Gastrointestinal
malignancies frequently recur with metastatic disease limited to the abdominal cavity. Due to full thickness penetration of
tumor through bowel wall and spillage of
tumor from lymphatic channels by surgical
trauma,
tumor cells are disseminated throughout the peritoneal surfaces either prior to at the time of surgical removal of the primary
tumor. Diagnosis of recurrent
cancer is difficult because no sensitive diagnostic test is available by which to image a small
tumor volume present on peritoneal surfaces. Computerized tomography can not demonstrate small to moderate nodules. Intraperitoneal instillation of 131-1 labeled
monoclonal antibody has allowed visualization of mucinous
tumor on peritoneal surfaces not seen by any other radiologic test. Intraperitoneal
chemotherapy has been shown to provide palliation in patients with small volume disease confined to peritoneal surfaces. Because of limited penetration of
chemotherapy into large
tumor nodules this treatment strategy has not been effective for bulky intraabdominal recurrent
cancer.
Cytoreductive surgery can make patients relatively disease free. New surgical technologies combined with postoperative intraperitoneal
chemotherapy have been shown to be curative for selected patients with recurrent
cystadenocarcinoma. The wider application of immediate postoperative intraperitoneal
chemotherapy treatments for gastrointestinal patients in an adjuvant setting may be of value in preventing the occurrence of
peritoneal carcinomatosis and in improving survival.