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ASCO Educational Book; 2008
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Overview of Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Dissemination of Appendiceal and Colorectal Neoplasms

Edward A. Levine, MD, Brigitte M. Ronnett, MD, Paul F. Mansfield, MD, and Cathy Eng, MD

From the Surgical Oncology Service, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Departments of Pathology and Gynecology & Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and the Departments of Gastrointestinal Medical Oncology and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Authors' disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Cathy Eng, MD, Assistant Professor, Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Unit 426, 1515 Holcombe Boulevard, Houston, TX 77030-1402; e-mail: ceng{at}mdanderson.org

Overview: Management of peritoneal disease originating from the appendix and colon — two distinct entities — is challenging to the treating physician. Appendiceal neoplasms tend to run a fairly indolent course and only involve peritoneal disease. In contrast, colorectal peritoneal disease often includes multiorgan involvement. Regardless of origin, these patients will face a high risk of bowel obstruction and early mortality. Hence, optimal therapy for these patients is often debated. There has been increasing interest in treating appendiceal carcinoma with peritoneal dissemination with cytoreductive surgery (CRS) and intraperitoneal hyperthermic chemotherapy (HIPEC). Long-term survival is possible in the majority of appendiceal patients who are treated with CRS and HIPEC, as demonstrated in literature, and aggressive treatment should be considered for all appendiceal neoplasms. Multidisciplinary expertise is a prerequisite and may significantly affect treatment and outcome. Histologic grade and completeness of resection are the strongest prognostic indicators. In contrast, the role of CRS and HIPEC is not clearly defined for peritoneal dissemination of colorectal cancer but may be beneficial in selected patients. Regardless, CRS and HIPEC are formidable operative procedures and are best approached by an experienced team. Although the role of systemic chemotherapy and biologic therapies in advanced colorectal cancer is well substantiated, their role in focal peritoneal dissemination of both colorectal and appendiceal neoplasms has not been determined.