Paul Sugarbaker and his colleagues have persevered in the study and treat ment of peritoneal carcinomatosis. The peritoneal cavity has many unique and incompletely appreciated properties. These properties, coupled with the biologic behavior of many cancers, results in the seeding and growth of these cancers on the peritoneum. Many of these cancers remain localized to the peritoneum only, never metastasizing to other sites. One possible reason for this may be the obstruction of the afferent lymphatics on the undersurface of the diaphragm. The mucopolysaccharides produced by many of these neoplasma are probably viscous enough to obstruct these lymphatics, leading to the syndrome of pseudomyxoma peritonei. Many of the neoplasms taking residence on the peritoneum have extremely long cell-cycle times and are resistant to radiotherapy and many chemotherapeutic agents. How ever, much can be done for these patients - resection of primary cancers, omentectomies to reduce ascites formation, management of recurrent ascites, management of intestinal obstruction, nutritional care, and, hopefully, intraperitoneal chemotherapy. We have reviewed many of these problems in the past [1-7]. Dr. Sugarbaker and his colleagues have organized the current state of knowledge and technology for continuing use. The book provides a basis for thoughtful, prospective research planning. John S. Spratt, M. D. , F. A. C. S. Professor of Surgery The James Graham Brown Cancer Center University of Louisville Louisville, Kentucky References 1. Long RTL, Spratt JS, Dowling E.

Klappentext

The dissemination of cancer on peritoneal surfaces has hitherto been regarded as a terminal condition. Only a few patients with ovarian cancer - a disease where there is extreme drug sensitivity - have been maintained in a disease-free state over the long term. The tumour biology questions are as follows: Is the dissemination of cancer on peritoneal surfaces to be regarded as finite spread of malignancy, or as evidence of systematic disease? Is peritoneal carcinomatosis in selected patients a limited process that can be treated for cure, using surgery and chemotherapy? Can treatments lead to a complete resolution of the cancerous process? Most oncologists would regard peritoneal carcinomatosis as a condition that can only be palliated. This book presents the principles that support aggressive management plans with disease eradication as an end point. br/ New technologies have emerged, bringing about this conceptual change in thinking. Technologies have been developed for complete chemotherapeutic treatment of all peritoneal surfaces. Technologies have been developed for uncovering minute foci of disease in remote portions of the abdomen. Also, new surgical and electrosurgical techniques are important aspects of this revised management plan. Even the data management tools required to quantitate improvements in treatment have been developed, and are presented here. br/ The book shows that peritoneal carcinomatosis can be treated and that complete eradication of malignancy can occur. br/

Zusammenfassung
How ever, much can be done for these patients - resection of primary cancers, omentectomies to reduce ascites formation, management of recurrent ascites, management of intestinal obstruction, nutritional care, and, hopefully, intraperitoneal chemotherapy.

Inhalt
I. General Principles.- 1. Metastatic inefficiency: Intravascular and intraperitoneal implantation of cancer cells.- 2. Intraperitoneal immunotherapy of cancer: A review of options for treatment.- 3. Pharmacokinetics of the peritoneal-plasma barrier after systemic mitomycin C administration.- 4. Peritoneal-plasma barrier.- 5. Patterns of spread of recurrent intraabdominal sarcoma.- 6. Observations concerning cancer spread within the peritoneal cavity and concepts supporting an ordered pathophysiology.- 7. In vitro pharmalogic rationale for intraperitoneal regional chemotherapy.- 8. Immunotherapy for peritoneal ovarian carcinoma metastasis using ex vivo expanded tumor infiltrating lymphocytes.- 9. Role of omentum-associated lymphoid tissue in the progression of peritoneal carcinomatosis.- 10. Cancer cell seeding during abdominal surgery: Experimental studies.- 11. Krukenberg syndrome as a natural manifestation of tumor cell entrapment.- II. Techniques.- 12. Peritoneal carcinomatosis and radioimmunoguided surgery.- 13. Diffuse and gross peritoneal carcinomatosis treated by intraperitoneal hyperthermic chemoperfusion.- 14. Complications of heated intraperitioneal chemotherapy and strategies for prevention.- 15. Peritonectomy procedures.- 16. Progressive release of the left colon for a tension-free colorectal or coloanal anastomosis.- 17. Radiology of peritoneal carcinomatosis.- 18. Methodologic considerations in treatment using intraperitoneal chemotherapy.- 19. Safety constiderations in the use of intraoperative intrapertioneal chemotherapy.- 20. Treatment of peritoneal carcinomatosis from colon or appendiceal cancer with induction intraperitoneal chemotherapy.- 21. Effects of postoperative intraperitoneal chemotherapy on peritoneal wound healing and adhesion formation.-22. Current status of staging laparotomy in colorectal and ovarian cancer.- 23. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis.- 24. Laser-mode electrosurgery.- 25. Peritoneal access devices for intraperitoneal chemotherapy.- 26. A simplified approach to hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) using a self retaining retractor.