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abstract
Peritoneal
tumour dissemination is still considered as a terminal disease. For the
last two decades, cytoreductive surgery (CRS) combined with
intraoperative hyperthermic chemotherapy (HIPEC) has been popularised by
Paul Sugarbaker almost doubling survival in selected patients compared
with systemic chemotherapy alone. Nowadays, this particular treatment
protocol is available in comprehensive cancer
centres with reasonable mortality and morbidity. However, patient
selection is still challenging. In general, CRS and HIPEC is indicated
in primary peritoneal tumours such as mesothelioma and pseudomyxoma
peritonei as well as in peritoneal metastases derived from
gastrointestinal malignancies and ovarian
cancers. Since systemic tumour spread is uncommon in patients with
peritoneal metastases, peritoneal tumour dissemination was defined as
localised disease within the "compartment abdomen". However, CRS and
HIPEC are only beneficial as long as complete cytoreduction is achieved
(CC-0 or CC-1). Histopathological parameters, the Sugarbaker peritoneal
carcinomatosis index (PCI) and general condition of the patient have
been established as patient selection criteria. In primary peritoneal
cancers, individual tumour biology is the predominant criterium for
patient selection as opposed to intraabdominal tumour load in peritoneal
metastases derived from gastrointestinal cancers. In gastric cancer,
CRS and HIPEC should be restricted to synchronous limited disease
because of its biological aggressiveness. In patients with free floating
cancer cells
without macroscopic signs of peritoneal spread, however, CRS and HIPEC
following preoperative "neoadjuvant" chemotherapy preserves chances for
cure. So far, there is no general recommendation for CRS and HIPEC by
clinical practice guidelines. In the recent S3 guideline for treatment of colorectal cancer, however, CRS and HIPEC have been included as possible treatment options.
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