PERITONEAL CARCINOMATOSIS FROM ADENOCARCINOMA OF THE COLON

Peritoneal carcinomatosis is a major cause of surgical treatment failu re in patients with colorectal cancer. In the past patients with this condition have had a lethal outcome, In this study, 64 consecutive pat ients were treated by the cytoreductive approach, which involved surge ry to maximally resect all cancer in the abdomen and pelvis, early pos toperative intraperitoneal chemotherapy with 5-fluorouracil (5-FU) and mitomycin C, and three cycles of adjuvant intraperitoneal 5-FU with s ystemic mitomycin C. The clinical features that may affect prognosis w ere assessed and critically analyzed statistically. Peritoneal implant size of < 5 cm present in the abdomen and pelvis at the time of explo ration correlated with a good prognosis (p < 0.0001), as did complete cytoreduction with tumor removed to nodules < 2.5 mm (p < 0.0001), Inv olvement of only one or two of the five abdominopelvic regions, compar ed to three or more regions, was a significant determinant of prognosi s (p < 0.0001). Finally, a mucinous histologic type correlated adverse ly with prognosis when compared to intestinal-type adenocarcinomas (p < 0.001), These data suggest that patients with small-volume peritonea l seeding from colon cancer should be treated with cytoreductive surge ry and aggressive regional and systemic chemotherapy in an attempt to achieve long-term disease-free survival.