EPIC has been associated with a higher risk of complications after CRS, possibly due to the prolonged contact between the chemotherapeuticum Sorafenib Tosylate side effects and damaged tissues at the operated surfaces [16]. Other disadvantages of EPIC are an uneven distribution of the chemotherapeutic fluid in the abdomen and causing less comfort for the patients (e.g., nausea and impaired mobility) linked to the chemotherapeutic fluid present in the abdomen [17]. As the main drawback of HIPEC is the necessity to perform this technique in the operating room, requiring specialized equipment and an experienced perfusionist, HIPEC is the preferred technique.

When performing the open HIPEC technique, the abdomen is covered with a plastic sheet, aerosolized droplets for the IP heated chemotherapy are aspirated and the surgeon who is manipulating the viscera is wearing special sterile gloves; each of these a precaution to minimize the risk of exposure of the operating room personnel to the chemotherapeuticum [18]. In most cases HIPEC is performed under hyperthermic conditions (41-42��C) as hyperthermia is claimed to enhance the effect of different cytotoxic agents (e.g., mitocyn C, doxorubicin, cisplatin, and oxaliplatin) [19]. However, some studies suggest that there is no synergistic effect between the cytotoxic agent and hyperthermia, and no differences were observed when performing IP at normothermic or hyperthermic conditions [15, 20].Promising results when combining CRS and perioperative chemotherapy were reported in several studies.

HIPEC with mitomycin C followed by systemic chemotherapy resulted in a 45% 5-year survival in colorectal patients receiving complete cytoreduction [21]. In a second study the 5-year survival among 1290 patients with PC from different primary origins receiving CRS and perioperative chemotherapy was 37% AV-951 [12].3. Drug Selection for IP TherapyAlthough IP therapy is already conducted for many years, no standard treatment in terms of schedule, residence time, drug, or carrier solution has been established. In the case of IP therapy, the cytotoxic agent must be able to penetrate the peritoneal surface and the tumor nodules effectively, in combination with its ability to eradicate microscopic residual disease within the peritoneal fluid. During IP therapy, drug delivery to peritoneal tumors is twofold. The primary route is drug diffusion through the tumor interstitium, while the second route is the recirculation of the drug absorbed from the peritoneal cavity. However, it is evident that the latter route is of minor importance as efficient and safe IP therapy requires systemic drug levels as low as possible in order to minimize systemic side effects caused by the cytotoxic agent.