History Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis and Evolution and Contemporary Application in Peritoneal Mesothelioma

Abstract

Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) involves resecting affected organs to remove macroscopic disease along with the administration of intraoperative chemotherapy to treat microscopic disease. Key principles include removing all macroscopic disease and then administering heated mitomycin C or a platinum-based chemotherapeutic agent intraperitoneal for 90–120 minutes intraoperatively. The addition of hyperthermia is synergistic, increasing cytotoxicity of the chemotherapeutic agent, and given the properties of peritoneal cavity, this treatment adds minimal toxicity. CRS/HIPEC has demonstrated utility in cancers that spread in the peritoneal cavity (peritoneal surface malignancies/peritoneal metastasis) and has demonstrated benefits in cancers arising from the ovarian, appendiceal, colon, as well as peritoneal mesothelioma.

Malignant peritoneal mesothelioma (MPM) is a rare but aggressive malignancy with a life expectancy of 4–12 months if left untreated. Efforts to treat and control MPM with intravenous chemotherapies alone have not dramatically improved outcomes for patients. These tumors spread and grow on the surface of abdominal organs often leading to symptoms for patients. Surgery, specifically cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC), has emerged as therapy that can resolve or prevent symptoms, extend survival, and yield long-term remission. Published data reports median survival following CRS/HIPEC of 40–100 months. This chapter briefly reviews the history CRS/HPEC and the utilization of CRS/HIPEC for MPM. Additionally the factors in patient selection and tools for preoperative assessment are reviewed. Similarly, how these factors influence not only patient selection for surgery but also the prognostic value in survival outcome are described.