This book reviews current research in peritoneal malignant dissemination, from its pathogenesis and molecular mechanisms to the latest clinical trials. The book covers the essentials of perioperative intraperitoneal chemotherapy and modern histopathological assessment of peritoneal surface malignancy. The book’s historical perspective on the unfolding of new knowledge points the way for future research. Contributors include leading experts, among them the pioneers who gave birth to this new era in oncology.

This issue of the Surgical Oncology Clinics of North America, Guest Edited by Dr. Jesus Esquivel, will focus on the current status and future directions of the treatment of the most common peritoneal surface malignancies: appendix cancer, colorectal cancer, ovarian cancer, gastric cancer, and peritoneal mesothelioma. This issue will also outline some of the most common issues that arise regarding cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), such as pharmacokinetic rationale of heat and intraperitoneal chemotherapy, HIPEC techniques and safety considerations, how to start a peritoneal surface malignancy program, anesthesia considerations during cytoreductive surgery and HIPEC, patient selection for cytoreductive surgery and HIPEC, and the role of dystemic chemotherapy in the management of peritoneal surface malignancies of appendiceal and colorectal origin.

The widespread acceptance among the oncology community at large of cytoreductive surgery and HIPEC as a potentially curative treatment for peritoneal metastases has paved the way for innovative new therapies that could benefit a larger proportion of patients. Much has been and continues to be published on this subject. This book provides comprehensive reviews on the various aspects of managing peritoneal metastases. The authors highlight essential practical issues that surgical oncologists encounter in their day-to-day practice, and try to before provide evidence based answers to address them. All chapters were written and/or reviewed by leading experts in this field.

This book has been designed to provide the full description of the comprehensive management of peritoneal surface malignancies as a new emerging specialty. Combined treatment of cytoreductive surgery (CRS) and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) introduced by our leader Paul H. Sugarbaker are performed to treat peritoneal metastases by surgeons all around the world. Therefore this book is focused on detailed surgical anatomy of the peritoneum, preoperative clinical assessment of the peritoneal surface malignancy, patient preparation and operation room equipments, different surgical procedures for CRS and reconstruction, intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and neoadjuvant intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy (EPIC) and molecular basis of peritoneal surface malignancies. The chapter on molecular mechanisms of the formation of peritoneal carcinomatosis provides insight into a rapidly expanding knowledge within this speciality. This book should be valuable for surgical oncologists who deal with multimodal treatment for peritoneal surface malignancies, as well as for the trained peritonectomy surgeons. For the senior surgeons, it will also introduce new techniques and approaches in this field such as dealing with the omental cakes and massive organ involvement that requires multi-organ resection.

Peritoneal surface malignancies (PSM) include a heterogeneous group of primary tumors, like peritoneal mesothelioma, and peritoneal metastases from various origins such as ovarian, gastric, colorectal, or appendicular cancers. Their pathophysiology is complex and still not fully elucidated. Historically, due to their dismal prognosis, peritoneal surface malignancies were considered a terminal condition and treated as such in palliative intent.. Surgery has become pivotal in the treatment of PSM and the development of specific techniques of cytoreductive surgery (peritonectomies, “en-bloc” resection) open up a new era of curative intent treatments.

This monograph summarizes state of the art knowledge regarding peritoneal surface malignancies, with in-depth description of treatment options and the results achieved to date. It explores the most challenging problems on the basis of the authors’ very extensive clinical experience and examines the most relevant clinical trials. A comprehensive summary is provided of all phase 2 studies (the only available completed studies) and of ongoing and future phase 3 studies. Particular attention is paid to the results of integrated treatment comprising cytoreduction (peritonectomy) and hyperthermic intraperitoneal chemotherapy (HIPEC). Helpful background information is also included on the definition and clinical assessment of each clinical form. The book, drawing on data from the entire Italian experience as well as world literature, will be an outstanding benchmark for health professionals and researchers.

This issue of Surgical Oncology Clinics of North America, guest edited by Dr. Edward A. Levine, is devoted to Treatment of Peritoneal Metastasis. Dr. Levine has assembled expert authors to review the following topics: History of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy; Imaging for peritoneal metastases; Patient selection for cytoreductive surgery; Pharmacodynamics and pharmacokinetics of intraperitoneal chemotherapy; Genomics and peritoneal metastases; Techniques and safety issue for intraperitoneal chemotherapy; Learning curve for cytoreductive surgery; Peritoneal metastases from gastric cancer; Peritoneal metastases from mesothelioma; Peritoneal metastases from appendiceal cancer; Peritoneal metastasis from colorectal cancer; Peritoneal metastases from ovarian cancer; Palliative care of advanced peritoneal disease; and more!

This book covers some well-known and some unexplored pathological aspects of management of peritoneal metastases and should be read by both surgeons and pathologists involved in the management of peritoneal surface malignancies. The evaluation of cytoreductive surgery specimens is explored for the prognostic information it can provide and recommendations for evaluation of such specimens are provided. The pathways and patterns of peritoneal dissemination and their clinical implications on the extent of surgery performed and other aspects of management are discussed for some common peritoneal tumours. The exploratory studies presented here provide a new perspective on the surgical resection of peritoneal metastases. Other important aspects of pathological evaluation like pathological response to chemotherapy, diagnosis and classification of rare peritoneal tumors have also been covered in different chapters. Keeping in sync with the progress in molecular oncology, the role of molecular oncology in the current and future management of peritoneal metastases is addressed for different tumors.

This issue of the Surgical Oncology Clinics of North America, Guest Edited by Dr. Jesus Esquivel, will focus on the current status and future directions of the treatment of the most common peritoneal surface malignancies: appendix cancer, colorectal cancer, ovarian cancer, gastric cancer, and peritoneal mesothelioma. This issue will also outline some of the most common issues that arise regarding cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), such as pharmacokinetic rationale of heat and intraperitoneal chemotherapy, HIPEC techniques and safety considerations, how to start a peritoneal surface malignancy program, anesthesia considerations during cytoreductive surgery and HIPEC, patient selection for cytoreductive surgery and HIPEC, and the role of dystemic chemotherapy in the management of peritoneal surface malignancies of appendiceal and colorectal origin.

This is the first volume to provide a multidisciplinary approach to peritoneal carcinomatosis encompassing molecular mechanisms, histopathology, regional and systemic cytotoxic therapy, and surgical options. Illustrations aid the reader throughout in the many facets of this disease. The book will be of particular interest for medical, surgical and gynecological oncologists faced with the complexities of decision making in patients suffering from PC.