feasibility and perioperative safety of high-pressure/high-dose pressurized intraperitoneal aerosol chemotherapy (HP/HD-PIPAC) to manage peritoneal surface malignancies (PSM). Retrospective analysis of a prospective database of about 130 consecutive patients scheduled for HP/HD-PIPACs for PSM. Doxorubicin plus cisplatin (PIPAC-C/D) or oxaliplatin (PIPAC-Ox) were nebulized into a constant capnoperitoneum of 20mmHg at doses of 6, 30, or 120mg/m2 of body surface area (BSA). Outcome criteria were perioperative complications (Clavien-Dindo). The median age of patients was 62 years (range 9-82), and the primary tumor site was of colorectal (CRC), upper gastrointestinal tract (UGI), unknown primary (CUP), malignant epithelioid mesothelioma of the peritoneum (MPM), hepato-pancreatic-biliary tract (HPB), and other origin in 30 (23.1%), 27 (20.8%), 16 (12.3%), 16 (12.3%), 6 (4.6%), and 35 (26.9%) patients, respectively. Abdominal access failed for a first, second, third, and fourth or more HP/HD-PIPAC in 12/130 (9.2%), 4/64 (6.3%), 6/40 (15.0%), and 2/33 (6.1%) patients. A total of 243 procedures were performed in 118 patients. No intraoperative complications related to increased capnoperitoneal pressure occurred, but an intraoperative bleeding complication was observed in 1/243 (0.4%) patients. The overall rate of postoperative procedure-related complications was 19.3% (47/243), while 15.3% (37/243), 1.6% (6/243), 1.6% (1/243), 0.4% (1/243), and 0.4% (1/243) were Grade I, II, III, IV, and V complications, respectively. Perioperative complications of HP/HD-PIPAC are comparable with standard pressure/dose PIPAC treatment protocols. Prospective studies are warranted to examine potential improvement in therapy outcomes.

The reliability of pre-operative CT imaging in predicting cardiophrenic lymph node involvement prior to both PDS and DDS for advanced ovarian cancer (532)

<b>Objectives:</b> Cardiophrenic lymph node (CPLN) involvement represents stage IVB ovarian cancer. Driven by the prognostic importance of complete cytoreduction, the surgical practice has evolved to increasingly incorporate CPLN dissection as a component of ultraradical debulking for advanced disease. We aimed to evaluate the reliability of preoperative imaging in accurately identifying positive CPLN - and hence those patients for whom removal may confer benefit. <b>Methods:</b> Preoperative CT imaging was retrospectively reviewed for all patients undergoing either primary (PDS) or delayed debulking surgery (DDS) for stage III or IV tubo-ovarian / primary peritoneal carcinoma in a UK cancer center between 2017-2020. CPLN measuring >5 millimeters - or those with abnormal morphology (irregular border / absent fatty hilum / heterogeneous internal attenuation) - were deemed radiologically suspicious. For patients within this ‘node-positive' cohort, histology for those having undergone CPLN dissection was also reviewed, and the correlation between imaging and final pathology was analyzed. <b>Results:</b> A total of 141 patients undergoing either PDS or DDS for advanced tubo-ovarian or primary peritoneal cancer were identified. On review of preoperative CT, 60 patients (42.6%) were deemed to have radiologically involved CPLN. Of these, 13 patients had undergone CPLN dissection, with positive histopathology confirming CPLN metastases in 11/13 patients (84.6%). This equates to a positive predictive value (PPV) for CT in identifying this disease entity of 0.846, with no significant difference seen in the context of PDS versus DDS. <b>Conclusions:</b> While our patient numbers are limited, reflecting the introduction of this evolving surgical technique to our center during the timeframe reviewed, our data suggest that preoperative CT is an accurate predictor of CPLN disease in advanced tubo-ovarian / primary peritoneal malignancy in advance of both PDS and DDS and can be reliably used to guide patient selection for CPLN dissection.

Primary malignant peritoneal mesothelioma mimicking tuberculous peritonitis: A case report

BACKGROUNDMalignant peritoneal mesothelioma (MPM) is a rare malignancy arising in mesothelial cells in the peritoneum. It can be mistaken for many other diseases, such as peritoneal carcinomatosis and tuberculous peritonitis (TBP), because its clinical manifestations are often nonspecific. Therefore, the diagnosis of MPM is often challenging and delayed.CASE SUMMARYA 42-year-old man was referred to our hospital with lower abdominal pain for 1 wk and ascites observed under abdominal sonography. His laboratory findings revealed an isolated elevated tumor marker of carcinoma antigen 125 (167.4 U/mL; normal, < 35 U/mL), and contrast enhanced computed tomography showed peritoneal thickening. Thus, differential diagnoses of TBP, carcinomatosis of an unknown nature, and primary peritoneal malignancy were considered. After both esophagogastroduodenoscopy and colonoscopy produced negative findings, laparoscopic intervention was performed. The histopathological results revealed mesothelioma invasion into soft tissue composed of a papillary, tubular, single-cell arrangement of epithelioid cells. In addition, immunohistochemical staining was positive for mesothelioma markers and negative for adenocarcinoma markers. Based on the above findings, TBP was excluded, and the patient was diagnosed with MPM.CONCLUSIONIt is important to distinguish MPM from TBP because they have similar symptoms and blood test findings.

ASO Author Reflections: The Management of Appendiceal Primary Peritoneal Surface Malignancies.

ASO Author Reflections: The Management of Appendiceal Primary Peritoneal Surface Malignancies.

The Landmark Series: Appendiceal Primary Peritoneal Surface Malignancy.

Appendiceal primary peritoneal surface malignancies are rare and include a broad spectrum of pathologies ranging from indolent disease to aggressive disease. As such, the data that drive the management of appendiceal peritoneal surface malignancies is generally not based on prospective clinical trial data, but rather consists of level 1 data based on retrospective studies and high-volume institutional experiences. Complete surgical debulking typically offers the best chance for long-term survival. This review highlights the landmark articles on which management of primary appendiceal peritoneal surface malignancies are based.

O02 Cancer, Covid and control of RA – a toxic combination?

Case report - IntroductionThis case highlights the dilemma of keeping rheumatoid arthritis disease under control in active cancer cases and establishing a consistent multidisciplinary dialogue during a pandemic and staffing crises.During chemotherapy and active cancer treatment, disease-modifying therapies (conventional and biologic) are often stopped. In some cases, the potential benefits versus risks of restarting usual therapies have to be balanced against risks of suppressing disease activity with high-dose steroids. Risks of infection (common and atypical) need to be considered.Case report - Case descriptionA is a 67-year-old female non-smoker diagnosed with seropositive rheumatoid arthritis (RF, anti –CCP positive) in 2008. Other conditions include type 2 diabetes, atrial fibrillation (on warfarin), hypothyroidism and obstructive sleep apnoea. Due to active disease, despite triple therapy (methotrexate, sulphasalazine and hydroxychloroquine), anti-TNF therapy (etanercept) commenced in 2009 with primary non-response. However, she responded well to B-cell therapy (rituximab) in conjunction with oral methotrexate (25mg weekly) receiving annual infusions from 2010 to 2016.In 2017, an elective sleeve gastrectomy procedure for high BMI was abandoned after peritoneal deposits of concern were noted. Histology and CT imaging were consistent with a primary peritoneal malignancy (Stage 3c low-grade serous adenocarcinoma). Treatment involved debulking surgery (total abdominal hysterectomy, bilateral salpinoophorectomy, omentectomy) and tamoxifen.Treatment for rheumatoid arthritis stalled during this period but as frequent steroids were required for active joint inflammation, in agreement with the oncologists, she had a rituximab cycle in 2018.Unfortunately, in 2019 she had signs of cancer progression (elevated tumour markers, CT imaging) and has subsequently started carboplatin chemotherapy. She has been unable to continue methotrexate or rituximab pending completion of the chemotherapy cycles (ongoing). However, her arthritis is now uncontrolled without increased steroids. Due to recurrent flares, her maintenance dose has been increased from 5mg to 7.5—10mg prednisolone daily until we can establish if it is safe and appropriate to recommence her usual arthritis regime.Even without disease-modifying therapy like methotrexate and rituximab, risk of infection (including atypical ones) is still significant with the combination of chemotherapy and steroids. Risk of progressive joint damage and adverse quality of life with active arthritis also needs to be considered. Staffing crises, exacerbated by COVID pandemic issues, have added to complexity of decision making and coordination of regular multidisciplinary discussions regarding treatment.Case report - DiscussionCancer is a known association in rheumatoid arthritis patients with a twofold higher risk of lymphoma compared to the general population. Whether condition or treatment affects risk remains unclear as immune dysregulation is relevant in both autoimmunity and cancer. Paraneoplastic, recent onset arthritis, chemotherapy- or immunotherapy-induced arthralgia/arthritis are also well documented. This case had a seropositive rheumatoid arthritis phenotype quite a few years prior to cancer diagnosis. Primary peritoneal cancer is uncommon, often presenting as in this case as an incidental finding. It is usually treated like ovarian cancerWhilst methotrexate has been implicated in lung cancer, melanoma and non-Hodgkin lymphoma, overall safety data suggest any risk is quite low (e.g., EBV-associated lymphoproliferative disorders usually resolve with drug discontinuation). It is also a known chemotherapeutic agent. Anti-TNF treatment algorithms generally exclude patients with recent cancer. Rituximab, originally developed as a cancer drug, is not thought to affect risk of cancer development or progression.Treatment with disease-modifying therapy (conventional and biologics) is often withheld in patients with active malignancy undergoing chemotherapy due to a theoretical risk of potentiated immunosuppression and toxicity, particularly cytopaenias. However, maintaining arthritis control with glucocorticoids also has short- and long-term risks. Combining chemotherapy agents like carboplatin with methotrexate has been used for urothelial carcinoma and can be well tolerated with close monitoring of haematological parameters.Thus, it could be argued this patient is at risk of infections whichever treatment approach is taken and regaining control of arthritis with recommencement of methotrexate and rituximab is much better for her quality of life.Regular multidisciplinary discussions are important to outline risks versus benefits of combined treatment. This may be difficult in practice during staffing crises. Covid risk in patients receiving rituximab and/or chemotherapy, timing and response to COVID vaccination are also important considerations.Case report - Key learning pointsPrimary peritoneal cancer is uncommon and can present as an incidental findingWhilst treatment for progressive cancer is important, withholding rheumatoid arthritis treatment can have a significant adverse impact on quality of lifeMorbidity and mortality risks of stopping treatment versus combined treatment (cancer therapy and disease-modifying therapy) ideally needs to be fully discussed and agreed with the patient and all care providers – lack of “named” providers, restructuring, redeployment, multi-specialty care and a global pandemic can make coordination of this difficult

Stage of ovarian cancer at diagnosis. Does presentation as an emergency make a difference?

ObjectivesThe purpose of this study is to evaluate whether presentation of ovarian cancer as an emergency compared to presentation via referral to diagnostic clinic has an impact on stage of disease at diagnosis. Secondary outcomes include the relationship between stage of diagnosis and age as well as socioeconomic status and type of presentation (emergency or clinic referral). Study designData were obtained from the central database for all new diagnoses of ovarian, fallopian tube or primary peritoneal malignancy at a tertiary teaching hospital for 2016–2018 (n = 147). The electronic patient records were manually reviewed to determine the patient’s presentation. Age and stage at diagnosis were from the central records. Socioeconomic status was determined by the multiple deprivation index deciles obtained from patient postcode data. Non parametric chi squared analysis was used to assess for any significant results. Results51 % of women presented through a gynaecology two-week wait service; 27 % presented as an emergency admission; 12 % through a routine gynaecology outpatient clinic and 10 % after initial referral to a non-gynaecological two-week wait service. There was a significant (p = 0.008) association with later stage disease and emergency presentation. Increased age was also strongly linked to later stage at diagnosis (p = 0.00001). There was no association between stage at diagnosis and socioeconomic status. ConclusionsEmergency presentations account for just over a quarter of new diagnoses and are significantly associated with later stage disease with increased morbidity and mortality. Older women were also more likely to present at an advanced stage. Socioeconomic status did not impact on staging at diagnosis.

Impact of “ovarian staging” on operative and long-term outcomes in females affected by primary peritoneal surface malignancies requiring CRS and HIPEC: Final results

CRS/HIPEC is a complex procedure that becomes even more challenging after previous surgical manipulation, due to adhesions and tumor spread through the scars. In female patients, non-gynecological peritoneal surface malignancies (PSM) are often misdiagnosed as disseminated epithelial ovarian cancer (EOC) and consequently extensive gynecological procedures are attempted before referral to specialized centers for CRS/HIPEC. In our experience, about half the part of female patients affected by primary PSM underwent planned surgical staging for EOC before being referred to our Institution for definitive treatment. We attempted to assess surgical and prognostic outcomes of patients undergoing CRS/HIPEC after these previous often inappropriate surgical procedures.

Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up

Peritoneal mesothelioma (PM) is a rare and aggressive primary peritoneal malignancy characterized by widespread multiple metastatic tumour nodules originating from the peritoneum. The conventional classification distinguishes diffuse malignant peritoneal mesothelioma (DMPM) and border-line forms: multicystic peritoneal mesothelioma (MCPM) and well-differentiated papillary peritoneal mesothelioma (WDPPM). Despite the novel achievements in the management of PM, there is difficulty in conducting randomized trials due to its rarity and aggressive biology in many cases.

Relationship between positive peritoneal fluid cytology and the type of the malignancy in patients with malignancy related ascites

Aim: Malignancy related ascites may be due to abdominal origin, extraabdominal origin and primary peritoneal malignancy. The relationship between positive peritoneal fluid cytology and the type of the malignancy and the burden of the tumor in the abdomen was investigated.Materials and Methods: One-hundred eighty-nine consecutive patients with malignancy who were examined for ascites fluid cytology were retrospectively identified in the last two years. Age, gender, primary tumor site, radiologic imaging and pathology results of the patients were recorded. According to the abdominal imaging at the time of the paracentesis procedure, the extensiveness of disease in the abdomen was classified as only ascites, ascites with peritoneal carcinomatosis, ascites with liver involvement (primary tumor or metastases) and ascites with peritoneal carcinomatosis with liver involvement. Results: Out of 189 patients, 119 patients (63.0%) were female. The primary tumor site was ovary in 49 patients, stomach in 38 patients, pancreatobiliary system in 37 patients, breast in 16 patients, colorectal in 14 patients, uterine in 13 patients, kidney or bladder in 6 patients, liver in 6 patients, lymphoma in 4 patients, malignant mesothelioma in 3 patients, lung in 2 patients and skin in one patient. Peritoneal fluid cytology revealed malignant cells in 102 patients (54.0%), while 87 patients (46.0%) had benign results. There was a relationship between primary tumor site and malignant cell detection in the fluid (p= 0.001). The detection of malignant cells was correlated with abdominal extensiveness of disease as well (p = 0.01). In multivariate analysis, only primary tumor site [(p = 0.001), risk ratio: 2.28, 95% confidence interval: 1.83-2.73] was the independent factor affecting cytologic positivity.Conclusion: Considering primary tumor site and the extensiveness of disease in the abdomen, primary tumor site was the most important factor affecting peritoneal fluid positivity.

Trends in peritoneal surface malignancies: evidence from a Czech nationwide population-based study

BackgroundThe aim of this study is to identify the incidence trends of primary and secondary peritoneal surface malignancies in a representative Czech population.MethodsData were obtained from patients registered in the Czech National Cancer Registry between 1979 and 2016. The incidence rates were analyzed between 2012 and 2016. To observe the incidence trends, we analyzed the data from two time periods, 1979–2005 and 2006–2016. The analyzed data included age, sex, and the histological types and primary origins of the malignancies. The Cochrane-Armitage test for linear trends was used for verification of the null hypothesis. The significance level established for hypothesis testing was p = 0.05.ResultsBetween 2012 and 2016, 230 patients with primary peritoneal tumors were identified and divided into the following groups according to their “International Statistical Classification of Diseases and Related Health Problems, 10th revision” codes: malignant neoplasm of specified parts of the peritoneum (C48.1); malignant neoplasm of the peritoneum, unspecified (C48.2); and malignant neoplasm of overlapping sites of the retroperitoneum and peritoneum (C48.8). Moreover, 549 primary tumors of the appendix (C18.1, encompassing all appendiceal malignancies) and 3137 secondary synchronous peritoneal carcinomatoses of other primary origins were documented. The age-adjusted incidence of primary peritoneal tumors in 2012–2016 was 4.36/year/1,000,000 inhabitants. The age-adjusted incidence of synchronous secondary peritoneal malignancies in 2014–2016 was 99.0/year/1,000,000 inhabitants. The diagnoses of primary peritoneal malignancies followed a stable trend between 1979 and 2016. However, the incidences of primary tumors of the appendix increased by 76.7%.ConclusionsThe data produced in our study ought to clarify the status of peritoneal surface malignancies in the Czech Republic, which can lead to improved planning and development of therapeutic interventions as well as physician training.

Malignant Peritoneal Tumors - Introduction.

This article provides an introduction to peritoneal tumors, which are the subject of a series of review papers published in Issue 5 (2019) of Klinicka onkologie. Many malignant peritoneal tumors are characterized by production of mucinous and gelatinous masses, multiple peritoneal disability, so-called peritoneal carcinomatosis, and various grades of malignancy depending on their origin, staging, and histological type. Malignant peritoneal tumors are rare and their clinical symptomatology is nonspecific and varies according to the extent of disability. Diagnosis, particularly in the initial asymptomatic stages, is very complicated and often impossible, and tumors are often diagnosed by chance during other operations. Malignant peritoneal tumors were regarded as incurable and lethal for a long time; however, this view has changed over the past three decades. The Sugarbaker method, a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, was introduced in the 1990s. Postoperative cytostatic lavage is usually performed in specific cases. Classifications for the extent of disease and completeness of cytoreduction were established. Studies repeatedly confirmed the efficacy of this treatment for peritoneal malignancy. The combination of an aggressive surgical approach and intraperitoneal chemotherapy not only enhances quality of life, but also prolongs progression-free survival and overall survival in selected patients. Specialized centers for treatment of peritoneal malignancy were established based on results from the Czech Republic and around the world. These centers provide complex care, including specific surgical interventions and follow-up, for selected patients with primary and secondary peritoneal malignancy.

Society of Onco-Anaesthesia and Perioperative Care consensus guidelines for perioperative management of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for primary peritoneal malignancies or peritoneal spread of malignant neoplasm is being done at many centres worldwide. Perioperative management is challenging with varied haemodynamic and temperature instabilities, and the literature is scarce in many aspects of its perioperative management. There is a need to have coalition of the existing evidence and experts' consensus opinion for better perioperative management. The purpose of this consensus practice guideline is to provide consensus for best practice pattern based on the best available evidence by the expert committee of the Society of Onco-Anaesthesia and Perioperative Care comprising perioperative physicians for better perioperative management of patients of CRS-HIPEC.

The Evolving Role of 18F-FDG PET/CT in Assessment of Primary and Secondary Peritoneal Malignancies

The Evolving Role of 18F-FDG PET/CT in Assessment of Primary and Secondary Peritoneal Malignancies

Data on the quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancies: does it concern patients with gastric cancer?

AbstractIntroduction.So far there are no reports devoted exclusively to the quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in metastatic gastric cancer. Current literature concerning this issue was, thus, reviewed in order to: 1) search for such data concerning metastatic gastric cancer; 2) assess if the latest reviews evenly pertain to all peritoneal surface malignancies; and 3) conclude if they are a reliable source of data for patients with metastatic gastric cancer.Materials and Methods.The electronic PubMed/MEDLINE and EMBASE databases were retrieved for studies concerning the influence of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on quality of life in patients with metastatic gastric cancer and regardless of initial diagnosis. The data on the number of patients with particular tumours were analysed and the results were presented in the form of a table.Results.Approximately half of all patients encompassed by the reviews had a form of primary peritoneal surface malignancies. Within peritoneal metastases, the most numerous were colorectal (21-24%) and ovarian cancers (5-15%). Gastric cancers and sarcomas were the smallest defined subgroups (4% each).Conclusions.The promising outcomes in quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in primary peritoneal surface malignancies might differ from rarely reported ones in metastatic gastric cancer. The problem needs further, gastric cancer-devoted investigations.