Numerous examples exist of tumors that remain confined to the abdominal cavity leading to significant symptoms and death, including ovarian cancer, colon cancer, stomach cancer, pancreatic cancer, gallbladder cancer, appendiceal cancer and mesothelioma (combined estimated 52,000 patients per year with cancer which has spread to the peritoneal surface). Once spread of a cancer has occurred through an organ in the abdominal cavity, tumor cells contaminate the abdominal cavity. Surgeons are not satisfied simply removing the tumor at this stage, as the microscopic cancer cells left behind will soon grow into new tumors and cause problems. The ability to treat those residual cells with chemotherapy at the time of surgery is quite appealing. This is the best chance that a surgeon has of eliminating all of the cancer. The most common sequelae of tumor advancement in the abdominal cavity is blockage of the intestines, causing abdominal cramping, nausea, vomiting and severe debilitation. The build-up of fluid in the abdominal cavity (ascites) is another common sequelae, which leads to distention of the abdomen, pain, and difficulty breathing.

Cancer in the region of the abdominal cavity can be treated using a combination of surgical removal of as much tumor as possible followed by treatment of the residual tumor with a bath of heated chemotherapy. In the operating room with the patient asleep, the surgeon opens the abdomen and removes all the tumor that can be seen. The abdomen is closed, and inflow and outflow tubes are placed through the abdominal wall. These tubes are connected to the perfusion circuit, which includes a pump, and a heat exchanger. Heated chemotherapy is recirculated through the abdominal cavity for 90-120 minutes. The lining of the abdominal cavity acts as a barrier to drug absorption into the circulation, so that high concentrations of drugs can be delivered directly to the tumor during surgery. The heat (hyperthermia) can serve to kill cancer cells directly as well as enhance the ability of the drugs to kill the cancer cells. Recirculating the fluid through the abdominal cavity and manually shaking the patient during the procedure assures even distribution of the drug and heat throughout the complex cavity. At the end of the procedure the drug is washed out to avoid erratic absorption of the drug.

The technique of the intraperitoneal hyperthermic chemoperfusion is one that is becoming widely known and accepted. We have described an 80% two year survival in mesothelioma patients, where historical controls would suggest a median survival of less than one year. Others have suggested long term cures in patients with aggressive colon cancers having spread to the peritoneal cavity.