Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Summary of Key Clinical Trials

Abstract

The peritoneal cavity is a common site of metastatic spread from colorectal cancer (CRC). Patients with peritoneal metastases (PM) often have aggressive underlying tumor biology and poor survival. While only a minority of patients with CRC have potentially resectable disease, the high overall incidence of CRC makes management of PM a common clinical problem. In this population, cytoreductive surgery (CRS)-hyperthermic intraperitoneal chemotherapy (HIPEC) is the only effective therapy for appropriately selected patients. In this narrative review, we summarize the existing literature on CRS-HIPEC in colorectal PM. Recent prospective clinical trials have shown conflicting evidence regarding the benefit of HIPEC perfusion in addition to CRS. Current strategies to prevent PM in those at high-risk have been shown to be ineffective. Herein we will provide a framework for clinicians to understand and apply these data to treat this complex disease presentation.

Keywords: colorectal peritoneal carcinomatosis; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy (HIPEC).

Figure 1

Netherlands trial schema comparing CRS-HIPEC to adjuvant systemic therapy evaluating overall survival.

Figure 2

PRODIGE 7 trial schem comparing CRS-HIPEC to CRS alone evaluating overall survival.

Figure 3

COLOPEC trial schema comparing adjuvant HIPEC to adjuvant systemic therapy in high-risk patients for peritoneal metastases.

Figure 4

PROPHYLOCHIP-PRODIGE 15 trial schema comparing second-look laparotomy with CRS-HIPEC to surveillance in high-risk patients for peritoneal metastases.