Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for mucinous tumors of the gastrointestinal tract

The peritoneal cavity is the largest potential space in the body. With its own lymphatic and vascular systems, it is critical to appreciate the biology of the peritoneum to better understand how disease may spread. For example, benign or low-grade malignancies may spread along the peritoneal surface by exploiting the lymphatic flow patterns of peritoneal fluid. Any pathologic process involving the peritoneal cavity can easily disseminate throughout this space by means of unrestricted movement of fluid and cells. These varied mechanisms of disease spread necessitate a range of therapeutic options including the administration of intra-abdominal chemotherapies. In the past, cancer dissemination to peritoneal surfaces (i.e., carcinomatosis) was universally lethal with limited survival. Peritoneal carcinomatosis constitutes 10-12% of colorectal cancer metastases and 40% of gastric cancer metastases. This chapter discusses the peritoneal surgical treatment options for mucinous peritoneal tumors of the gastrointestinal tract. Cytoreductive surgery (CRS) entails removing all visible disease within the abdomen. This is followed by administration of hyperthermic intraperitoneal chemotherapy (HIPEC). CRS/HIPEC has become a well-recognized, standardized method in a select patient population for treatment of mucinous carcinomatosis. An approach to this treatment strategy is detailed in this chapter. Though CRS/HIPEC by experienced surgeons has increased survival for patients with primary peritoneal cancers and peritoneal metastases, multimodality treatment options must always be considered.