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Imaging studies are crucial in the evaluation of patients with suspected or known peritoneal cancerous dissemination. Despite the major progress that has occurred in radiological technology in the last few years, adequate and early detection of peritoneal surface disease remains a challenge. Improvements in spatial resolution are still insufficient to detect small volume peritoneal implants, often resulting in an underestimation of peritoneal disease burden, as assessed at subsequent surgical exploration. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has provided unprecedented results in the management of peritoneal-based neoplasms, provided that a complete (adequate) cytoreduction is achieved. Diagnostic imaging tests are used to select patients who may benefit from this combined treatment by ruling out extraperitoneal involvement and signs of unresectable peritoneal disease. Furthermore, a careful assessment of the disease distribution within the peritoneal cavity, guided by a deep knowledge of the disease's clinical and biological behavior helps in planning the surgical procedure. Close interaction and cooperation between surgeons and radiologists is of utmost importance in this regard, and dedicated, motivated radiologists are required. Contrast-enhanced, multidetector computed tomography scan remains the standard imaging modality in the assessment of peritoneal carcinomatosis. Magnetic resonance imaging may offer complementary valuable data. Positron emission tomography (PET) has a more limited role, its main indication being the detection of unsuspected extraperitoneal involvement in nonmucinous neoplasms. [ABSTRACT FROM AUTHOR]

Abstract: The new treatment strategy for Peritoneal Surface Malignancy combines a cytoreductive surgery and perioperative intraperitoneal chemotherapy. Cytoreduction removes all macroscopic tumor. Intraperitoneal chemotherapy avoids implantation of microscopic residual tumor cells on intra-abdominal surfaces when it is administered intraoperatively and/or early in the postoperative period. Delivering cytotoxic drugs directly into the peritoneal cavity maximizes dose intensity and minimizes systemic toxicity. Hyperthermia is selectively cytotoxic for malignant cells and potentiates the effect of chemotherapy. Implementation of this procedure makes the perioperative personnel to face a risk of exposure to cytotoxic agents. Furthermore, peritonectomies and electro-evaporation of tumor nodules are performed with high voltage electrocautery, generating a large amount of surgical smoke during several hours. Inhalation of these fumes may be also a risk for healthcare workers. In this article, we analyse in depth these new risks of the operating room personnel, we review the literature, and we give guidelines for secure performance of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy, as well as for early postoperative intraperitoneal chemotherapy administration. These new procedures are safe techniques for patients and healthcare workers provided adequate policies are adopted to avoid occupational exposure. [Copyright &y& Elsevier]