Gastrointestinal malignancy: rationale for adjuvant therapy using early postoperative intraperitoneal chemotherapy.

The treatment of gastrointestinal cancer and the prognosis of patients with this disease have changed very little over the past several decades. No screening tools have been developed which allow this disease to be surgically treated for cure at an early stage. None of the forms of adjuvant chemotherapy instituted in the months and years after surgical resection of cancer have been successful. We show that resection site recurrence and spread of disease on the peritoneal surfaces are the most common sites for surgical treatment failure. By changing the route of administration and the timing of chemotherapy, the efficacy of drugs now routinely employed in gastrointestinal cancer can be markedly improved. Our early studies suggest that there is a definite change in the natural history of these malignancies when intraperitoneal chemotherapy is administered immediately after surgery. The pharmacology and physiology of drug delivery in the immediate postoperative period are explored. Toxicity studies have been performed in a series of treatment protocols already in use. These protocols need to be subjected to randomized controlled trials in the near future.