Peritoneal carcinomatosis of gastrointestinal tumors: Where are we now?


Terzi C., Arslan N. C., Canda A. E.

WORLD JOURNAL OF GASTROENTEROLOGY, vol.20, no.39, pp.14371-14380, 2014 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 20 Issue: 39
  • Publication Date: 2014
  • Doi Number: 10.3748/wjg.v20.i39.14371
  • Journal Name: WORLD JOURNAL OF GASTROENTEROLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.14371-14380
  • Keywords: Peritoneal carcinomatosis, Gastrointestinal tumors, Cytoreductive surgery, Intraperitoneal chemotherapy, Oncologic surgery, HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY, SMALL-BOWEL ADENOCARCINOMA, LOCO-REGIONAL TREATMENT, CYTOREDUCTIVE SURGERY, COLORECTAL-CANCER, PSEUDOMYXOMA-PERITONEI, GASTRIC-CANCER, SURFACE MALIGNANCY, MESOTHELIAL CELLS, SYSTEMIC CHEMOTHERAPY
  • Dokuz Eylül University Affiliated: Yes

Abstract

The peritoneal stromal tissue which provides a rich source of growth factors and chemokines is a favorable environment for tumor proliferation. The pathophysiological mechanism of peritoneal carcinomatosis is an individual sequence consisting of genetic and environmental factors and remains controversial. The natural history of the disease reveals a poor median prognosis of approximately 6 mo; however aggressive surgery and multimodal treatment options can improve oncologic outcomes. Considering peritoneal carcinomatosis as though it is a locoregional disease but not a metastatic process, cytoreductive surgery and and intraperitoneal chemotherapy has been a curative option during recent years. Cytoreductive surgery implies a series of visceral resections and peritonectomy procedures. Although the aim of cytoreductive surgery is to eliminate all macroscopic disease, viable tumor cells may remain in the peritoneal cavity. At that point, intraperitoneal chemotherapy can extend the macroscopic disease elimination to microscopic disease elimination. The successful treatment of peritoneal carcinomatosis requires a comprehensive management plan including proper patient selection, complete resection of all visible disease, perioperative intraperitoneal chemotherapy and postoperative systemic chemotherapy. Surgical and oncologic outcomes are strictly associated with extent of the tumor, completeness of cytoreduction and patient-related factors as well as multidisciplinary management and experience of the surgical team. In this review, pathophysiology and current management of peritoneal carcinomatosis originating from gastrointestinal tumors are discussed according to the latest literature. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.