Peritonectomy and hyperthermic antiblastic perfusion in the treatment of peritoneal carcinomatosis

Aims: Some low-grade malignant tumours arising in the abdomen tend to remai n loco-regionally confined to peritoneal surfaces, without systemic dissemi nation. In these cases complete surgical tumour cytoreduction followed by i ntra- or post-operative regional chemotherapy has curative potential. The a im of this study was to evaluate the outcome for patients treated in this w ay. Methods: Peritonectomy was performed, involving the complete removal of all the visceral and parietal peritoneum involved by disease. After peritonect omy, hyperthermic antiblastic perfusion was carried out throughout the abdo minopelvic cavity for 90 min, at a temperature of 41.5-42.5 degrees C, with mitomycin C (3.3 mg/m(2)/l) and cisplatin (25 mg/m(2)/l) (for appendicular or colorectal primaries), or cisplatin alone (for ovarian primaries). Alte rnatively, the immediate post-operative regional chemotherapy was performed with 5-fluorouracil (13.5 mg/kg) and Lederfolin (125 mg/m(2)) (for colonic or appendicular tumours) or cisplatin (25 mg/m(2)) (for ovarian rumours, e ach day for 5 days. Results: Thirty-five patients affected by extensive peritoneal carcinomatos is were submitted to peritonectomy, with no residual macroscopic disease in all cases except three. Twenty-six patients were able to undergo the combi ned treatment involving loco-regional chemotherapy. Complications were obse rved in 54% of the patients and led to death in four of them. Ar a mean fol low-up of 17 months overall 2-year survival was 55.2%, with a median surviv al of 26 months. Conclusions: After a learning curve of 18 months the feasibility of the int egrated treatment increased to more than 90%,. while mortality decreased dr amatically. The curative potential of the combined therapeutic approach see ms high in selected patients with peritoneal carcinomatosis not responding to systemic chemotherapy. Careful selection of patients can minimize the su rgical risk, but the treatment should currently be reserved for clinical tr ials. (C) 2000 Harcourt Publishers Ltd.