Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis: Does it really save lives?

• Published in: World journal of gastroenterology : WJG Vol. 23; no. 3; pp. 377 - 381
• Main Author: Delia Cortes-Guiral Dominique Elias Pedro Antonio Cascales-Campos Alfredo Badía Yébenes Ismael Guijo Castellano Ana Isabel León Carbonero José Ignacio Martín Valadés Jesus Garcia-Foncillas Damian Garcia-Olmo
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.01.2017
• Subjects: Carcinoma - mortality; Carcinoma - secondary; Carcinoma - therapy; Chemotherapy, Cancer, Regional Perfusion - methods; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Combined Modality Therapy - methods; Cytoreduction Surgical Procedures; Disease-Free Survival; Humans; Hyperthermia, Induced - methods; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - prevention & control; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Risk Assessment; Second-Look Surgery; Second-look surgery; Hyperthermic intraperitoneal chemotherapy; High-risk patients; Colo-rectal cancer; Peritoneal carcinomatosis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v23.i3.377

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.