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