ABSTRACT
This chapter provides an overview of the underlying mechanisms giving rise to accelerated tumor growth in the presence of microscopic residual disease, with an emphasis on peritoneal cancer recurrence. It describes the various mechanisms known to cause minimal residual disease (MRD) after open and laparoscopic surgery. The chapter presents the evidence supporting the hypothesis that cancer removal creates a permissive environment enhancing residual tumor growth. It highlights potential preventive and therapeutic approaches. Strategies proposed to prevent the presence or outgrowth of peritoneal MRD encompass avoidance of tumor spill and minimization of surgical trauma and related inflammation. The inflammatory process associated with surgery shares a number of central mediators and pathways with tumor growth and invasiveness. Many of the growth factors, chemokines, and cytokines released in the wound healing process may promote tumor progression locally or at a distance. Exfoliated cancer cells may be eradicated by irrigation of the peritoneal cavity, either mechanically or by using a tumoricidal solution.
