Cytoreductive surgery and intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy

Despite new developments in the treatment of solid tumors, complete resection remains as an absolute requirement for cure of gastrointestinal cancer. Success in the surgical management of peritoneal surface malignancy depends on the surgeon's ability to complete complex cytoreductive procedures so that only microscopic disease remains. This paper describes the current strategy that the surgical oncologist should pursue in the treatment of patients with peritoneal carcinomatosis, sarcomatosis and mesothelioma. Technical details required for this surgery include patient position, incision and exposure, complete lysis of adhesions, electroevaporative dissection, peritonectomy procedures, proper positioning of drains for intraperitoneal chemotherapy, and reconstructive surgery. Understanding the treatment and mastery of surgical skills to manage the peritoneal surface spread of malignancy has led to long-term survival of selected patients. The success of this treatment strategy depends on a long-term dedication to achieve the full potential of a curative outcome.