Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis: Does it really save lives?

Abstract

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases (60%), perforated tumor onset or intraoperative tumor rupture (50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.

• Authors: Delia Cortes-Guiral, Dominique Elias, Pedro Antonio Cascales-Campos, Alfredo Badía Yébenes, Ismael Guijo Castellano, Ana Isabel León Carbonero, José Ignacio Martín Valadés, Jesus Garcia-Foncillas, Damian Garcia-Olmo
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 23 Issue 3 Pg. 377-381 (Jan 21 2017) ISSN: 2219-2840 [Electronic] United States
• PMID: 28210074 (Publication Type: Editorial)

Topics

• Carcinoma (mortality, secondary, therapy)
• Chemotherapy, Cancer, Regional Perfusion (methods)
• Colorectal Neoplasms (mortality, pathology, therapy)
• Combined Modality Therapy (methods)
• Cytoreduction Surgical Procedures
• Disease-Free Survival
• Humans
• Hyperthermia, Induced (methods)
• Neoplasm Recurrence, Local (mortality, prevention & control)
• Peritoneal Neoplasms (mortality, secondary, therapy)
• Risk Assessment
• Second-Look Surgery