Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2025; 17(1): 100199
Published online Jan 15, 2025. doi: 10.4251/wjgo.v17.i1.100199
Controversies around the treatment of peritoneal metastases of colorectal cancer
Francisco J Morera-Ocon, Clara Navarro-Campoy, Ticiano Guastella, Francisco Landete-Molina
Francisco J Morera-Ocon, Francisco Landete-Molina, Department of General Surgery, Hospital General de Requena, Requena 46340, Spain
Clara Navarro-Campoy, Department of Gynecology and Obstetrics, Hospital 9 Octubre, Valencia 46015, Spain
Ticiano Guastella, Department of Pathology, Hospital General de Requena, Requena 46340, Spain
Author contributions: Morera-Ocon FJ drafted the manuscript; Morera-Ocon FJ and Navarro-Campoy C translated and completed the manuscript; Guastella T and Landete-Molina F reviewed the manuscript. All authors contributed to the manuscript revision and approved the submitted version.
Conflict-of-interest statement: The authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Francisco J Morera-Ocon, PhD, Surgeon, Surgical Oncologist, Department of General Surgery, Hospital General de Requena, Paraje Casablanca s/n, Requena 46340, Spain. fmoreraocon@gmail.com
Received: August 9, 2024
Revised: October 24, 2024
Accepted: November 7, 2024
Published online: January 15, 2025
Processing time: 124 Days and 23.5 Hours
Abstract

In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology. Surgical resection for peritoneal metastases from colorectal cancer (CRC) has been gradually accepted in the medical oncology community. A randomized trial (PRODIGE 7) on cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin. Nevertheless, isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver. Another tool is required in those patients to achieve more local control of the disease. Surgical groups in peritoneal surgery continue to use HIPEC in their procedures, using other agents than oxaliplatin for peritoneal cavity infusion, such as mitomycin C. These patients present with complex surgical issues to manage, and consequently a large burden of complications has to be anticipated. Therefore, identifying patients who will benefit from CRS with or without HIPEC would be of great interest.

Keywords: Colorectal cancer; Peritoneal metastasis; Hyperthermic intraoperative chemotherapy; Treatment strategies; Peritoneal Surface Oncology GroupInternational

Core Tip: Local control of peritoneal metastasis in colorectal cancer requires surgical resection to assist the outcome of systemic chemotherapy and target therapy. Despite the negative results of a randomized phase III trial studying the effect of oxaliplatin as a hyperthermic intraperitoneal chemotherapy (HIPEC) agent, HIPEC therapy may work in synergy with complete surgical resection to achieve locoregional control of the disease. Studies focusing on diagnostic tools to achieve better selection of patients who will benefit from comprehensive treatment (surgery, HIPEC, and systemic chemotherapy) are welcome.