Cytoreductive Surgery
General information about the method

Cytoreductive surgery and its use in cancer treatment:

Επιγαστρική περιτοναιοεκτομή
Epigastric Peritonectomy
cytoreductive surgery - subdiaphragmatic peritonectomy
Subdiaphragmatic Peritonectomy
cytoreductive surgery - pelvic peritonectomy
Pelvic Peritonectomy

The purpose of cytoreductive surgery is the maximum possible reduction or the eradication of the peritoneally spread cancer. As has been shown by Paul Sugarbaker this is possible by the performance of standard peritonectomy procedures which are the following:

  1. greater omentectomy and splenectomy

  2. right subdiaphragmatic peritonectomy

  3. left subdiaphragmatic peritonectomy

  4. cholecystectomy and resection of the omental bursa

  5. pelvic peritonectomy

  6. lesser omentectomy 

The resections are possible with the use of a 2mm ball-tip electrocautery by which the dissection of normal tissues from cancerous ones is possible.

The assessment of the extent and distribution of the peritoneal spread is possible by several ways bur the most frequently used is the calculation of the peritoneal cancer index (PCI).

The completeness of cytoreduction is assessed by the maximum diameter of the residual tumor. If the residual disease is not macroscopically visible, cytoreductive surgery is assessed as CC-0. If the residual disease is less than 0.25cm then surgery is assessed as CC-1. CC-2 is cytoreductive surgery if the residual disease is >0.25cm and <2.5cm and CC-3 if the disease is >2.5cm.

The two most important clinical variables that are strongly related to survival are the completeness of cytoreduction and the peritoneal cancer index. The less the extent of the peritoneal carcinomatosis or the less the residual tumor is the better the survival is and the less possibilities for tumor recurrence are.

Related publications:

  1. Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, Barone R, Yonemura Y, Cavaliere F, Quenet F, Gutman M, Tentes A. A, Lorimier G, Bernard JL, Bereder JM, Porcheron J, Gomez-Portilla A, Shen P, Deraco M, Rat P. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 2004, 22: 3284-3292 [View]

  2. A.-A.K. Tentes, C.G. Mirelis, S.K. Markakidis, K.A. Bekiaridou, I.G. Bougioukas, A.I. Xanthoulis, E.G. Tsalkidou, G.H. Zafiropoulos & I.H. Nikas. Long-term survival in advanced ovarian
    carcinoma following cytoreductive surgery with standard peritonectomy procedures. Int J Gynecol Cancer 2006, 16, 490–495 [View]

  3. A. Xanthoulis, Ch. Mirelis, S. Markakidis, I. Bougioukas, K. Bekiaridou, E. Tsalkidou, G. Zafeiropoulos, A. A. K. Tentes. Complete cytoreduction combined with early postoperative intraperitoneal chemotherapy for ovarian carcinosarcoma: report of two cases. Gynecol Obstet Invest 2006, 62: 100-102 [View]

  4. A. A. K. Tentes, O. S. Korakianitis, S. Kakolyris, D. Kyziridis, D. Veliovits, C. Karagiozoglou, E. Sgouridou, K. Moustakas. Cytoreductive surgery and perioperative intraperitoneal chemotherapy in recurrent ovarian cancer. Tumori 2010, 96: 411-416 [View]

  5. A. A. Tentes, S. A. Kakolyris, D. Kyziridis, C. Karamveri. Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy in the treatment of advanced epithelial ovarian cancer. J Oncol 2012, doi: 10.1155/2012/358341 [View]

  6. A. A. Tentes, O. Korakianitis, N. Pallas, C. Mavroudis, P. Sarlis, A. Liberis, A. Pagalos, S. Popidis. Peritoneal colorectal carcinomatosis treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Surgical Science 2012, 3: 72-77 [View]

  7. N. Courcoutsakis, A. A. Tentes, E. Astrinakis, P. Zezos, P. Prasopoulos. CT-enteroclysis in the preoperative assessment of the small bowel involvement in patients with peritoneal carcinomatosis, candidates for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Abdom Imaging 2012, DOI: 10.1007/s00261-012-9869-3 [View]

  8. A.A. Tentes, N. Pallas, O. Korakianitis, C. Mavroudis, A. Spiridonidou, G. Zorbas, S. Popidis, N. Papadoniou, V. Darladima, A. Smyrnis, C. Siopis. The cost of cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of peritoneal malignancy in one Greek institute. J BUON 2012, 17: 776-780 [View]

  9. Stamou K, Tsamis D, Pallas N, Samanta E, Courcoutsakis N, Prassopoulos P, Tentes A. A. Treating peritoneal mesothelioma with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A case series and review of the literature. Int J Hyperthermia 2015, 18: 1-7 [View]

  10. Korakianitis O, Daskalou T, Alevizos L, Stamou K, Mavroudis C, Iatrou C, Vogiatzaki T, Eleftheriadis S, Tentes A. A. Lack of significant coagulopathy in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) indicates that epidural anaesthesia is a safe option. Int J Hyperthermia 2015, 8: 1-6 [View]

  11. A. A. Tentes, K. Stamou, N. Pallas, C. Karamveri, E. Samanta, E. Evodia. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis from rectal cancer. Hell Surg Oncol 2015, 6: 43-47 [View]