The integrated treatment of peritoneal carcinomatosis. A preliminary experience

Some low-grade malignant tumors arising in the abdomen, lack of infiltrativ e attitude and "redistribute" on the peritoneum with no extraregional sprea ding. In this cases the complete tumor cytoreduction followed by intra- or postoperative regional chemotherapy has curative intent. Peritonectomy is the complete removal of all the parietal peritoneum and th e visceral peritoneum involved by disease. After peritonectomy hyperthermic antiblastic perfusion is carried out throughout the abdomino-pelvic cavity for 60 minutes, at a temperature of 41.5 degrees C, with mitomycin C (3.3 mg/m(2)/Lt of perfusate) and cisplatin (25 mg/m(2)/Lt) (appendicular or col orectal primary), or cisplatin alone is (ovarian primary), Alternatively th e immediate postoperative regional chemotherapy is performed with 5-fluorou racil (13.5 mg/Kg) and Lederfolin (125 mg/m(2)) (colic or appendicular tumo r) or cisplatin (25 ng/m(2)) (ovarian tumor), each day for 5 days. Twenty patients affected by extensive peritoneal carcinomatosis (12 ovarian , 5 colonic, 1 appendicular, 1 mesothelial and 1 gastric primary) were subm itted to peritonectomy with no residual macroscopic disease in all cases ex cept three. Six patients were treated with intraoperative intra-abdominal h yperthermic antiblastic perfusion, while immediate postoperative intra-abdo minal chemotherapy was given in 4 patients and systemic chemotherapy in oth er 5, Hospital mortality was 20%. At a mean follow-up of 11 months 14 patie nts are alive, 11 without disease and the median overall survival is 10.2 m onths. The curative potential of the combined therapeutic approach seems high in p atients with peritoneal carcinomatosis from ovarian or colorectal primary n ot responding to systemic chemotherapy. Selection criteria of patients can strictly affect the surgical risk and the treatment has to be reserved for controlled clinical trials.