Harold O. Douglass, Jr, MD, FACS

No American surgeon has thesame breadth of experiencewith extensive peritoneal resectionas Dr. Paul Sugarbaker. Moreover,only a few clinicians worldwidehave the same level of experiencewith intraperitoneal chemotherapy fora variety of intraperitoneal cancers,particularly after peritoneal resection.[1] The value of these therapiesis unquestionable in patients with lowgradetumors confined to the peritonealcavity. A number of patientstreated in this fashion show no evidenceof recurrent disease a decadeor more posttreatment.

Dr. Minsky provides an excellent overview of the current status of adjuvant therapy for patients with rectal cancer. The article includes not only the results of completed randomized and phase II trials but also some of the early toxicity data from ongoing and maturing neoadjuvant trials. Although it would appear that Dr. Minsky’s personal bias favors neoadjuvant combined-modality therapy, he clearly defines gaps in our existing knowledge that will need to be filled in by randomized trials.