Cytoreductive surgery plus hyperthermic perioperative chemotherapy for selected patients with peritoneal metastases from colorectal cancer: a new standard of care or an experimental approach?

Abstract

Peritoneal metastases (PM) are a common presentation for patients with metastatic colorectal cancer (CRC), and the median survival of patients with PM is approximately one year. In a majority of patients, the disease remains limited to the peritoneal cavity. Therefore, investigators have applied cytoreductive surgery (CRS) and heated perioperative chemotherapy (HIPEC) as a standard approach for selected patients with PM from CRC. These investigators have demonstrated a very promising long-term survival in a subset of patients with a limited amount of isolated peritoneal metastatic disease. This paper presents the data that supports CRS and HIPEC as a treatment option for CRC patients with PM. These results of treatment are compared and contrasted to the results that can be expected with systemic chemotherapy alone.

Figure 1

Prognostic impact of the completeness of cytoreductive surgery (P < 0.001) on overall survival [5].

Figure 2

Prognostic impact of the extent of carcinomatosis (i.e., peritoneal cancer index; P < 0.001) on overall survival [5].

Figure 3

Schematic diagram that presents a theoretical model comparing the progression of one colorectal liver metastasis to one peritoneal metastases over one year. The liver metastasis will expand within the liver parenchyma with a doubling time of approximately three months. The peritoneal metastasis will progress at approximately the same speed but will also exfoliate cancer cells into the free peritoneal space. Many cancer nodules of many different sizes will occur widely distributed throughout the abdomen and pelvis within one year.

Figure 4

Comparison of survival of colon and appendiceal peritoneal metastases in patients having the same treatments [1].