International recommendations for the management of peritoneal metastases

Cytoreductive Surgery (CRS) defined as removal of macroscopic abdominal and peritoneal disease, combined with hyperthermic perioperative chemotherapy (HIPEC) is the treatment indicated for pseudomyxoma peritonei (PMP) and appendiceal neoplasms with peritoneal metastases.

CRS and HIPEC should now be considered as the standard of care for selected patients with peritoneal mesothelioma and moderate to small volume peritoneal metastases secondary to colorectal cancer.

Patients who have ovarian or advanced peritoneal metastases from gastric cancer may profit from this strategy but additional evidence should be generated from ongoing collaborative studies at experienced treatment centers.

Further evaluation of neo-adjuvant intraperitoneal, systemic chemotherapy and cytoreductive surgery with HIPEC is required for patients with peritoneal metastases from gastric cancer.

CRS and HIPEC should be avoided in patients who are unlikely to undergo a complete or near-complete resection, or – due to co-morbidities – are unlikely to achieve a full recovary.

CRS and HIPEC should not be offered at institutions where there is insufficient knowledge or insufficient skill to achieve a complete cytoreduction and to manage the safe administration of perioperative chemotherapy

CRS and HIPEC should be offered in experienced centres where the morbidity and mortality is acceptable and the benefit gained by patients far outweighs the risks.

Developing centres should seek support from established teams to assist their development whilst gaining experience in these techniques.