Multimodal Treatment of Metastasis: Peritoneal metastases/carcinosis
Peritoneal carcinosis (PC) has a very poor prognosis with and without chemotherapy. PC as single metastatic site has been regarded as nonoperable for cure and the patients had very low survival times. Paul Sugarbaker at NCI, subsequently Washington Hospital Cancer Center, USA, showed that the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) offered the option for cure. The Ulm group was among the first in Europe to establish this method and supported its standardization/acceptance.
Why and how?
Excellent surgical oncological standards at Univ.Ulm. Longstanding friendly cooperation and mutual support of K.H.Link with P.Sugarbaker and S.Fujimoto, both outstanding initiators of the technique CRS/HIPEC. Structure, knowledge and cooperations were transferred to APK Wiesbaden. Co-foundation of the DGAV/CAO group „Peritoneal Cancer“. Support for CRS/HIPEC to be recommended in the German S3 Guide Lines. Now Patients with peritoneal carcinosis of colon- or rectal cancer should be referred to specialized centers.
Certification of the Team at APK/ATC as „Competence Center for the Treatment of Malignant Diseases of the Peritoneum by DGAV (German Society of General and Visceral Surgery) in 2013. K.H.Link and team with multiple publications
Slides (click to enlarge):
Peritoneal carcinosis can be fully removed by high level expert surgery (CRS) and treated by hyperthermic abdominal perfusion chemtherapy (HIPEC). Postoperative chemotherapy added to CRS/HIPEC may further improve survival. The Ulm group performed basic research in order to optimize chemotherapy. K. H. Link visited with Paul Sugarbaker and T.Fijimoto to get trained in the method. CRS/HIPEC may cause high morbidity/mortality, that is low only in expert hands, and continiuosly checked by independent auditors in certified centers. As general secretary and co-chairman of the DGAV working group on visceral surgical oncology (CAO-V) K. H. Link helped, that CRS/HIPEC gets standardized and accepted in Europe and in the S3 National Guide Lines in Germany. Many review presentations and publications were published by the Ulm and Wiesbaden groups.