A Minimally-invasive Approach to Cytoreduction and HIPEC for Peritoneal Surface Malignancy

Inclusion Criteria:

1. Aged \> 18 years old
2. Capable of providing informed consent.
3. Histologically confirmed peritoneal carcinomatosis from appendiceal, colorectal, ovarian, or primary mesothelioma, with no systemic metastases.
4. Evidence of low-volume peritoneal disease defined by a PCI \< 10 based on cross-sectional imaging / and / or diagnostic laparoscopy findings.
5. Eastern Cooperative Oncology Group (ECOG) (Zubrod) performance status of 0-2.
6. Patients who are medically fit for surgery defined as the following:

   * No parenchymal hepatic metastases
   * No evidence of clinical (jaundice), biochemical (abnormally elevated serum bilirubin and/or alkaline phosphatase) or radiological (ultrasound, CT, or MR) biliary obstruction
   * No cross sectional imaging findings indicative of multi-segmental (\>1 site) small bowel obstruction, or small bowel loops matted together, or gross disease of the small bowel mesentery characterized by distortion, thickening or loss of mesenteric vascular clarity
   * No clinical or radiological evidence of hematogenous or distant nodal (retroperitoneal, pelvic, mediastinal, peri-portal or peri-aortic) metastasis
   * Absolute neutrophil count (ANC) \> 1200/mm3, white blood cell count (WBC) \> 4000/mm3 and platelet count \> 150,000/mm3
   * An international normalized ratio (INR) ≤ 1.5 (patients who are therapeutically anticoagulated for unrelated medical conditions such as atrial fibrillation and whose antithrombotic treatment can be withheld for operation will be eligible).
   * Adequate hepatic function must be met as evidenced by total serum bilirubin ≤ 1.5 mg/dl (patients with total bilirubin \> 1.5 mg/dL eligible only with Gilbert's syndrome);
   * Alkaline phosphatase \< 2.5 times the upper limit of normal; and/or
   * Aspartate transaminase (AST) \< 1.5 times upper limit of normal (alkaline phosphatase and AST cannot both exceed the upper limit of normal)
   * Serum renal functional parameters, blood urea nitrogen (BUN) and creatinine are within normal limits
   * Satisfactory cardiopulmonary function (no history of severe congestive heart failure or severe pulmonary disease, as indicated by clinically acceptable risks to undergo major abdominal - cytoreductive surgery).
   * No clinical history of acute myocardial infarction within six months of registration.
   * Patients who are status post revascularization procedures with satisfactory cardiac function are eligible.
   * No significant history of a medical problem or co-morbidity that would preclude the patient from undergoing a major abdominal operation such as a history of severe congestive heart failure or active ischemic heart disease.
7. No concurrent second malignancy requiring systemic therapy.
8. No psychiatric or addictive disorders or other conditions that would preclude the patient from meeting the study requirements.

Exclusion Criteria:

1. Peritoneal carcinomatosis index (PCI) \> 10
2. Systemic (extraperitoneal) disease, pregnant, incarcerated.
3. Pregnant and lactating women. Women of reproductive age must be willing to use contraception during study therapy.