Management of peritoneal XXXX - Basic concepts.

@entity1 @entity43 @entity5 @entity3 @entity14 @entity1104 @entity356
Despite the fact that @entity1104 ( @entity1104 ) and hyperthermic perioperative chemotherapy (HIPEC) is conceptually simplistic, optimal implementation of this combined treatment remains complex. Multiple @entity1 -related variables, methodologic variables, and pharmacologic variables need to be considered in devising an optimal treatment strategy. Working through these variables considering the pathophysiology of peritoneal @entity3 and their possible treatments is more likely to provide guidance in terms of successful management than multiple randomized controlled trials. The principles of management include: 1) A surgical technology involving peritonectomy procedures and visceral resections that will result in a complete cytoreduction. 2) Treatment of @entity1 at a maximal low peritoneal @entity5 index (PCI) will maximize the benefits especially in those @entity1 who have high grade peritoneal @entity3 from @entity356 , @entity14 , or @entity43 . 3) @entity5 cell entrapment should be avoided by preventing major surgical procedures prior to the definitive treatment with @entity1104 and HIPEC. 4) Mechanical removal of @entity5 cells and small nodules by mechanical irrigation prior to HIPEC is necessary. 5) A response must be generated using @entity5 chemotherapy to eradicate small volume residual disease that will remain even after a complete cytoreduction by visual inspection. 6) The benefits of multiple cycles of normothermic intraperitoneal and intravenous chemotherapy (NIPEC) used long-term to help preserve the surgical complete response needs to be integrated into the overall plan of management. Currently, with peritoneal @entity3 from high grade disease perioperative chemotherapy usually fails to maintain the surgical complete response. Major modifications of the perioperative chemotherapy using HIPEC, early postoperative intraperitoneal chemotherapy (EPIC) and NIPEC long-term will go far towards optimizing the treatment of peritoneal @entity3 no matter what the primary gastrointestinal or gynecologic malignancy is being treated.
