Peritoneal Surface Malignancy.

Surgical Oncology Clinics of North America | 2025 May

Peritoneal Surface Malignancy.

Surgical Oncology Clinics of North America | 2025 May

Disparities and Health Care Delivery for Patients with Peritoneal Surface Malignancy.

Management of peritoneal surface malignancy (PSM) is complex and requires care at a PSM center. Despite the reported benefit of cytoreductive surgery (CRS)/ hyperthermic intraperitoneal chemotherapy (HIPEC) across PSM primaries, the uptake nationwide is low. The reasons are multifaceted and related to factors that disproportionately impact racial and ethnic minorities, rural residents, and other socially vulnerable patient populations. There are significant misperceptions of CRS/HIPEC in the treatment of PSM and the potential benefit for appropriately selected patients. Much work is needed to improve patient and provider education and to expand the reach of expert PSM management to vulnerable patients.

Surgical Oncology Clinics of North America | 2025 May

Hyperthermic Intraperitoneal Chemotherapy in the Management of Ovarian, Fallopian Tube and Peritoneal Carcinomas.

Ovarian cancer (OC) is a leading cause of gynecologic cancer-related deaths. Despite improvements, the 10-year survival rate has remained relatively unchanged in recent years. Disease recurrence occurs in nearly 80% of patients with advanced disease symptoms. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a therapy that targets common sites of OC recurrence with heated chemotherapy during surgery, which promotes either direct cell death, heightened deoxyribonucleic acid damage, or increased tumor susceptibility to chemotherapeutics. Clinical trials utilizing HIPEC have shown promising results. This paper aims to provide an overview of HIPEC, including historical trials, mechanistic insights, recent advances, and ongoing clinical trials.

Surgical Oncology Clinics of North America | 2025 May

Systemic Therapy and Surgical Management of Peritoneal Mesothelioma.

Malignant peritoneal mesothelioma is an aggressive and rare disease that affects the serosal membranes. The outcomes of patients who suffer from this disease have improved because of the advances in imaging, genetics, and treatment strategies such as systemic therapy and cytoreduction surgery and hyperthermic intraperitoneal chemotherapy. Multidisciplinary care remains essential for enhancing survival and quality of life.

Surgical Oncology Clinics of North America | 2025 May

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer Peritoneal Metastases.

Gastric cancer with peritoneal metastases (GC-PM) carries a poor prognosis and estimated survival is less than 6 to 12 months. One potential treatment of GC-PM is cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Success of this treatment largely relies on tumor biology and patient selection. These operations carry a high risk of morbidity and mortality and their efficacy in GC-PM remains controversial. This study will review the updated literature for CRS ± HIPEC in patients with GC-PM.

Surgical Oncology Clinics of North America | 2025 May

The Role of Prophylactic or Adjuvant Hyperthermic Intraperitoneal Therapy in Appendiceal and Colorectal Cancer Peritoneal Metastasis.

Appendiceal neoplasms and colorectal cancer have a propensity to develop peritoneal metastases. Despite advancements in systemic therapy and surgical management, the development and management of peritoneal metastases remains a challenging problem. Utilization of adjuvant or prophylactic hyperthermic intraperitoneal chemotherapy has been described, with varying quality of data and reported outcomes. The utilization of prophylactic or adjuvant hyperthermic intraperitoneal chemotherapy in patients with appendiceal neoplasms and colorectal cancer remains an active area of exploration.

Surgical Oncology Clinics of North America | 2025 May

Treatment and Management of Peritoneal Spread from Colorectal Cancer Peritoneal Metastasis.

Peritoneal metastases from colorectal cancer (PMCRC) present a complex treatment challenge requiring multidisciplinary expertise. Significant controversy exists regarding the optimal management of PMCRC patients. In this article, we seek to review the currently available evidence and discuss key components of patient workup, treatment, and management.

Surgical Oncology Clinics of North America | 2025 May

Treatment and Management of Peritoneal Spread from Appendiceal Neoplasms.

Appendiceal neoplasms are rare entities prone to direct peritoneal spread. As these neoplasms occur in few patients, research regarding their management is largely retrospective, limiting its utility. Classification of these neoplasms continues to evolve and is largely based on histopathology. Thorough workup of patients with appendiceal mucinous neoplasms is essential for appropriate management and decision making. The cornerstone of treatment of low-grade and high-grade appendiceal mucinous neoplasms with peritoneal spread is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), with limited use of systemic chemotherapy. For those patients who experience recurrence, it may be managed using CRS/HIPEC and possibly systemic chemotherapy.

Surgical Oncology Clinics of North America | 2025 May

Diagnostic Advances and Novel Therapeutics in Peritoneal Metastasis.

Appropriate assessment of disease burden in patients with peritoneal surface malignancy (PSM) is critical for treatment decision-making, and conventional cross-sectional imaging (computed tomography and/or MRI) often underestimates burden of disease. Advances in imaging for PSM include novel functional imaging modalities that target cells unique to the tumor microenvironment. Novel alternative methods of diagnosis and disease monitoring are also potentially applicable to management of PSM. These include forms of "liquid biopsy" targeting circulating tumor DNA. Novel regional therapies include both new therapeutic agents (immune-based and nanoparticle-based), as well as new methods of delivery such as pressurized intraperitoneal aerosolized chemotherapy.

Surgical Oncology Clinics of North America | 2025 May