MANAGEMENT OF
PERITONEAL SURFACE MALIGNANCY
USING
INTRAPERITONEAL CHEMOTHERAPY
AND
CYTOREDUCTIVE SURGERY


A Manual for Physicians and Nurses



Paul H. Sugarbaker, M.D., F.A.C.S.

Washington Cancer Institute

110 Irving Street NW Washington, DC 20010



Third Edition


All rights reserved. Reproduction in whole or in part by any means without permission of the author is prohibited.

French, Italian and Turkish translations are available.

Printed in the United States of America

The Ludann Company Grand Rapids, Michigan

November 1998


Supported by an educational grant from the
Foundation for Applied Research in Gastrointestinal Oncology -

FARGO

 




TABLE OF CONTENTS


Introduction
   
I. Principles of Intraperitoneal Chemotherapy
  A. Peritoneal space to plasma barrier
B. Tumor cell entrapment
C. Change in the route and timing of chemotherapy administration
D. Implementation of heated intraoperative intraperitoneal chemotherapy administration
E. Prognostic groups of patients with peritoneal carcinomatosis
F. Predicting outcome for mucinous adenocarcinoma by CT
   
II. Current Indications for Cytoreductive Surgery and Intraperitoneal Chemotherapy
  A. Large volume noninvasive adenocarcinoma
B. Sarcoma and peritoneal mesothelioma
C. Peritoneal Cancer Index
D. Completeness of Cytoreduction score
E. Successful treatment of microscopic residual disease
F. Prevention of peritoneal carcinomatosis in high risk patients
G. Debilitating malignant ascites
   
III. Heated Intraoperative Intraperitoneal Chemotherapy by the Coliseum Technique
   
IV. Immediate Postoperative Abdominal Lavage in Preparation for
  Early Postoperative Intraperitoneal 5-Fluorouracil
   
V. Early Postoperative Intraperitoneal Chemotherapy for Adenocarcinoma
   
VI. Induction Intraperitoneal Chemotherapy and Treatment for Debilitating Ascites
   
VII. Cytoreductive Surgery for Peritoneal Surface Malignancy - Peritonectomy Procedures
  A. Position and incision
B. Abdominal exposure, greater omentectomy and splenectomy
C. Left upper quadrant peritonectomy
D. Right upper quadrant peritonectomy
E. Lesser omentectomy and cholecystectomy
F. Pelvic peritonectomy with resection of the rectosigmoid colon
G. Antrectomy and gastric reconstruction
H. Total gastrectomy and reconstruction
I. Tubes and drains required for heated intraoperative and early postoperative intraperitoneal chemotherapy
   
VIII. Results of Treatment of Peritoneal Surface Malignancy
   
IX. Conclusions
   
References




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