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World J Gastrointest Oncol. Jan 15, 2010; 2(1): 36-43
Published online Jan 15, 2010. doi: 10.4251/wjgo.v2.i1.36
Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Dario Baratti, Shigeki Kusamura, Barbara Laterza, Maria Rosaria Balestra, Marcello Deraco
Dario Baratti, Shigeki Kusamura, Barbara Laterza, Maria Rosaria Balestra, Marcello Deraco, Department of Surgery, National Cancer Institute, Via Venezian 1, 20133 Milan, Italy
Author contributions: Deraco M, Baratti D and Kusamura S designed the research; Baratti D wrote the paper; Balestra MR, Laterza B contributed to data collection. All authors approved the manuscript.
Correspondence to: Marcello Deraco, MD, Department of Surgery, Fondazione IRCCS, Istituto Nazionale Tumori Milano, Via Venezian 1, 20133 Milan, Italy.
Telephone: +39-2-23902362 Fax: +39-2-23902404
Received: July 2, 2009
Revised: August 31, 2009
Accepted: September 7, 2009
Published online: January 15, 2010

Peritoneal surface malignancies have been traditionally regarded as end-stage conditions amenable to merely palliative options. The combination of aggressive cytoreductive surgery (CRS), involving peritonectomy procedures and multivisceral resections, with intra-operative hyperthermic intra-peritoneal chemotherapy (HIPEC) and/or early postoperative intra-peritoneal chemotherapy (EPIC) to treat the microscopic residual tumor is a new concept. In recent years, promising results have been reported for peritoneal mesothelioma and carcinomatosis of gastrointestinal and gynaecologic origin treated by this combined protocol. However, CRS with HIPEC and/or EPIC is a complex procedure associated with high rates of potentially life-threatening complications. Furthermore, disease progression following comprehensive treatment is not uncommon and represents a relevant cause of treatment failure. The present paper reviews the available information on early postoperative management and long-term follow-up in patients treated with CRS and intraperitoneal chemotherapy. The peculiar clinical and biological alterations that can be expected during an uncomplicated postoperative course, as compared to standard digestive surgery, are discussed. Early recognition and appropriate management of the most common adverse events are addressed, in order to minimize the impact of treatment-related morbidity on survival and quality of life results. Since re-operative surgery with additional HIPEC, has proven to be useful in selected patients with recurrent disease, long-term surveillance aiming at early detection of postoperative disease progression has become a relevant issue. Current results on follow-up investigations are presented.

Keywords: Peritoneal surface malignancies, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Hyperthermic intra-peritoneal chemotherapy, Follow-up