Rationale and techniques of cytoreductive surgery and peritoneal chemohyperthermia

Abstract

The evolution of loco-regional treatments has occurred in the last two decades and has deeply changed the natural history of primitive and secondary peritoneal surface malignancies. Several phase II-III studies have proved the effectiveness of the combination of cytoreductive surgery with peritoneal chemohyperthermia. Cytoreductive surgery allows the reduction of the neoplastic mass and increases tumoral chemosensitivity. The development of chemohyperthermia finds its origins in the necessity to exceed the limits of intraperitoneal chemotherapy performed in normothermia. It permits a continuous high concentration gradient of chemotherapeutic drugs between the peritoneal cavity and the plasma compartment to and a more uniform distribution throughout the abdominal cavity compared to systemic administration.

Keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Loco-regional treatments; Peritoneal carcinomatosis; Peritoneal surface malignancies.

Figure 1

Pattern of hyperthermic intraperitoneal chemotherapy. From the site: www. healthinfoispower.wordpress.com.

Figure 2

Kaplan-Meier curves. A: Survival probability of patients submitted to cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy; B: Survival probability of gastrointestinal sample; C: Survival probability of ovarian sample.