Cytoreductive Surgery for Complications of Peritoneal Carcinomatosis

Abstract

Peritoneal carcinomatosis (PC) is detectable in 15–20% of patients with colorectal cancer (CRC) and up to 40% in patients with stage II–III gastric cancer at the time of diagnosis. In the initial treatment of PC, the surgeon’s role as key factor for the initiation and promotion of PC is essential, whereas the “natural” course of the disease is independent of iatrogenic factors. The clinical presentation and extent of PC in this case is determined exclusively by the biology of the underlying malignant disease and the time of diagnosis.

The initial phase of peritoneal migration of malignant cells is clinically asymptomatic. Indirect evidence of the presence of peritoneal-disseminated tumor disease is nonspecific and, in most cases, not pathognomonic for a tumor entity. Only local complications of the primary tumor such as pain, intestinal bleeding, obstruction, perforation, and compression or infiltration of adjacent organs accompanied by increase in abdominal circumference due to ascites and mucin production confirm the usually advanced extent of the disease. The primary goal of surgical treatment is therefore not necessarily a potentially curative intervention but the control of acute life-threatening complications, taking into account the possible yet realistic chance for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the further course of the disease.

In the following chapter, the most frequent complications in the “natural” course of PC are summarized and the treatment is discussed.