AIOM recommendations on the use of cytoreductive surgery and hipec in primary and secondary peritoneal tumors
Peritoneal surface malignancies represent rare and hard-to-treat entities that include primarily abdominal that involve disseminating cancer cells into abdominal peritoneum, with or without associated extraperitoneal disease. Diagnosis and management of these aggressive cancers need a dedicated multidisciplinary team and a high-volume center for locoregional treatment where technically and clinically feasible.
This article summarizes the most updated evidence- based guidelines that the Italian Medical Oncology Association (AIOM) has implemented with a multidisciplinary panel of experts, including dedicated expert clinicians such as pathologists, surgeons, medical oncologists, and the support of methodologists, to guide clinicians involved in the primary management of patients with peritoneal neoplasms in their daily clinical practice. Based on the type of studies addressing the questions and their methods, AIOM guideline methodologists used the GRADE method (Grading of Recommendations Assessment, Development, and Evaluation: GRADE) to classify the quality of each kind of evidence. In selected cases, the main curative treatment consists of a cytoreduction surgery (CRS) that implies the complete removal of the macroscopically appreciable disease or any minimum residual millimeter. It is then associated with intraperitoneal chemo-hyperthermia (HIPEC), carried out at the end of the surgical demolition time, a particular type of chemotherapy that exploits the combined effect of heat and high concentrations of drugs, with a localized action in the area affected by the neoplasm.
We here provide recommendations for 6 main clinical scenarios: primary treatment of primary serous peritoneal papillary carcinoma, pseudomixoma peritonei, colorectal and gastric cancer, ovarian carcinoma, and peritoneal mesothelioma.
This paper represents a synthesis of 2021 clinical practice guidelines about presentation, diagnosis and management of primary and secondary peritoneal surface malignancies provided by an expert panel on behalf of AIOM.