Comprehensive management of peritoneal surface malignancy using cytoreductive surgery and perioperative intraperitoneal chemotherapy: the Washington Cancer Institute approach.

The peritoneal surfaces are a common site of surgical treatment failure for gastrointestinal and ovarian cancer. Progressive cancer growth at this site will result in the patient's cancer-related death. Clinical and laboratory research support new technologies to prevent disease spread to peritoneum or to treat established disease at these sites. This new treatment strategy involves a multimodality approach that combines cytoreductive surgery with perioperative intraperitoneal chemotherapy irrigations. The surgery utilizes the new surgical technique of peritonectomy, which strips away the lining of the body cavity using ball-tip electrosurgery. The surgery removes the primary cancer and any dissemination within the peritoneal cavity; the goal of the chemotherapy solution is to eradicate the microscopic residual disease. Multiple reports to date document marked survival benefits; a previously lethal condition can be cured in selected patients. Further pharmacologic research and more knowledgeable patient selection for treatment are required.