Cytoreductive Surgery as the Cornerstone of Peritoneal Carcinomatosis Treatment

What Is Peritoneal Carcinomatosis?

Peritoneal carcinomatosis (PC) refers to the spread of cancer to the peritoneum — the membrane lining the abdominal cavity. It occurs most commonly from colorectal, ovarian, gastric and appendiceal cancers. Until recently it was considered terminal, but modern surgical approaches have transformed outcomes.

Cytoreductive Surgery (CRS)

Cytoreductive surgery involves removing all macroscopic tumour deposits from the peritoneum and abdominal organs. The objective is complete cytoreduction (CC-0) — no visible residual disease. This may include peritonectomy procedures, removal of the greater and lesser omentum, bowel resections, splenectomy, and diaphragmatic stripping.

Completeness of cytoreduction is the most important prognostic factor: patients achieving CC-0 have significantly better survival than those with residual disease.

Combined with HIPEC

After cytoreduction, HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is administered directly into the abdominal cavity at 41–43°C for 60–90 minutes. This local delivery allows much higher drug concentrations than systemic chemotherapy, targeting microscopic residual disease on the peritoneal surface.

Who Are the Ideal Candidates?

Patients with limited peritoneal disease extent (low Peritoneal Cancer Index), good performance status, no or limited extraperitoneal metastasis, and disease from colorectal, ovarian, appendiceal or primary peritoneal origin. Careful patient selection by an expert multidisciplinary team is essential.

Results and Survival

At experienced centres, CRS + HIPEC achieves median survival of 40–60 months for colorectal carcinomatosis, and long-term cure for appendiceal mucinous tumours. For ovarian cancer, the PRODIGE 7 and related studies continue to define its role. The key is referral to a high-volume specialised centre.