Iterative Cytoreductive Surgery Associated With Hyperthermic Intraperitoneal Chemotherapy for Treatment of Peritoneal Carcinomatosis of Colorectal Origin With or Without Liver Metastases

Abstract

Iterative CS + HIPEC is an effective treatment in PC from colorectal cancer. The presence of resectable LMs associated with PC does not contraindicate the prospect of an oncologic treatment in these patients.

Evolution of management in peritoneal surface malignancies

“…Systemic chemotherapy does not seem to provide better survival rates for these patients (6)(7)(8). It has been reported that prolonged survival was obtained with CRS and HIPEC in CRC patients with PM (9)(10)(11)(12)(13)(14)(15)(16)(17). A randomized controlled study from the Netherlands Cancer Institute supported these results (18).…”

Cytoreductive Surgery and Peritonectomy Procedures

“…Liver metastases may also be a contraindication except for colorectal carcinomatosis. Several studies have shown that the presence of few (one to three) liver metastases did not influence survival if they could be surgically removed for PC from colorectal cancer [47,48]. For conditions where there is no cut off for PCI, the contraindications are & Extensive bowel resection that is likely to compromise the future quality of life e.g.…”

Peritoneal Carcinomatosis

“…The combined treatment of synchronous liver metastases in patient with PCCRC is beyond the scope of this review, but this topic is strongly related to HIPEC: a variable percentage of patients included in retrospective studies underwent at the same time liver resection and CRS [128][129][130]145,163,164] ; the report of a different impact of liver metastasis in patient accordingly to the CCR (with a significant prognostic negative value only for CCR-0 patients) underlines the possible different meaning of these two types of tumor spread ("local" vs "systemic"); even if a liver metastasis is not considered an absolute but only a relative contraindication to HIPEC, it seems logical that all the randomized recently designed study on HIPEC should exclude cases with liver involvement.…”

“…As for other organs and pathologies, in the treatment of PCCRC the acronym HIPEC correlate to a wide spectrum of possible variation in temperature, molecules, concentration and contact time [129,131,134,145,146,150,151] . The associated systemic chemotherapy is highly variable too.…”