PERITONECTOMY PROCEDURES

Objective New surgical procedures designed to assist in the treatment of peritoneal surface malignancy were sought. Background Decisions regarding the treatment of cancer depend on the anatomic location of the malignancy and the biologic aggressiveness of the disease, Some patients may have isolated intra-abdominal seeding of malignancy of limited extent or of low biologic grade. In the past, these clinical situations have been regarded as lethal. Methods The cytoreductive approach may require six peritonectomy procedures to resect or strip cancer from all intra-abdominal surfaces. Results These are greater omentectomy-splenectomy; left upper quadrant peritonectomy; right upper quadrant peritonectomy; lesser omentectomy-cholecystectomy with stripping of the omental bursa; pelvic peritonectomy with sleeve resection of the sigmoid colon; and antrectomy. Conclusions Peritonectomy procedures and preparation of the abdomen for early postoperative intraperitoneal chemotherapy were described. The author has used the cytoreductive approach to achieve longterm, disease-free survival in selected patients with peritoneal carcinomatosis, peritoneal sarcomatosis or mesothelioma.