12/05/2020
Since the 1980s a concept emerged based on the revised hypothesis that peritoneal metastases may exist as a locoregional disease and therefore warrants a locoregional therapeutic approach. Now the term "carcinomatosis" has been abandoned and cancer spread in the peritoneal space is now referred as Peritoneal Surface Malignancies (PSM) including primary or metastatic peritoneal tumours. The peritoneal metastatic cascade (seed and soil) occurs for example when a gastrointestinal tumor invades the serosa and the detachment of tumor cells transmigrate to the peritoneum and invades the omental milky spots or subperitoneal tissue exposed during resection. The combined approach in the treatment of PSM includes Cytoreductive surgery (Peritonectomy procedures) with the aim of complete clearing of the abdomen and pelvis and Perioperative chemotherapy (HIPEC/Bidirectional) for preservation of the surgical clearing and eliminating microscopic disease. Cytoreductive surgery includes five peritonectomy procedures and several combined visceral resection. Perioperative chemotherapy frequently hyperthermic meets pharmacokinetic and pharmacodynamic reasons combining local therapeutic effects and limited systemic toxicity. Pseudomixoma peritonei (PMP) from appendiceal malignancy, Malignant peritoneal mesothelioma (MPM) and peritoneal metastases from ovarian, colorectal and gastric cancer are the main indications for combined treatment of PSM.