Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastrointestinal cancers: fad or standard of care?

Abstract

Peritoneal metastases (PM) are the common endpoint for patients with advanced gastrointestinal cancers.PM from these cancers are often managed in a similar fashion to other sites of systemic metastases, but the following must be taken into consideration. (a) PM do not respond to systemic chemotherapy in the same fashion as liver and lung metastases. (b) PM cause local problems, resulting in disruption of chemotherapy. (c) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) actually work for PM. (d) PM are not easily detected on imaging modalities. There has been mounting evidence of the effectiveness of CRS-HIPEC at prolonging survival in selected patients with colorectal and gastric PM, but there remains a reluctance to explore this treatment modality. This is likely because of the perceived morbidity and mortality. An effective management strategy employing CRS-HIPEC for selected patients with gastrointestinal PM can only be achieved if a concerted effort is made to understand this disease and address the concerns regarding this treatment.

Perioperative FLOT chemotherapy plus surgery for oligometastatic esophagogastric adenocarcinoma: surgical outcome and overall survival

“…Thus, the option of surgery as a potential curative treatment is standardly offered to patients with hepatic metastatic colorectal disease. Furthermore, even though the addition of treatment modalities like cytoreductive surgery and HIPEC have been shown to prolong survival in selected patients with gastrointestinal and gynecological tumors there is in an ongoing debate about the best management of patients with metastatic disease [ 19 – 21 ]. Although some retrospective studies suggest an improved survival of patients with surgical resection of metastases for EGAC [ 22 , 23 ], there is a lack of prospective, randomized evidence.…”

Perioperative FLOT Chemotherapy Plus Surgery for Oligometastatic Esophagogastric Adenocarcinoma: Surgical Outcome and Overall Survival

“…Thus, the option of surgery as a potential curative treatment is standardly offered to patients with hepatic metastatic colorectal disease. Furthermore, even though the addition of treatment modalities like cytoreductive surgery and HIPEC have been shown to prolong survival in selected patients with gastrointestinal and gynecological tumors there is in an ongoing debate about the best management of patients with metastatic disease [19][20][21]. Although some retrospective studies suggest an improved survival of patients with surgical resection of metastases for EGAC [22,23], there is a lack of prospective, randomized evidence.…”

Impact of Cytoreductive Surgery and HIPEC on Intraoperative Gastrointestinal Wall Thickness and Patient Outcomes

“…In a 2006 consensus statement, it was recognised that standardization of CRS and HIPEC technique significantly improved survival of Stage IV colon cancer (17). As a reflection of procedural complexity, there is a wide range of reported perioperative morbidity (40-80%) and mortality (3-20%) (18). Improvements with appropriate patient selection, high-volume surgeon and centre experience, standardization of CRS and HIPEC and in perioperative management continue to develop.…”