Surgical treatment of peritoneal carcinomatosis: 1988 Du Pont lecture.

Tumour spread onto peritoneal surfaces is frequent in patients who have recurrent gastrointestinal cancer. In this study the author describes (a) a cytoreductive surgical technique of ball-tipped electrocautery dissection, which can rapidly and definitively remove large volumes of intra-abdominal tumour, (b) a procedure for immediate postoperative lavage of the abdominal cavity to remove blood and tissue debris, and (c) a regimen of early and delayed intraperitoneal chemotherapy to destroy small quantities of residual cancer cells on intra-abdominal surfaces. Forty-seven patients underwent cytoreductive surgery to remove large volumes of adenocarcinoma widely disseminated through the abdomen. Most patients had intraperitoneal chemotherapy to destroy small volumes of cancer remaining within the abdomen. In the absence of previous radiotherapy, one patient died and the morbidity was acceptable. In eight patients who received radiotherapy, seven had bowel perforation and one died. Surprisingly, the majority of patients who had cytoreductive surgery plus intraperitoneal chemotherapy had disease-free long-term survival. In patients with peritoneal carcinomatosis, long-term disease-free survival correlated with low tumour aggressiveness, adequate cytoreductive surgery and the use of intraperitoneal chemotherapy.