Peritoneal Carcinomatosis: Principles Of Management (cancer Treatment And Research)

Paul Sugarbaker and his colleagues have persevered in the study and treat­ ment of peritoneal carcinomatosis. The peritoneal cavity has many unique and incompletely appreciated properties. These properties, coupled with the biologic behavior of many cancers, results in the seeding and growth of these cancers on the peritoneum. Many of these cancers remain localized to the peritoneum only, never metastasizing to other sites. One possible reason for this may be the obstruction of the afferent lymphatics on the undersurface of the diaphragm. The mucopolysaccharides produced by many of these neoplasma are probably viscous enough to obstruct these lymphatics, leading to the syndrome of pseudomyxoma peritonei. Many of the neoplasms taking residence on the peritoneum have extremely long cell-cycle times and are resistant to radiotherapy and many chemotherapeutic agents. How­ ever, much can be done for these patients - resection of primary cancers, omentectomies to reduce ascites formation, management of recurrent ascites, management of intestinal obstruction, nutritional care, and, hopefully, intraperitoneal chemotherapy. We have reviewed many of these problems in the past [1-7]. Dr. Sugarbaker and his colleagues have organized the current state of knowledge and technology for continuing use. The book provides a basis for thoughtful, prospective research planning. John S. Spratt, M. D. , F. A. C. S. Professor of Surgery The James Graham Brown Cancer Center University of Louisville Louisville, Kentucky References 1. Long RTL, Spratt JS, Dowling E. Front Matter....Pages i-xix Metastatic inefficiency: Intravascular and intraperitoneal implantation of cancer cells....Pages 1-11 Intraperitoneal immunotherapy of cancer: A review of options for treatment....Pages 13-40 Pharmacokinetics of the peritoneal-plasma barrier after systemic mitomycin C administration....Pages 41-52 Peritoneal-plasma barrier....Pages 53-63 Patterns of spread of recurrent intraabdominal sarcoma....Pages 65-77 Observations concerning cancer spread within the peritoneal cavity and concepts supporting an ordered pathophysiology....Pages 79-100 In vitro pharmalogic rationale for intraperitoneal regional chemotherapy....Pages 101-114 Immunotherapy for peritoneal ovarian carcinoma metastasis using ex vivo expanded tumor infiltrating lymphocytes....Pages 115-146 Role of omentum-associated lymphoid tissue in the progression of peritoneal carcinomatosis....Pages 147-154 Cancer cell seeding during abdominal surgery: Experimental studies....Pages 155-161 Krukenberg syndrome as a natural manifestation of tumor cell entrapment....Pages 163-191 Peritoneal carcinomatosis and radioimmunoguided surgery....Pages 193-209 Diffuse and gross peritoneal carcinomatosis treated by intraperitoneal hyperthermic chemoperfusion....Pages 211-219 Complications of heated intraperitioneal chemotherapy and strategies for prevention....Pages 221-233 Peritonectomy procedures....Pages 235-253 Progressive release of the left colon for a tension-free colorectal or coloanal anastomosis....Pages 255-261 Radiology of peritoneal carcinomatosis....Pages 263-288 Methodologic considerations in treatment using intraperitoneal chemotherapy....Pages 289-309 Safety constiderations in the use of intraoperative intraperitoneal chemotherapy....Pages 311-316 Treatment of peritoneal carcinomatosis from colon or appendiceal cancer with induction intraperitoneal chemotherapy....Pages 317-325 Effects of postoperative intraperitoneal chemotherapy on peritoneal wound healing and adhesion formation....Pages 327-335 Current status of staging laparotomy in colorectal and ovarian cancer....Pages 337-357 Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis....Pages 359-374 Laser-mode electrosurgery....Pages 375-385 Peritoneal access devices for intraperitoneal chemotherapy....Pages 387-413 A simplified approach to hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) using a self retaining retractor....Pages 415-421 Back Matter....Pages 423-434 The dissemination of cancer on peritoneal surfaces has hitherto been regarded as a terminal condition. Only a few patients with ovarian cancer - a disease where there is extreme drug sensitivity - have been maintained in a disease-free state over the long term. The tumour biology questions are as follows: Is the dissemination of cancer on peritoneal surfaces to be regarded as finite spread of malignancy, or as evidence of systematic disease? Is peritoneal carcinomatosis in selected patients a limited process that can be treated for cure, using surgery and chemotherapy? Can treatments lead to a complete resolution of the cancerous process? Most oncologists would regard peritoneal carcinomatosis as a condition that can only be palliated. This book presents the principles that support aggressive management plans with disease eradication as an end point.
New technologies have emerged, bringing about this conceptual change in thinking. Technologies have been developed for complete chemotherapeutic treatment of all peritoneal surfaces. Technologies have been developed for uncovering minute foci of disease in remote portions of the abdomen. Also, new surgical and electrosurgical techniques are important aspects of this revised management plan. Even the data management tools required to quantitate improvements in treatment have been developed, and are presented here.
The book shows that peritoneal carcinomatosis can be treated and that complete eradication of malignancy can occur.

The book contains black-and-white illustrations.