Treatment of surgically resectable colorectal peritoneal metastases

Abstract

Need for centres and training standards

Recurrence and outcome after complete tumour removal and hyperthermic intraperitoneal chemotherapy in 512 patients with pseudomyxoma peritonei from perforated appendiceal mucinous tumours

“…2 The techniques have been widely adopted in specialist units for PMP and have also been utilized extensively for other peritoneal malignancies, particularly colorectal peritoneal metastases. 4,5 A recent multicentre retrospective analysis of 2289 patients from 16 specialist units outlined the success of the combined strategy of complete macroscopic tumour removal combined with HIPEC, reporting 10 and 15 year survivals of 63% and 59% respectively with an acceptable treatment-related mortality of 2%. 7 These results are in contrast to reports on a strategy of repeated debulking surgery with a 10 year survival of 31% and similar operative mortality.…”

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Surgical Management

“…Diffuse dissemination of colorectal cancer within the peritoneal cavity is an ominous finding in about 10% of patients at initial diagnosis and 25% at recurrence. In the 25–35% of patients with recurrent disease confined to the peritoneum, a proportion will be amenable to potentially curative local therapy, using a combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) (Elias et al ., ; Klaver et al ., ; Moran & Cecil, ). The 2013 NHS England commissioning document (NHS England, ) recommends the following suitability criteria:…”

“…CRS/HIPEC was popularized by Sugarbaker, initially for Pseudomyxoma Peritonei (PMP) but its use was translated to colorectal peritoneal metastases. The rationale for this strategy is based on the ‘redistribution phenomenon’, which was initially described in perforated mucinous tumours of the appendix (Moran & Cecil, ; Sugarbaker, ). Free‐floating intraperitoneal cells accumulate at predictable sites within the peritoneal cavity including sites of normal peritoneal fluid absorption such as the omentum (hence the omental ‘cake’) and the under‐surface of the diaphragm (particularly the right), the effects of gravity resulting in disease in the pelvis and paracolic gutters, with relative sparing of motile organs, particularly small bowel unless there are adhesions from extensive prior surgery.…”

“…Whilst the biology of colorectal cancer in the peritoneal cavity is generally more invasive compared with PMP, the redistribution phenomenon may also apply to a subset with either limited disease, or ‘visceral sparing’ and thus amenable to CRS/HIPEC (Moran & Cecil, ). In this context the term resectable ‘colorectal peritoneal metastases’ (CPM or PMCR) is a useful concept helping to select appropriate candidates for intervention (Moran & Cecil, ).…”

Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy

“…The optimal approach for selected patients with peritoneal malignancy involves complete macroscopic tumour removal, known as cytoreductive surgery (CRS), combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The surgery generally involves a full midline laparotomy aiming for complete cytoreduction, often in patients who have had one or more abdominal procedures previously.…”