Minimally-Invasive Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy in Treating Patients with Low-Volume Peritoneal Carcinomatosis

Inclusion Criteria

• Capable of providing informed consent
• Histologically confirmed peritoneal carcinomatosis from appendiceal, colorectal, ovarian, or primary mesothelioma, with no systemic metastases
• Evidence of low-volume peritoneal disease defined by a peritoneal carcinomatosis index (PCI) =< 10 based on cross-sectional imaging and/or diagnostic laparoscopy findings
• Eastern Cooperative Oncology Group (ECOG) (Zubrod) performance status of 0-2
• Patients who are medically fit for surgery defined as the following
• No parenchymal hepatic metastases
• No cross sectional imaging findings indicative of multi-segmental (> 1 site) small bowel obstruction, or small bowel loops matted together, or gross disease of the small bowel mesentery characterized by distortion, thickening or loss of mesenteric vascular clarity
• No clinical or radiological evidence of hematogenous or distant nodal (retroperitoneal, pelvic, mediastinal, peri-portal or peri-aortic) metastasis
• Absolute neutrophil count (ANC) > 1500/mm^3
• White blood cell count (WBC) > 4000/mm^3
• Platelet count > 150,000/mm^3
• An international normalized ratio (INR) =< 1.5 (patients who are therapeutically anticoagulated for unrelated medical conditions such as atrial fibrillation and whose antithrombotic treatment can be withheld for operation will be eligible)
• Total serum bilirubin =< 1.5 mg/dl (patients with total bilirubin > 1.5 mg/dL eligible only with Gilbert’s syndrome)
• Alkaline phosphatase < 3 times the upper limit of normal (alkaline phosphatase and aspartate aminotransferase [AST] cannot both exceed the upper limit of normal)
• AST < 3 times upper limit of normal (alkaline phosphatase and AST cannot both exceed the upper limit of normal)
• Serum renal functional parameters, blood urea nitrogen (BUN) and creatinine within normal limits
• Creatinine within normal limits
• Satisfactory cardiopulmonary function (no history of severe congestive heart failure or severe pulmonary disease, as indicated by clinically acceptable risks to undergo major abdominal - cytoreductive surgery)
• No clinical history of acute myocardial infarction within six months of registration
• Patients who are status post revascularization procedures with satisfactory cardiac function are eligible
• No significant history of a medical problem or co-morbidity that would preclude the patient from undergoing a major abdominal operation such as a history of severe congestive heart failure or active ischemic heart disease
• No concurrent second malignancy requiring systemic therapy
• No psychiatric or addictive disorders or other conditions that would preclude the patient from meeting the study requirements

Exclusion Criteria

• Peritoneal carcinomatosis index (PCI) >= 10
• Systemic (extraperitoneal) disease, pregnant, incarcerated
• Pregnant and lactating women; women of reproductive age must be willing to use contraception during study therapy