Published online Dec 15, 2015. doi: 10.4251/wjgo.v7.i12.445
Peer-review started: May 7, 2015
First decision: June 6, 2015
Revised: June 20, 2015
Accepted: September 30, 2015
Article in press: October 9, 2015
Published online: December 15, 2015
Processing time: 229 Days and 20 Hours
Cytoreductive surgery combined with intraperitoneal chemotherapy can improve survival in appropriately selected patients with colorectal peritoneal metastases. Outcomes are best in those patients in whom a complete cytoreduction can be achieved. Unresectable disease is however encountered in approximately one-quarter of patients at laparotomy. The merits, or otherwise, of proceeding with an incomplete cytoreduction in this setting are unclear. We performed a review of published outcomes following incomplete cytoreduction for colorectal peritoneal metastases. Using the electronic databases, PubMed and MEDLINE, a systematic search of available literature published during the period January 1997 to September 2014 was conducted. Following application of exclusion criteria, 19 papers were identified and included in this review. These comprised fifteen case series, 3 case control studies and one randomised control trial. In the nineteen studies included in this review, 2790 patients underwent cytoreductive surgery with or without intraperitoneal chemotherapy for peritoneal metastases of colorectal origin. Of these, 1732 (62%) underwent a complete cytoreduction while 986 (35%) patients underwent an incomplete cytoreduction. Median survival in the complete cytoreduction group ranged from 11 to 62 mo while survival in the latter group ranged from 2.4 to 32 mo. Of the 986 patients with an incomplete cytoreduction, 331 patients received intraperitoneal chemotherapy and survival in this cohort ranged from 4.5 to 32 mo. An incomplete cytoreduction, with or without intraperitoneal chemotherapy, does not appear to confer a survival benefit. The limited available data points to a palliative benefit in a subset of patients. In the absence of high quality data, the decision as to whether or not to proceed with surgery should be made on an individual patient basis.
Core tip: Cytoreductive surgery combined with intraperitoneal chemotherapy for colorectal peritoneal metastases improves survival in appropriately selected patients following complete cytoreduction. The merits of an incomplete cytoreduction, with or without intraperitoneal chemotherapy, are unclear. The available evidence is heterogenous and of poor quality. The current review has not shown a benefit to surgery in the setting of unresectable disease. Certain patients, particularly those with ascites may however gain from a quality of life point of view.