Recurrent intraabdominal cancer causing intestinal obstruction: Washington Hospital Center experience with 42 patients managed by surgery and intraperitoneal chemotherapy.

Reoperative surgery was used as a treatment for patients with recurrent obstructing cancer. In this group of patients intraperitoneal chemotherapy was used in an attempt to prolong the beneficial effects of treatment. This aggressive approach may be recommended irrespective of patient performance status if the patient is not terminally ill. This treatment was associated with a high rate of postoperative complications (55%) but low mortality (7%). To avoid or reduce the incidence of postoperative complications, this treatment should be performed only by an experienced surgical oncologist. Long-term benefits of this treatment were related to biologic factors reflected by cancer origin in the appendix, low-grade tumor histopathology, and a free interval of > 2 years. Treatment-related factors were completeness of cytoreduction and administration of intraperitoneal chemotherapy. The best outcome was achieved with pseudomyxoma peritonei of appendiceal origin with a time interval between surgeries of 2 or more years, a complete cytoreduction, and treatment with intraperitoneal chemotherapy. This treatment modality can be recommended for palliation of patients with recurrent obstruction due to other gastrointestinal and ovarian malignancies, although, long-term results may not be so encouraging as with appendix tumors. In the group of colorectal cancer patients treated by aggressive reoperative surgery and intraperitoneal chemotherapy, 35.3 percent survived 1 year, which differs significantly from the 4-5 month survival after treatment by the standard approach.