Surgically directed chemotherapy: Heated intraperitoneal lavage with mitomycin C

Abstract

For both colon and rectal cancer, a common site of recurrence is the resection site and peritoneal surfaces. Nearly 50 percent of patients with recurrent disease have peritoneal implants. The cause of death in a large proportion of patients with colorectal cancer is peritoneal carcinomatosis with its complications. Intraperitoneal chemotherapy is considered an alternative route of administration to systemic chemotherapy as an adjuvant treatment of advanced (node-positive) colorectal tumors. Sites with a high risk of recurrence can be exposed to high doses of chemotherapy with acceptable toxicity. In addition, portal vein drug levels with intraperitoneal chemotherapy are 10–40 times greater in the portal venous blood than in the peripheral venous samples. Intraperitoneal chemotherapy may not only protect against local and regional recurrence but also minimizes the incidence of liver metastasis. The rationale for using this procedure in the early postoperative period is to prevent the implantation of tumor cells disseminated by surgical removal of the primary tumor on abraded peritoneal surfaces and to provide cytotoxic levels of intraperitoneal drug that may destroy minimal residual disease on peritoneal surfaces or at the site of the primary tumor.