Since November 2003, thirty-four Patients underwent aggressive cytoreductive surgery and HIIC because of primary or recurrent advanced malignancy, arising from colon-rectum, ovary, appendix, pseudomixoma, uterus and stomach. Complete cytoreduction (CC : O) was achieved in 22; overall morbidity rate was 20.5%, mortality 5.8%.

A 62 year old woman presented an advanced recurrent abdominal malignancy. In the past she underwent hystero-ovariectomy because of fibromatosis. Laparoscopic sigmoidectomy had been practised elsewhere in October 2002 because of colonic cancer ( pT3N0 ); no following adjuvant therapies. One year later, local extraluminal recurrence was detected by C.T.: chemotherapy alone (irinotecan + capecitabine: 7 cycles) was administrated. In June 2004 a huge 19 x 10 cm bulk was present in left abdominal-iliac cavity; another 15 x 13 cm mass was growing in anterior abdominal wall up to skin infiltration, presumably born in a trocar site. C.T. showed involvement of iliac vessels, left kidney and ureter bringing hydronephrosis, invasion of psoas and iliac muscles. No hepatic nor lung metastases were evident.

At laparotomy, a little mass was discovered on gastric serosa along the great gastric curve; gut was involved in ileal tract, too. Spread to parietal peritoneum was also detected.

After wall demolition, the tumor was removed "en bloc" performing: left hemicolectomy and colo-rectal anastomosis, double ileal resection and protective ileostomy, retroperitoneal and obturator-iliac adenectomy, left nephrectomy, left parietal peritonectomy, omentectomy, partial muscular resection, wedge gastric resection.

At last, intraperitoneal hypertermic chemotherapy with Cisplatin 125mg (CDDP: 25mg/m²/l) and Mitomycin-C 20mg (MMC: 3.3mg/m²/l) in perfusion liquid 5500cc for 60 minutes at 42.5°C of temperature by closed circuit technique was administered.

Operative time was 8 hours for surgical procedures and 2 hours for drugs perfusion and closure with prosthetic wall reconstruction. The patient had post-operative intensive care treatment, correcting transitory renal failure; ecoguided drainage of a fluid collection in left abdomen was practised in p.o. day 21; no other major complications occurred. Hospital stay was 26 days.

Pathology confirmed cancer spread in all the specimens except for omental tissue. The patient is still alive and disease-free after 7 months.