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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

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Surgical Oncology

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Abstract

Although uncommon, intra-abdominal neoplasms may spread when tumor cells seed the surrounding peritoneal surfaces. Although intraperitoneal dissemination of neoplastic cells represents a universally fatal problem that is difficult to treat, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a treatment paradigm that can prolong survival in patients with peritoneal surface disease (PSD) arising from a variety of primary tumors. The goal is the complete cytoreduction of all macroscopic disease prior to perfusion with HIPEC. Therefore, appropriate candidates are identified based not only on their ability to tolerate aggressive CRS but also the likelihood of obtaining a complete or near-complete cytoreduction. Resection is accomplished with the removal of all involved organs and peritonectomy procedures to remove tumor implants. Although morbidity and mortality are significant, our group and others have shown that CRS-HIPEC can achieve meaningful prolongation of survival with acceptable quality of life. Careful selection of patients can help ensure that only those who can expect to have the greatest benefits are subjected to the inherent risks of this treatment paradigm.

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Abbreviations

CC:

Completeness of cytoreduction

CDDP:

Cisplatin

CRC:

Colorectal cancer

CRS:

Cytoreductive surgery

CT:

Computed tomography

DPAM:

Disseminated peritoneal adenomucinosis

ECOG:

Eastern Cooperative Oncology Group

GIST:

Gastrointestinal stromal tumor

HIPEC:

Hyperthermic intraperitoneal chemo-therapy

MMC:

Mitomycin C

MRI:

Magnetic resonance imaging

OS:

Overall survival

PCI:

Peritoneal carcinomatosis index

PET:

Positron-emission tomography

PFS:

Progression-free survival

PMCA:

Peritoneal mucinous carcinomatosis

PMP:

Pseudomyxoma peritonei

PSD:

Peritoneal surface disease

ULS:

Uterine leiomyosarcoma

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Authors and Affiliations

  1. Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, 27157, NC, USA

    Reese W. Randle M.D., Konstantinos I. Votanopoulos M.D., Ph.D., Perry Shen M.D. & Edward A. Levine M.D.

  2. Department of General Surgery, Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, 27157, NC, USA

    John H. Stewart IV M.D., M.B.A.

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  1. Reese W. Randle M.D.
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  2. Konstantinos I. Votanopoulos M.D., Ph.D.
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  3. Perry Shen M.D.
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  4. Edward A. Levine M.D.
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  5. John H. Stewart IV M.D., M.B.A.
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Correspondence to John H. Stewart IV M.D., M.B.A. .

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  1. Department of Surgery, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana, USA

    Quyen D. Chu

  2. Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey, USA

    John F. Gibbs

  3. John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, Louisiana, USA

    Gazi B. Zibari

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Randle, R.W., Votanopoulos, K.I., Shen, P., Levine, E.A., Stewart, J.H. (2015). Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. In: Chu, Q., Gibbs, J., Zibari, G. (eds) Surgical Oncology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1423-4_21

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