Perceptions in the management of colorectal peritoneal metastases: A bi-national survey of colorectal surgeons

Abstract

BackgroundThere is great variability in the uptake of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of colorectal peritoneal metastases (CRPM) in Australia and New Zealand. This study aims to provide a snapshot of perceptions among colorectal surgeons in the management of CRPM.MethodsA structured ten-question online survey was sent to all colorectal surgeons, with three questions on clinical experience and demographics, one on health economics and six on hypothetical clinical scenarios. Scores were collated and reported based on Likert scales.ResultsEighty-one respondents (36.2%) completed the survey. Most surgeons (66.7%) strongly disagreed with offering CRS and HIPEC at all hospitals. The majority (87.7%) agreed that CRS and HIPEC offered a higher survival benefit than systemic chemotherapy in pseudomyxoma peritonei (PMP), and 69.1% in CRPM (comparators: 60.5% ovarian cancer, 14.8% gastric cancer). There were mixed strategies in managing low-volume, isolated peritoneal recurrences. The majority did not recommend second-look laparoscopy, but favoured operative management of Krukenberg tumours. In the presence of incidental peritoneal metastases, only 29.6% favoured biopsy only and referring the patient to a peritoneal disease centre.ConclusionsResponse rate was relatively low. In Australia and New Zealand, colorectal surgeons see a strong role for CRS and HIPEC in the management of PMP and CRPM. The role of “second look” surgery in high-risk cases is controversial and not supported. Krukenberg tumours are viewed as surgical disease. Regular updates and collaboration with peritoneal centres may help surgeons stay abreast with latest evidence in the field.

Consensus Guideline for the Management of Colorectal Cancer with Peritoneal Metastases

“…A 2019 bi-national survey of Australasian Colorectal Surgeons differed critically from our recommendations in questioning the value of CRS ± IPCT and referral to PSM centers for patients with CRC-PM [108]. It is important to highlight differences in the structuring questions between this survey and our consensus, with the former lumping CRS and HIPEC together whereas ours offered flexibility in considering CRS with or without IPCT.…”

“…It is important to highlight differences in the structuring questions between this survey and our consensus, with the former lumping CRS and HIPEC together whereas ours offered flexibility in considering CRS with or without IPCT. Of note, the survey, a 2018 international PSOGI consensus, and our consensus consider Krukenberg tumors as PM and not an absolute contraindication to CRS [108, 109].…”

Practice patterns, attitudes, and knowledge among clinicians regarding hyperthermic intraperitoneal chemotherapy and pressurized intraperitoneal aerosol chemotherapy: a national survey by Indian society of peritoneal surface malignancies (ISPSM)

“…Studies showed lack of familiarity with the results of CRS/HIPEC, both in terms of survival, for various pathologies and morbidity and mortality, would be one of the reasons for poor adoption. These gaps in knowledge and lack of awareness needs to urgently bridged [ 17 ], [ 23 ], [ 24 ]. Few international guidelines have been created to optimize the benefits and minimize the adverse events for patients with colorectal cancer.…”