- Pseudomyxoma peritonei (PMP)
Pseudomyxoma peritonei is a rare tumor characterised by the accumulation of mucinous deposits throughout the abdominal cavity. Symptoms are non-specific and usually do not develop until the disease is quite advanced. The most common primary tumor associated with PMP is a mucinous tumor of the appendix called LAMN (low grade mucinous appendiceal neoplasm) or HAMN (high-grade mucinous appendiceal neoplasm). Cytoreductive surgery with HIPEC is extremely successful and the preferred treatment for PMP. Thanks to the development of CRS and HIPEC, PMP has changed from an incurable disease to a condition associated with long-term survival or cure for the majority of patients.
There are other types of tumors of the appendix associated with a high risk of peritoneal involvement such as adenocarcinoma of the appendix, Goblet-cell carcinomas, neuroendocrine tumors and others. Unlike PMP, where CRS and HIPEC is not only the primary but often the only recommended treatment, these tumors are often treated with systemic chemotherapy in addition to CRS and HIPEC.
- Ovarian cancer
Ovarian cancer is a malignant tumor of the ovary or the Fallopian tube that has already spread to the peritoneum at the time of diagnosis in the majority of patients. Complete macroscopic removal of all tumor deposits during primary surgery is particularly important in this disease as it is strongly associated with survival. For patients with advanced ovarian cancer, cytoreductive surgery performed by a peritoneal surface malignancies specialist may offer the best chance for complete tumor removal. The addition of heated intraperitoneal chemotherapy (HIPEC) has been shown to further improve survival in patients undergoing interval cytoreduction as demonstrated in randomized clinical trials.
- Peritoneal mesothelioma
Malignant peritoneal mesothelioma (DMPM) is a primary cancer of the peritoneal lining. Although very rare, its incidence has been increasing and in some cases it is associated with asbestos exposure. Prior to the development of cytoreductive surgery and HIPEC, peritoneal mesothelioma had a dismal prognosis as the only available treatment was palliative chemotherapy which has a low response rate. Nowadays, cytoreductive surgery with HIPEC is the preferred treatment for all patients who are surgical candidates and it is associated with a 5-year survival rate greater than 50%.
- Colorectal cancer
Colorectal cancer is one of the most frequent malignancies in developed countries. Approximately 5-10% of patients with colorectal cancer will develop peritoneal metastases either at the time of diagnosis or during the course of the disease in the form of peritoneal recurrence. Cytoreductive surgery for peritoneal metastases of colorectal cancer can give some patients the chance for cure and significantly prolongs survival in other patients compared to treatment with systemic chemotherapy alone. A surgeon specialised in peritoneal malignancies can determine if cytoreductive surgery is indicated based on a series of factors such as molecular profile of the tumor, the extent of peritoneal involvement and prior treatments.
- Gastric cancer
Gastric cancer is a malignant tumor that starts in the stomach but quickly spreads to other areas such as the lymph nodes, liver and peritoneum in the majority of patients. Due to the fact that it is biologically a more aggressive tumor compared to other peritoneal malignancies, the criteria for cytoreductive surgery are more restrictive. For patients who are not candidates for cytoreductive surgery, PIPAC can offer encouraging results. In some patients, PIPAC can even induce significant enough reduction in the extent of peritoneal metastasis to permit subsequent cytoreductive surgery.
- Other tumors
Many other tumors of the gastrointestinal and genitourinary tract can cause peritoneal metastases. In some of these tumors, cytoreductive surgery with HIPEC and/or PIPAC may be an indicated treatment.The evaluation of an expert and experienced surgeon and a multidisciplinary team specialized in the treatment of peritoneal malignancies is of paramount importance in these cases.
