Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer
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BioMed Central
Open Access
Review
Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer Rhonda L Harmon and Paul H Sugarbaker* Address: Washington Cancer Institute, Washington Hospital Center, 110 Irving St., NW, Washington, DC, 20010 USA Email: Rhonda L Harmon - [email protected]; Paul H Sugarbaker* - [email protected] * Corresponding author
Published: 08 February 2005 International Seminars in Surgical Oncology 2005, 2:3
doi:10.1186/1477-7800-2-3
Received: 18 November 2004 Accepted: 08 February 2005
This article is available from: http://www.issoonline.com/content/2/1/3 © 2005 Harmon and Sugarbaker; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Carcinomatosisprognostic indicatorsperitonectomycytoreductive surgerycolorectal cancergastric cancerintraperitoneal chemotherapy.
Abstract Peritoneal carcinomatosis from gastrointestinal cancer has new treatment options for surgical management. The approach uses cytoreductive surgery which combines peritonectomy and visceral resection in an effort to remove all visible cancer within the abdomen and pelvis. Then the peritoneal cavity is flooded with chemotherapy solution in an attempt to eradicate residual disease. In order to select patients for this approach the quantitative prognostic indicators for carcinomatosis were reviewed, compared and contrasted. Prognostic indicators to be used to select patients for this aggressive approach at the initiation of surgery and after completion of cytoreduction were studied. Four quantitative assessments to be used at the time of abdominal exploration were the Gilly staging, Japanese gastric cancer P score, peritoneal cancer index (PCI), and the simplified peritoneal cancer index (SPCI). All have value with the PCI being the most validated and most precise. Preoperative assessments include the tumor histopathology and the prior surgical score. The completeness of cytoreduction score is an assessment of residual disease after a maximal surgical effort. An opportunity for long-term survival following treatment for carcinomatosis requires a complete cytoreduction in all reports for gastrointestinal cancer. Quantitative prognostic indicators need to be knowledgeably employed when patients with carcinomatosis are being treated. Improved patient selection with greater benefit and reduced morbidity and mortality should result.
I. Introduction Peritoneal carcinomatosis has always been regarded as a terminal condition. It is present in 10 to 30% of patients with gastrointestinal cancer at the time of their initial surgery and is a frequent finding in patients who develop recurrent cancer. Important natural history studies establish a 6-month median survival in this group of patients [1-3]. Recent multicenter phase II and a single phase
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