Review article
Natural history of peritoneal carcinomatosis from nongynecologic malignancies

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Pathophysiology of carcinomatosis

The pathophysiology of carcinomatosis is well studied in gastrointestinal cancer by in vitro and in vivo experiments. In the progression of a digestive cancer the first malignant cells appear in the intestinal mucosa. Invasion moves to the submucosa, the muscular layers, and finally, the serosal surface. During this time, three patterns of dissemination may occur. Malignant cells may invade into the venules of the bowel wall and thereby disseminate via the hematogenous route through the portal

Clinical features of carcinomatosis from nongynecologic malignancies

The clinical features of peritoneal carcinomatosis have been reported from the prospective study conducted by Chu et al. on 100 patients. There were 45 colorectal, 20 pancreas, 6 gastric, 4 small bowel, 2 appendix, 2 unknown primaries, and 21 miscellaneous malignancies [5]. Also, the French prospective multicentric study EVOCAPE 1 reported on 370 patients. There were 125 gastric, 118 colorectal, 58 pancreas, 4 small bowel, 3 liver, 12 pseudomyxoma peritonei, 7 mesothelioma, and 43 unknown

Clinical presentation of carcinomatosis

Synchronous carcinomatosis occurring with primary cancer was found in 55% of patients (257 of 470); carcinomatosis documented in follow-up occurred in the other 45%. Ascites (164 of 470) and bowel obstructions (114 of 470) were the main clinical symptoms in both groups. Resection of the primary tumor was performed for 42.0% of the patients, while only by-pass surgery was performed to reestablish gastrointestinal continuity in 34.2% of the patients. Explorative laparotomy and biopsies were

Clinical information on EVOCAPE 1 patients

The purpose of the EVOCAPE 1 study initiated in 1997 was to gather more precise information on the evolution of nongynecologic carcinomatosis treated with palliative intent and the survival of patients with this disease [6]. To fulfill these requirements, patients diagnosed by laparoscopy need to be excluded as well as the patients treated by new aggressive approaches such as intraperitoneal chemohyperthermia with or without peritonectomy procedures. Of these 370 patients, 212 (57%) were

Survival of patients in EVOCAPE 1

The mean and the median overall survival were 6.0 months (0.1 to 48.0 months) and 3.1 months respectively (Fig. 1). Mean and median survival according to the peritoneal carcinomatosis staging are shown in Table 5.

For gastric carcinoma patients, overall mean and median survival were 6.5 months (range 0.1–48.0) and 3.1 months, respectively. Several potential prognostic factors were analyzed for survival differences: synchronous or metachronous peritoneal carcinomatosis, initial pTNM

Symptoms of carcinomatosis patients

The major symptoms indicative of carcinomatosis are bowel obstruction and ascites [10], [11], [12], [13]. Bowel obstructions were most frequently reported for colorectal cancers (20% in the present study), while ascites was more often reported for pancreatic cancer (43%). The clinical presentations of carcinomatosis are not specific except when the abdominal examination revealed malignant masses palpable through the anterior abdominal wall. Other symptoms that exist may be related to the

Comparison of site-specific survival

The French EVOCAPE 1 study confirms the very poor prognosis (median 3.1 months) for all carcinomatosis patients. The length of survival seemed to be greatly influenced by the stage of the peritoneal carcinomatosis. It was 5 to 10 months for stages 0, 1 and 2 versus 2.0 to 3.9 for stages 3 and 4 (Fig. 1). Survival times do differ according to the location of the primary tumor. A pancreatic origin has the shortest survival (2.1 months), gastric origin 3.1 months, and colorectal location 5.2

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