Surgical decision making in treating patients with metastatic tumors. focus on surgical treatment of peritoneal carcinomatosis

Surgeons are keyplayers in multidisciplinary care for patients with stage IV and metastatic malignancies of various origins. The tumor biology such as pattern and rate of growth, response to multimodality treatment defines surgical reasoning behind a certain type of surgical intervention. Depending on the treatment goal surgeons perform curative, palliative, and cytoreductive procedures. When analyzing the medical literature and using international treatment guidelines (such as the NCCN guidelines) it is paramount to have common understanding of the definitions and to share the logic behind them. This article walks the reader through the main questions that surgeons commonly face in caring for patients with metastatic disease. It is focused particularly on the cytoreductive approach in treatment of appendiceal and advanced ovarian cancers. The authors advocated a systematic approach to organizing programs for treatment of the challenging patients with metastatic tumors. This may not only improve the clinical outcomes but also would build a foundation for advancing the actively researched field of surgical oncology.