Carcinomatosis from gastrointestinal cancer.

Gastrointestinal cancer has in the past been regarded as a lethal extension of the malignant process. Natural history studies have confirmed that this is so in the absence of special treatments. Recently, a combined treatment approach which utilizes cytoreductive surgery to remove all visible disease within the abdomen and pelvis followed by perioperative intraperitoneal chemotherapy has demonstrated success in phase II and phase III studies. The greatest benefit has been seen with appendiceal malignancy with cure rates approaching 80%. Also, colon cancer has been cured in approximately 30% of patients with complete removal of tumor by cytoreductive surgery. The morbidity and mortality of these procedures compares well with other gastrointestinal cancer operations. One may conclude that selected patients with carcinomatosis should expect longterm survival with a combined treatment approach using cytoreductive surgery with perioperative intraperitoneal chemotherapy.