Routine second-look after surgical treatment of colonic peritoneal carcinomatosis

Abstract

RSLS combined with HIPEC after initial resection of synchronous colonic PC allows diagnosis and treatment of low-score PC, with limited post-operative complications and increased overall survival rates.

Prevention of peritoneal recurrence in high‐risk colorectal cancer and evidence of T4 status as a potential risk factor

“…These results suggested a considerable benefit of second‐look surgery in patients at high risk of PM relapse. Another trial in France was able to replicate these results . The incidence of histology‐proven PM during routine second‐look surgery in the same subset of patients was slightly higher at 71% (10/14) at a mean follow‐up of 10.36 months.…”

“…Another trial in France was able to replicate these results. 15 The incidence of histology-proven PM during routine second-look surgery in the same subset of patients was slightly higher at 71% (10/14) at a mean follow-up of 10.36 months. After a median follow-up of 14 months, Delhorme et al reported a 2-year overall and recurrence-free survival of 91 and 38%, respectively.…”

“…In the aforementioned studies, 9,10,15 the authors displayed a mortality rate of 0-2% (1/84) across the three studies following the second-look surgery. Meanwhile, grade III/IV morbidity was reported to be 7-14%.…”

“…28 Adjuvant laparoscopic HIPEC has been done with a mean post-operative hospital stay as short as 1.5 days, 25 whereas open second-look surgery and adjuvant HIPEC groups were associated with a higher mean hospital stay (11-16 days and 16-21 days, respectively). 9,13,15,20,21 However, a limitation to this is that patients underwent open technique for complete exploration +/− CRS, where the majority of these patients had peritoneal diseasenot simply laparoscopic HIPEC alone. Another issue concerning laparoscopic HIPEC is adhesions, where tumour cell entrapment may occur.…”

Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis

“…Two approaches being tested are second-look surgery and prophylactic HIPEC, both of which involve selecting patients without detectable peritoneal metastases or those with low-volume peritoneal disease but who harbor risk factors. 90,91 In the former, patients without clinically or radiologically detectable disease undergo a second-look surgery at the end of a fixed period of follow-up. HIPEC is systemically performed in all patients, with cytoreductive surgery performed in those with macroscopic peritoneal disease alone.…”