2 The condition, current treatments and procedure
2.1 Peritoneal carcinomatosis is an advanced form of cancer resulting from the regional spread of gastrointestinal, gynaecological and other malignancies. It is associated with short survival and poor quality of life. It may lead to bowel obstruction, ascites and pain.
2.2 Current standard management includes treating complications such as bowel obstruction using systemic chemotherapy (alone or with surgery), closed peritoneal instillation of chemotherapy or surgery alone.
2.3 Cytoreduction surgery is done to remove all macroscopic tumours within the abdominal cavity. Hyperthermic intraoperative peritoneal chemotherapy is then used to distribute a chemotherapeutic drug uniformly to all surfaces within the abdominal cavity and to increase drug penetration. This is done to treat any remaining microscopic traces of the cancer. The aim is to reduce symptoms, extend survival and improve quality of life.
2.4 Using general anaesthesia, a laparotomy is done and all macroscopic tumour is removed, with resection of involved organs and stripping of the tumour from the surface of some organs and peritoneum. The surgery is extensive and complex. It is followed by perfusion of the abdominal cavity with a heated (between 40 and 48°degrees Celsius) chemotherapy solution for 30 to 120 minutes, with the abdomen open or closed. The fluid is drained from the abdominal cavity before closure. A further course of systemic or early postoperative intraperitoneal chemotherapy may be administered.