If the primary cancer with peritoneal seeding is resected in the absence of a chemotherapy wash, the cancer cells on the peritoneal surface will be implanted deep within the tissues and will be difficult, if not impossible to eradicate. It is likely that surgical skill is a more important determinant of prognosis than the aggressive nature of the cancer or its stage at diagnosis. In conclusion, peritoneal dissemination can be prevented by the responsible surgeon at least in part by proper surgical technique which is utilized to resect the primary malignancy. Containment must be the number one priority of the gastrointestinal cancer surgery. Also, established peritoneal carcinomatosis can be cured if it is attacked in a timely fashion with heated intraoperative intraperitoneal chemotherapy, peritonectomy procedures, and visceral resections for cancer on bowel surfaces.
Many little changes can make a big difference in survival with gastrointestinal cancer surgery.
Surgery must do all that it can to benefit the patient with the facilities and time that one has available with acceptable morbidity and mortality. Adequate surgical skill implies that cancer spread is prevented or treated and thereby optimizes survivorship. Paul H. Sugarbaker Director, Surgical Oncology Peritoneal Carcinomatosis Program Center for Surgical Oncology Washington Hospital Center Tab. 1 Absolute indications for the use of heated intraoperative intraperitoneal chemotherapy in gastrointestinal cancer patients. 1 Technique for heated intraoperative intraperitoneal chemotherapy using the Coliseum Technique.