Peritonectomy and peritonealcarcinoses
Cytoreductive surgery means a complete removal of all visible tumors into the peritoneal cavity. It requires peritonectomy procedures eventually associated with multiple intestinal and/or organ resection.
The present knowledge of cell-kill kinetics with cytotoxic drugs indicates that, due to a larger proportion of cell growth fraction, micrometastases are more susceptible to chemotherapy than macroscopic ones, so that cancer cells free in the peritoneal cavity represent an ideal target of a locoregional treatment consisting in a high concentrated administration of cytotoxic drugs under hyperthermic conditions.
For the combination of hyperthermia and chemotherapy, spatial cooperation can explain the additive effects.
- the efficacy of many drugs is potentiated by heat.
- the addition of hyperthermia to chemotherapy can counteract drug resistance.
- Increase in intracellular drug uptake
- enhanced DNA damage
- increase in intratumour drug concentrations, resulting from an increase in blood flow.
Indicationen for Cytoreductive surgery plus intraperitoneal chemotherapy
- non invasive peritoneal carcinoses or sarcomatoses
- peritoneal mesothelioma
- limited peritonealcarcinose with invasive tumors
- perforated primary gastrointestinal carcinoma
- primary T4- gastrointestinal carcinome
- primary gastrointestial Carcinome with positiv peritoneal cytology
- Palliation von Patienten mit malignem Aszites