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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2016; 8(1): 67-82
Published online Jan 15, 2016. doi: 10.4251/wjgo.v8.i1.67
Multimodality treatment strategies have changed prognosis of peritoneal metastases
Corneliu Lungoci, Aurel Ion Mironiuc, Valentin Muntean, Traian Oniu, Hubert Leebmann, Max Mayr, Pompiliu Piso
Corneliu Lungoci, Aurel Ion Mironiuc, Valentin Muntean, Traian Oniu, Department of Surgery, “Iuliu Htieganu” University of Medicine and Pharmacy Cluj-Napoca, 400015 Cluj-Napoca, Cluj Province, Romania
Hubert Leebmann, Max Mayr, Pompiliu Piso, Clinic of Visceral and General Surgery, Krankenhaus Barmherzige Brueder, Academic Teaching Hospitals of the University Regensburg, 93049 Regensburg, Bavaria Province, Germany
Author contributions: Lungoci C and Piso P designed the research; Lungoci C, Oniu T, Leebmann H and Mayr M acquired the data; Lungoci C, Oniu T and Leebmann H wrote the paper; all the authors contributed to the interpretation of the data and to the revision of the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: None to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Pompiliu Piso, Professor of Surgery, Dr. Honoris Causa, Clinic of Visceral and General Surgery, Krankenhaus Barmherzige Brueder, Academic Teaching Hospitals of the University Regensburg, 86 Prufeninger Street, 93049 Regensburg, Bavaria Province, Germany. pompiliu.piso@barmherzige-regensburg.de
Telephone: +49-941-3692201 Fax: +49-941-3692206
Received: June 23, 2015
Peer-review started: June 24, 2015
First decision: August 25, 2015
Revised: September 22, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: January 15, 2016
Processing time: 204 Days and 22.6 Hours
Abstract

For a long time, treatment of peritoneal metastases (PM) was mostly palliative and thus, this status was link with “terminal status/despair”. The current multimodal treatment strategy, consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), has been strenuously achieved over time, but seems to be the best treatment option for PM patients. As we reviewed the literature data, we could emphasize some milestones and also, controversies in the history of proposed multimodal treatment and thus, outline the philosophy of this approach, which seems to be an unusual one indeed. Initially marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources (multi-center and -institutional research), over a period of 30 years, CRS and HIPEC found their place in the treatment of PM. The next 4 years were dedicated to the refinement of the multimodal treatment, by launching research pathways. In selected patients, with requires training, it demonstrated a significant survival results (similar to the Hepatic Metastases treatment), with acceptable risks and costs. The main debates regarding CRS and HIPEC treatment were based on the oncologists’ perspective and the small number of randomized clinical trials. It is important to statement the PM patient has the right to be informed of the existence of CRS and HIPEC, as a real treatment resource, the decision being made by multidisciplinary teams.

Keywords: Hyperthermic intraperitoneal chemotherapy; Peritonectomy procedures; Systemic chemotherapy; Peritoneal metastases; Survival

Core tip: The multimodal treatment of peritoneal metastases (PM), involving cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, has been strenuously achieved over time, but seems to be the best treatment option, for selected cases. This paper addresses data about the multimodal treatment strategy, focused to patient’s survival, the key indicator for assessing results, in the case of PM. Also, it were highlighted the treatment key aspects and the controversies, high in the 35 years of treatment implementing. By understanding the philosophy of multimodal treatment, physicians will be able to offer an alternative to the routine systemic chemotherapy.