Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2014; 20(28): 9286-9291
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9286
Update on the prevention of local recurrence and peritoneal metastases in patients with colorectal cancer
Paul H Sugarbaker
Paul H Sugarbaker, Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, Washington, DC 20010, United States
Author contributions: Sugarbaker PH wrote the paper.
Correspondence to: Paul H Sugarbaker, MD, FACS, FRCS, FASAS, Chief, Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, 106 Irving Street, NW, Suite 3900, Washington, DC 20010, United States. paul.sugarbaker@medstar.net
Telephone: +1-202-8773908 Fax: +1-202-8778602
Received: October 19, 2013
Revised: February 15, 2014
Accepted: April 5, 2014
Published online: July 28, 2014
Processing time: 280 Days and 10.9 Hours
Abstract

The prevention of a disease process has always been superior to the treatment of the same disease throughout the history of medicine and surgery. Local recurrence and peritoneal metastases occur in approximately 8% of colon cancer patients and 25% of rectal cancer patients and should be prevented. Strategies to prevent colon or rectal cancer local recurrence and peritoneal metastases include cytoreductive surgery and hyperthermic perioperative chemotherapy (HIPEC). These strategies can be used at the time of primary colon or rectal cancer resection if the HIPEC is available. At institutions where HIPEC is not available with the treatment of primary malignancy, a proactive second-look surgery is recommended. Several phase II studies strongly support the proactive approach. If peritoneal metastases were treated along with the primary colon resection, 5-year survival was seen and these results were superior to the results of treatment after peritoneal metastases had developed as recurrence. Also, prophylactic HIPEC improved survival with T3/T4 mucinous or signet ring colon cancers. A second-look has been shown to be effective in two published manuscripts. Unpublished data from MedStar Washington Cancer Institute also produced favorable date. Rectal cancer with peritoneal metastases may not be so effectively treated. There are both credits and debits of this proactive approach. Selection factors should be reviewed by the multidisciplinary team for individualized management of patients with or at high risk for peritoneal metastases.

Keywords: Peritoneal metastases; Carcinomatosis; Local recurrence; Hyperthermic perioperative chemotherapy; Secondary prevention; Proactive treatment; Mucinous colon cancer; Signet ring colon cancer

Core tip: The prevention of a disease process has always been superior to the treatment of the same disease throughout the history of medicine and surgery. Local recurrence and peritoneal metastases occur in approximately 8% of colon cancer patients and 25% of rectal cancer patients and should be prevented. If peritoneal metastases are treated along with the primary colon resection, improved 5-year survival was seen. These results are superior to the results of treatment after peritoneal metastases developed as recurrence. A second-look in selected patients has been shown to be effective.