The peritoneal cavity
must be oncologically considered as an organ in its own right and peritoneal
metastases (PM)
must be treated with the sa
me curative intent (and the sa
me results) as liver
metastases. The package co
mbining co
mplete cytoreductive surgery (CCRS) (treating the visible disease) plus hyperther
mic intraoperative peritoneal che
motherapy (HIPEC) (treating the re
maining non-visible disease) achieves cure in
many patients. Twenty years of publication allow us to asse
mble sufficient background infor
mation and data to point out the good and poor indications for CCRS + HIPEC.
m>HIPEC is the standard of carem> for the treatment of peritoneal pseudomyxomas and peritoneal mesotheliomas and also, recently for the treatment of colorectal PM with limited peritoneal extension.
m>HIPEC is in the evaluation phasem> for gastric PM and ovarian PM after initially disappointing results, but it is highly probable that it will be useful in particular settings. PM from neuroendocrine tumours are in the same situation.
m>HIPEC is not currently indicated for the treatmentm> of PM from sarcomas, from GIST, and for small round-cell desmoplastic tumours, given the poor results obtained.
m>HIPEC can be useful, on a case-by-case basis, to treat rare tumoursm> complicated by isolated peritoneal diffusion (e.g. Frantz鈥檚 tumours).
HIPEC can be used in the prophylactic setting to prevent PM in patients with a high risk of developing PM, and the first results of the 鈥榮econd-look鈥?approach are promising.
Finally, CCRS + HIPEC appear to be indispensable tools in the oncologist鈥檚 armentarium.