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Abstract
Peritoneal metastases from gastrointestinal cancers remain a morbid and fatal disease entity, reflecting an advanced metastatic stage in the disease natural history. It has been previously regarded as an untreatable condition. Survival with palliative management including systemic chemotherapy and best supportive care rarely exceeds 12 months. With advances in surgical technology and multi-modality therapy, a combined approach of surgery and chemotherapy was introduced. This surgical technique termed peritonectomy strips away the lining of the abdominal cavity using electrosurgery allowing removal of peritoneal tumor. At the completion of surgery, intraoperative instillation of heated chemotherapy solution into the peritoneal cavity known otherwise as hyperthermic intraperitoneal chemotherapy (HIPEC) is performed to eradicate microscopic residual disease. This treatment reflects a progress in understanding of the pathophysiology of peritoneal metastasis as a loco-regional spread of free-circulating tumor cells in the peritoneal cavity. Initial clinical investigations reporting the outcome of this surgical therapy has shown promise demonstrating survival benefits over survival results from historical data. Recently, an increased amount of evidence of the efficacy and safety of this therapy has emerged from randomized controlled trials and an update of institutional experience from high-volume tertiary treatment centres. To improve outcomes of this therapy, there has been improved patient selection, advances in understanding of disease prognostic indicators and tailoring adjuvant therapies. This thesis compiles a series of clinical studies that highlight the development and progress of the application of this therapeutic modality, which has become landmark studies in the management of patients with peritoneal metastasis.