Functional Anatomy in Relation to Peritoneal Surface Malignancies (PSM): Lessons Learnt after 254 Cases of Peritonectomy at a Tertiary Oncology Centre in India

Abstract

Introduction: Peritoneal Surface Malignancies (PSMs) are a heterogenous group of diseases. They are still considered terminal in many tertiary care centers in India. Cytoreductive Surgery (CRS) including peritonectomy has been the main stay of treatment of PSMs. In this article, we elaborate the applied anatomy of peritoneum from macroscopic to microscopic structure, the mechanism of spread, common sites of involvements and the techniques of perfection in CRS leading to better surgical outcomes based on our experience. Methods: We have performed 254 cases of peritonectomy-Total Parietal Peritonectomy (TPP) in 104 cases (40.9%) and disease selective in 150 cases (59.1%) from 2014 to 2021. We have performed TPP in cases of Pseudomyxoma Peritonei (PMP), Malignant Peritoneal Mesothelioma (MPM) and post NACT cytoreduction in all patients of PSMs Results: In all cases of CRS we removed the primary tumor as per standard oncological principles. Apart from this we removed total greater omentum, lesser omentum, omental bursa and all lymph nodes pertaining to respective diseases. The distribution of our patients was Ovarian carcinoma (n = 152), Colorectal (n = 43), PMP (n = 34), MPM (n = 11), Sarcomatosis (n = 7), Gastric Cancer (n = 3) and Miscellaneous (n = 4). With our 7 years’ experience we share our inputs on the anatomical basis of peritoneal carcinomatosis and sarcomatosis. Conclusion: We have performed 254 peritonectomy procedures. On the basis of our experience and evidence, we conclude that anatomy of peritoneum is very important as it is the most common site of recurrence in PSMs after CRS. We recommend TPP in all cases of PMP, MPM and in interval cytoreduction setting. Keywords: CRS; HIPEC; Peritoneum; Peritoneal carcinomatosis; Sarcomatosis