Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.377
Peer-review started: August 28, 2016
First decision: October 20, 2016
Revised: November 2, 2016
Accepted: November 15, 2016
Article in press: November 16, 2016
Published online: January 21, 2017
Processing time: 139 Days and 10.7 Hours
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.
Core tip: Metachronous peritoneal carcinomatosis of colorectal origin is so predictable that at-risk patients can be clearly identified. Treating peritoneal carcinomatosis in its early stages, when the peritoneal carcinomatosis index is as low as possible, is vitally important to get the maximum benefit from cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). 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.