Operability and early outcome in 100 consecutive laparotomies for peritoneal malignancy.

Abstract

Peritoneal malignancy is common at the terminal stages of many intra-abdominal neoplasms. In selected patients a novel approach of complete macroscopic tumour removal by extensive surgical cytoreduction, combined with intraperitoneal chemotherapy, provides a possibility of cure. Initial experience with 100 consecutive laparotomies is reported. Between 1994 and 2002, 218 patients with peritoneal malignancy were referred to a specialized unit. One hundred underwent laparotomy, of whom 85 had a primary appendiceal tumour. Treatment aims were complete macroscopic tumour excision combined with intraoperative intraperitoneal chemotherapy. Sixty-five patients had complete macroscopic tumour excision, 28 palliative major cytoreduction and seven were inoperable. The overall mortality rate was 8 per cent. The most common complications were pulmonary (25 per cent) and wound (14 per cent) infection. At a median follow-up of 30 (range 3-113) months, 44 of 51 patients with primary appendiceal tumours who had complete macroscopic cytoreduction were alive and 36 were disease free. Cytoreduction combined with intraperitoneal chemotherapy is an emerging technique with promising results in selected patients with peritoneal malignancy.