Peritoneal carcinomatosis from adenocarcinoma of the colon

Abstract

Adenocarcinoma of the large bowel is one of the most common cancers and occurs in about 1 person in 20 in the United States and in most westernized countries [1]. The major anatomic sites for colorectal cancer dissemination are lymphatic metastases to the lymph nodes, hematogenous metastases to the liver, and cancer spread to the peritoneum. Peritoneal dissemination of colon cancer cells is a common cause of morbidity and eventual mortality with recurrent disease and may result in intestinal obstruction, symptomatic ascites, and intestinal fistulization. Peritoneal carcinomatosis from colon cancer is a clinical entity characterized by peritoneal implants of the tumor in the resection site, on the peritoneal surface, or, most commonly, at both of these anatomic locations. Cass and coworkers reported that two thirds of patients with colorectal malignancy have local-regional recurrence [2]. Peritoneal carcinomatosis has, to this point in time, been regarded as a lethal condition. Most of the patients with peritoneal implantation have a limited survival of approximately 9 months [3]. In an attempt to critically evaluate a treatment plan for patients with peritoneal carcinomatosis from colon cancer, 56 patients were retrospectively studied. The new surgical treatment strategy utilized cytoreductive surgery, an aggressive treatment strategy using laser mode electrosurgery to achieve a disease-free margin of resection. Cytoreductive surgery was combined with early postoperative intraperitoneal chemotherapy at least three cycles of delayed intraperitoneal and systemic chemotherapy [4–9].