The rationale of perioperative intraperitoneal chemotherapy in the treatment of peritoneal surface malignancies.

In summary, the use of perioperative intraperitoneal chemotherapy is a rational and scientifically sound treatment option for patients with peritoneal carcinomatosis. By delivering chemotherapeutic agents directly into the peritoneal cavity in the perioperative period, after cytoreductive procedures resulting in minimal residual tumor load, the cytotoxicity, efficacy, and safety of these agents can be maximized. The use of this treatment strategy in the intraoperative or perioperative period ensures that the efficacy of the chemotherapeutic agents is not reduced by limitations of abdominal compartmentalization and scarring. Treating patients under hyperthermic conditions may confer an additional benefit. Although the use of perioperative chemotherapy or hyperthermic intraperitoneal chemotherapy is not yet part of the standard of care for the treatment of advanced abdominal malignancies, both basic science and clinical investigations have confirmed the validity of these regimens. Further clinical studies in a cooperative group setting are necessary to prove the efficacy of perioperative intraperitoneal chemotherapy in both the treatment and prevention of peritoneal surface malignancy.