Colorectal peritoneal metastases: Optimal management review

World J Gastroenterol. 2019 Jul 21;25(27):3484-3502. doi: 10.3748/wjg.v25.i27.3484.

Abstract

The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.

Keywords: Colorectal cancer; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Peritoneal carcinomatosis; Peritoneal metastases.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / standards
  • Chemotherapy, Adjuvant / methods
  • Chemotherapy, Adjuvant / standards
  • Chemotherapy, Cancer, Regional Perfusion / methods
  • Chemotherapy, Cancer, Regional Perfusion / standards*
  • Clinical Trials as Topic
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / therapy*
  • Cytoreduction Surgical Procedures / standards*
  • Disease-Free Survival
  • Feasibility Studies
  • Humans
  • Hyperthermia, Induced / methods
  • Hyperthermia, Induced / standards*
  • Meta-Analysis as Topic
  • Patient Care Team / standards
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Peritoneum / pathology
  • Peritoneum / surgery
  • Practice Guidelines as Topic
  • Prognosis