Rationale for Integrated Procedures: Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Combined

  • Paolo Sammartino
  • Fabio Accarpio
  • Tommaso Cornali
  • Daniele Biacchi
  • Maurizio Cardi
  • Giammaria Fiorentini
Chapter
Part of the Updates in Surgery book series (UPDATESSURG)

Abstract

Diffuse peritoneal malignancy raises major therapeutic problems and puts the patient’s life at high risk. In the past, systemic chemotherapy regimens functioned as a purely palliative approach, and palliative surgery aimed merely at reducing the symptoms, being unable to alter the natural course of the disease [1]. At the beginning of the 1990s, thanks to Sugarbaker’s pioneering efforts, research began to develop integrated procedures for treating peritoneal surface malignancies based on a therapeutic approach. This approach involved cytoreductive surgery (CRS) (peritonectomy procedures) combined with perioperative intraperitoneally administered chemotherapy (IP-CHT)—eventually integrated with hyperthermia—done immediately after surgical cytoreduction ended [hyperthermic intraperitoneal chemotherapy (HIPEC)], or during the early postoperative course [early postoperative intraperitoneal chemotherapy (EPIC)] [2]. The therapeutic rationale underlying integrated treatment originates from advances in systemic chemotherapy and improved knowledge about the pharmacological mechanisms underlying endoperitoneal drug delivery. The rationale for cancer chemotherapy hinges upon several well-known theoretical hypotheses. According to the Gompertzian cellular kinetic model (the tumor-growth profile can be depicted as an S-shaped curve), a tumor initially grows slowly and then rapidly becomes fast growing [3]. As the tumor enlarges, its blood supply and growth slows down, and a larger tumor cell percentage gradually enters a nonproliferative cell-cycle stage (Fig. 8.1).

Keywords

Peritoneal Carcinomatosis Interstitial Fluid Pressure Hyperthermic Intraperitoneal Chemotherapy Malignant Peritoneal Mesothelioma Early Postoperative Intraperitoneal Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  • Paolo Sammartino
    • 1
  • Fabio Accarpio
  • Tommaso Cornali
  • Daniele Biacchi
  • Maurizio Cardi
  • Giammaria Fiorentini
  1. 1.Department of Surgery “Pietro Valdoni”Sapienza University of RomeRomeItaly

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