Revised guidelines for second-look surgery in patients with colon and rectal cancer

• Published in: Clinical & translational oncology Vol. 12; no. 9; pp. 621 - 628
• Main Author: Sugarbaker, Paul H.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.09.2010
• Subjects: Antineoplastic Agents - administration & dosage; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Digestive System Surgical Procedures - methods; Humans; Infusions, Parenteral; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - surgery; Oncology; Patient Care Planning - standards; Patient Selection; Practice Guidelines as Topic; Reviews; Second-Look Surgery - standards; Time Factors; Second-look surgery; Local recurrence; Cytoreductive surgery; Intraperitoneal chemotherapy; Peritoneal carcinomatosis; Colorectal cancer; Peritonectomy; Hyperthermia
• ISSN: 1699-048X; 1699-3055; 1699-3055
• DOI: 10.1007/s12094-010-0567-8

Proper indications for a second surgical intervention in patients with colorectal cancer have always been a controversial subject. Surgeons find benefit in a second-look operation where a limited extent of cancer is discovered and resected with negative margins. However, a negative exploratory laparotomy or an intervention that is unable to achieve an R0 resection provides little or no benefit. Unfortunately, this type of intervention may place the patient in a worse condition, leading to morbidity or mortality. This manuscript attempts to define clinical parameters of primary colorectal cancer that are associated with a pattern of recurrence and that can be definitively addressed by second-look surgery. Also, new surgical technologies that may assist in achieving a potentially curative resection of local-regional recurrence are described. Cytoreductive surgery with peritonectomy and perioperative intraperitoneal chemotherapy with hyperthermia is presented as a new treatment option for reoperative surgery. A new management plan utilized in patients at high risk for local-regional recurrence may result in a high likelihood of conversion of a second-look cancer-positive patient to a long-term survivor.