Peritoneal carcinomatosis from colorectal cancer

• Published in: Hellenic journal of surgery Vol. 83; no. 6; pp. 317 - 325
• Main Authors: Korkolis, D. P., Aggeli, Ch, Passas, I., Plataniotis, G.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.12.2011
• Subjects: Medicine; Medicine & Public Health; Review Article; Surgery; Hyperthermic intraperitoneal chemotherapy; Cytoreductive surgery; Colorectal cancer; Peritoneal carcinomatosis
• ISSN: 0018-0092; 1868-8845
• DOI: 10.1007/s13126-011-0056-8

Peritoneal carcinomatosis is the most frequent cause of death in patients treated for colorectal cancer. It presents with a rate of 25–35% and is traditionally followed by median survival of less than 6 months. In 1982, Paul Sugarbaker proposed combined cytoreductive surgery with intraperitoneal hyperthermic chemotherapy in the treatment of peritoneal carcinomatosis as a local relapse of the disease; he achieved a five-year survival rate of >30%. The spectrum of peritoneal carcinomatosis ranges from the presence of some tiny surface nodules, usually near the primary site of the tumour, to the full coverage of the peritoneal surface with invasive neoplastic massive tumours, with or without clinical evidence of systemic metastatic disease. In 10–15% of patients it appears synchronous with the primary tumour and in 20–50% as a late recurrence. The intrabdominal relapse of colorectal cancer can be successfully treated with radical oncologic cytoreductive peritonectomy and intraoperative intraperitoneal hyperthermic chemotherapy. The aim is the complete excision of the macroscopically visible neoplastic disease (peritonectomy and excision of all infected organs) as well as treatment of the remnant microscopic disease with intraoperative intraperitoneal hyperthermic chemotherapy. This combined approach can be performed with acceptable rates of surgical morbidity and mortality in high volume reference centres. A multivariate oncologic approach in combination with a meticulous patient selection, significantly improves the survival rate compared to the conventional palliative chemotherapy.