Giorgio Ercolani

The Role of Surgery

Peritoneal carcinomatosis (PC) has commonly been considered a terminal disease stage: patients with PC have not been considered candidates for surgical resection and still often receive only palliative surgery, if any, and are committed to systemic chemotherapy (CHT) with minimal improvement in their chances of survival. This attitude arose from the traditional belief that PC is just one of the different forms of cancer metastasis, such as hematogenous or lymphatic metastasis, and is a signal that the disease has become systemic and is no longer curable with surgery. This belief-challenged in recent years by evidence that surgical resection of hepatic or limited pulmonary metastases from colorectal cancer (CRC) is associated with improved survival—is now the subject of an intense debate due to evidence that aggressive surgical treatment of PC—coupled with intraperitoneal chemotherapy (IP-CHT)—is associated with improved survival in patients with peritoneal malignancies such as mesothelioma, pseudomyxoma peritonei (PMP), and PC from colorectal, gastric and epithelial ovarian cancer.