| Theme |
How to Manage Distant Metastases from Gastrointestinal Cancer? |
| Title |
Regional Treatment of Peritoneal Dissemination |
| Author |
Yutaka Yonemura |
Department of Surgery, Peritoneal Dissemination Program, Shizuoka Cancer Center |
| Author |
Etsuro Bando |
Department of Surgery, Peritoneal Dissemination Program, Shizuoka Cancer Center |
| Author |
Yasukazu Kawamura |
Department of Surgery, Peritoneal Dissemination Program, Shizuoka Cancer Center |
| Author |
Francois N Gilly |
Lyon University |
| Author |
Oliver Glehen |
Lyon University |
| Author |
Paul Sugarbaker |
Washington Cancer Center |
| [ Summary ] |
Peritoneal dissemination is the most frequent cause of death from gastric cancer and colon cancer accounting for death in 20 to 40 % of patients. Neoadjuvant intraperitoneal / systemic chemotherapy (NIPS), peritonectomy, intraoperative chemo-hyperthermic perfusion (ICHP) and early postoperative intraperitoneal chemotherapy (EPIC) have been reported to be effective treatment modalities. NIPS can eradicate peritoneal free cancer cells, and also may facilitate complete cytoreduction of visible peritoneal dissemination with peritonectomy. Further, NIPS can preserve a wider area of the healthy peritoneal surface. Complete cytoreduction can be achieved more often when peritonectomy is included in the surgical treatment of gastric cancer having peritoneal dissemination. Aggressive cytoreduction of peritoneal dissemination with peritonectomy can reduce the residual tumor burden to micrometastases on the peritoneal surface so that it can be treated with intraoperative chemotherapy and early postoperative intraperitoneal chemotherapy. Among these modalities and clinicopathologic factors, surgical cytoreduction is the most important for survival benefits. If the surgical cytoreduction is complete, survival may be significantly improved. The surgeon's goal is to reduce the cancer cell burden to a microscopic level. |