Olivier Glehen - Pathology of Peritoneal Metastases: The Unchartered Fields

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This is a book on pathology of peritoneal metastases that has been edited and largely authored by surgeons which is unusual. Peritoneal surface oncology is a field that has always been at the cross roadsin the early years of evolution of surgical treatment, hyperthermia was being increasingly used to potentiate cancer therapy and thus was combined with the surgical treatment of peritoneal metastases, that is, cytoreductive surgery. The surgery itself had to prove its merit over systemic therapies and was burdened with proving the merit of another treatment that added to the morbidity. Similarly, disease biology was only partially understood and remains a major challenge for future progresses. While the prognostic factors were still being identified, and validated, oncology ushered into the era of genetics and molecular biology. And the gaps in understanding the pathophysiology of peritoneal metastases persisted. Pathological expertise has largely been directed at the diagnosis and classification of uncommon tumors.

During cytoreductive surgery that comprises of peritonectomy procedures and visceral resections, a large amount of tissue is submitted for histopathological evaluation. This remains a potential source of prognostic information regarding tumor biology. It provides a good opportunity to also study the patterns and pathways of peritoneal dissemination from various tumors.

In this book, we use these pathological findings to better explain the patterns and pathways of peritoneal cancer dissemination and their potential implications on clinical practice. We provide a rationale and recommendations for standardizing CRS procedures and evaluation of surgical specimens. In turn, we raise research question that can be addressed in future studies.

Some of the other aspects of pathological evaluation like pathological response to chemotherapy, diagnosis and classification of rare peritoneal tumors have also been covered in different chapters. Keeping in sync with the progress in molecular oncology, we look at the role of molecular oncology in the current and future management of peritoneal metastases.

We are grateful to all the contributors for lending their time and expertise to this book. We are also grateful to our pathology colleagues for their invaluable contribution to this work.