Systematic Reviews
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World J Gastroenterol. Oct 14, 2014; 20(38): 14018-14032
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.14018
Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal metastases
Reza Mirnezami, Brendan J Moran, Kate Harvey, Tom Cecil, Kandiah Chandrakumaran, Norman Carr, Faheez Mohamed, Alexander H Mirnezami
Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, London W2 1NY, United Kingdom
Brendan J Moran, Kate Harvey, Tom Cecil, Kandiah Chandrakumaran, Faheez Mohamed, National Pseudomyxoma Peritonei Centre, Hampshire Hospitals Foundation Trust, Basingstoke RG24 9NA, United Kingdom
Norman Carr, Alexander H Mirnezami, Somers Cancer Research Building, University of Southampton Cancer Sciences Division, Southampton University Hospital NHS Trust, Southampton SO166YD, United Kingdom
Author contributions: Mirnezami R, Moran BJ, Mohamed F and Mirnezami AH contributed to study conception, literature search and manuscript preparation; Harvey K prepared the manuscript; Cecil T, Chandrakumaran K and Carr N prepared and edited the manuscript.
Supported by Cancer Research United Kingdom; Wessex Medical Research
Correspondence to: Dr. Alexander H Mirnezami, Somers Cancer Research Building, University of Southampton Cancer Sciences Division, Southampton University Hospital NHS Trust, Tremona Road, Southampton SO166YD, United Kingdom. ahm@soton.ac.uk
Telephone: +44-2380-795170  Fax: +44-2380-794020
Received: September 29, 2013
Revised: December 16, 2013
Accepted: June 26, 2014
Published online: October 14, 2014
Abstract

AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).

METHODS: An electronic literature search was carried out to identify publications reporting oncological outcome data (overall survival and/or disease free survival and/or recurrence rates) following CRS and IPC for treatment of CPM. Studies reporting outcomes following CRS and IPC for cancer subtypes other than colorectal were only included if data were reported independently for colorectal cancer-associated cases; in addition studies reporting outcomes for peritoneal carcinomatosis of appendiceal origin were excluded.

RESULTS: Twenty seven studies, published between 1999 and 2013 with a combined population of 2838 patients met the predefined inclusion criteria. Included studies comprised 21 case series, 5 case-control studies and 1 randomised controlled trial. Four studies provided comparative oncological outcome data for patients undergoing CRS in combination with IPC vs systemic chemotherapy alone. The primary indication for treatment was CPM in 96% of cases (2714/2838) and recurrent CPM (rCPM) in the remaining 4% (124/2838). In the majority of included studies (20/27) CRS was combined with hyperthermic intraperitoneal chemotherapy (HIPEC). In 3 studies HIPEC was used in combination with early post-operative intraperitoneal chemotherapy (EPIC), and 2 studies used EPIC only, following CRS. Two studies evaluated comparative outcomes with CRS + HIPEC vs CRS + EPIC for treatment of CPM. The delivery of IPC was performed using an “open” or “closed” abdomen approach in the included studies.

CONCLUSION: The available evidence presented in this review indicates that enhanced survival times can be achieved for CPM after combined treatment with CRS and IPC.

Keywords: Colorectal cancer, Peritoneal metastasis, Cytoreductive surgery, Intraperitoneal chemotherapy, Hyperthermic intraperitoneal chemotherapy

Core tip: Colorectal cancer peritoneal metastases (CPM) confer a dismal prognosis and traditional treatment involving systemic chemotherapy, with or without palliative surgery has poor outcomes. Cytoreductive surgery (CRS) combined with intraperitoneal chemotherapy (IPC) is now advocated for selected patients with CPM. The present study provides a comprehensive summary of the available evidence relating to CRS in combination with IPC in the setting of CPM, focusing on techniques, oncological outcomes, and complications.