Role of cytoreductive surgery and HIPEC in the management of peritoneal surface malignancies

Abstract

thermic intraperitoneal chemotherapy (HIPEC) is an effective option for peritoneal malignancies. Primary peritoneal malignancies are rare carcinomas with serous type being the most common. PM spreads through 4 pathways: direct spread via the serosa, lymphatic spread, ascitic fluid redistribution characteristic of pseudomyxoma and ovarian cancer, and hematogenous route used by intra- and extra-abdominal tumors. CRS involves peritonectomy and visceral resections aiming for no residual disease or nodules no larger than 2.5 mm. HIPEC is ineffective for tumor nodules >2.5mm. Electrosurgery is an effective technique to minimize tumor cell dissemination, crucial for the success of HIPEC. Purpose of the study. This literature review aims to evaluate the principles underlying CRS and HIPEC, and the criteria for appropriate patient selection. It also addresses the challenges and contraindications associated with these procedures to optimize patient outcomes. Material and methods. A literature review using full-text articles on PubMed, World journal of gastroenterology, HHS, Asia Journal of Surgery, International Journal of Surgery and several other articles using the relevant Keywords: Results. This underscores the need for fastidious patient selection criteria with main prognostic indicators being, histopathology, imaging findings, PCS (<12-15) and CCR. While CRS and HIPEC can significantly improve survival rates in selected patients, the procedure’s intricacy calls for a skilled surgical team and comprehensive preoperative assessment. Conclusion. CRS and HIPEC embody a potent combination for treating peritoneal malignancies, provided patient selection is meticulously conducted based on established prognostic indicators and systemic health evaluation. Procedural success relies heavily on surgical expertise, effective teamwork, and rigorous adherence to the principles of oncologic surgery.