Diagnostic and therapeutic algorithm for colorectal peritoneal metastases. A consensus of the peritoneal surface malignancies onco-team of the Italian society of surgical oncology

Abstract

Aim: the surgical workup for colorectal cancer peritoneal metastases (CRCPM) is complex and should be managed in specialized centers. Diagnostic and therapeutic algorithms (DTA) have been proposed to balance optimal patients management and correct use of resources. Aim of this study was to establish a consensus on DTA for CRCPM patients in Italy. Method: a panel of 18 delegated members of centers afferent to Peritoneal Surface Malignancies Oncoteam of the Italian Society of Surgical Oncology was established. A list of statements regarding the DTA of patients with CRCPM was prepared according to different activities and decision-making nodes with a defined entry and exit point. Consensus was obtained through RAND UCLA methodology. Results: two different DTA were defined and approved according to the modality of presentation of CRCPM (synchronous and metachronous). A consensus was also obtained on 17 of the 19 statements related to DTA. Conclusion: a shared model of DTA is now available for healthcare providers to monitor appropriateness in diagnosis and treatment of patients with isolated peritoneal metastases from CRC.

Treatment Strategies and Prognosis of Patients With Synchronous or Metachronous Colorectal Peritoneal Metastases: A Population-Based Study

“…5,6 Recently, an Italian society of experts in peritoneal surface malignancies defined and approved different diagnostic and therapeutic algorithms for synchronous peritoneal metastases and metachronous peritoneal metastases. 7 However, most international guidelines do not take the presentation of CPM into account in recommendations regarding treatment. [8][9][10][11] Also, in some randomized trials, the synchronous or metachronous presentation of CPM is used as a stratification factor.…”

Colorectal Cancer with Peritoneal Metastases: The Impact of the Results of PROPHYLOCHIP, COLOPEC, and PRODIGE 7 Trials on Peritoneal Disease Management

“…These results are obtained in centers with expertise, following a defined diagnostic and therapeutic pathway and performing surgery according to a standardized surgical plan, including xiphopubic midline laparotomy, complete lysis of adhesion, and full abdominal recesses exploration. After the PRODIGE 7 study, there is a substantial consensus to consider cytoreductive surgery as surgery for CRC liver or lung metastases if adopted in the context of a multimodality approach to systemic chemotherapy after a multidisciplinary discussion of every single case [13,14]. Preoperative staging should be directed toward select patients with limited disease, and the indication for surgery should be balanced with other well-established prognostic factors such as primary tumor presentation (obstruction/perforation), signet ring histology, BRAF and MSI status, and the presence of liver metastases [15][16][17][18][19].…”