When is it safe to omit surgery in primary peritoneal cancer with small volume disease?

Primary peritoneal cancer (PPC) is considered a very rare condition, with mesotheliomas deemed the only true PPC when considering the cellular content and embryological derivation of the peritoneum. However, in women, PPC are seen in much greater abundance than that in men and the type of cancer detected is often that of a serous epithelial carcinoma, histologically similar to serous ovarian carcinomas. The management is also similar, i.e. surgery and platin-based chemotherapy. The definition clinically of PPC is that of widespread carcinomatosis with normal-sized ovaries. The carcinomatosis is often extensive, and the only bulk disease may be within the omentum and achieving complete clearance of all disease at primary surgery unlikely. Thus, the concept of using chemotherapy as the main strategy is a reasonable approach and may well be the best single therapeutic option in some patients. This paper reviews the data on PPC and how this approach could be assessed.