Patterns of recurrence following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer

Abstract

Disease recurrence after CRS and HIPEC is common; in selected patients, an aggressive surgical approach may be beneficial and extend survival.

Incidence and treatment of recurrent disease after cytoreductive surgery and intraperitoneal chemotherapy for peritoneally metastasized colorectal cancer: A systematic review

“…12 In a more recent study performed by Braam and colleagues, a 46% recurrence rate was detected even though only patients with CCR 0e1 were included in this analyses. 9 Similar results were observed in other groups included in this review. 9e15…”

“…Although no difference was detected between locoregional or systemic recurrence, the combination of both had a significantly lower survival compared to systemic recurrence alone. 9 Furthermore, survival after recurrent disease was negatively affected by nodal involvement of primary tumor, extent of disease at initial presentation and inability to treat the recurrent disease. It has been pointed out that especially in those patients with early recurrence, repeated surgery is less applied due to a possibly more aggressive tumor, although no data to date supports this theory.…”

“…5e7 Comparable to the surgical treatment of liver metastases, 8 disease recurrence is a strong negative prognostic factor for survival. 9 In PC, even though a macroscopic complete resection is achieved in the majority of patients treated with CRS and IPC, recurrent disease is very common. 10 It is postulated that in these patients, too high microscopic tumor burden is left behind to be eliminated by intraperitoneal chemotherapy (surgical failure) or that the chemotherapeutic agent itself was not effective enough to eliminate the tumor cells (chemotherapeutic failure).…”

Major Postoperative Complications Are a Risk Factor for Impaired Survival after CRS/HIPEC

“…20,21 The observed patterns of recurrence agree with previous reports demonstrating the worst survival for a combined recurrence type. 22 Additionally, the amount of peritoneal involvement significantly influences CSS. Yet this finding is not new, and it undermines once more a key principle of CRS: the imperative to achieve a complete resection.…”

Nanomedicine-based intraperitoneal therapy for the treatment of peritoneal carcinomatosis — Mission possible?

“…A major drawback of currently used local therapies for PC is the significant risk of recurrent peritoneal disease [38,39]. Due to the short exposure time to conventional small chemotherapeutics, which rapidly leak from the peritoneal cavity, there is a need for therapeutic approaches that enable a prolonged residence time of chemotherapeutics in the peritoneal cavity following CRS.…”