Strategies to Prevent Peritoneal Carcinomatosis Arising from Colorectal Cancer

Gelli, Maximiliano; Huguenin, Janina F.L.; Cerebelli, Cecilia; Benhaïm, Léonor; Honoré, Charles; Élias, Dominique; Goèré, Diane

doi:10.2217/fon-2016-0389

Cited by 15 publications

(8 citation statements)

References 92 publications

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“…Non-obstructed tumors should not be resected but treated by stomas or stents, although colonic stenting should be avoided in patient candidates for antiangiogenic agents because of higher rates of perforation reported[1]; (2) Always provide adequate biopsies of the primary tumor and/or peritoneal implants; (3) Describe the extension of the peritoneal disease using the peritoneal cancer index (PCI) score. If limited peritoneal disease is found, there is still a high recommendation to not perform surgical resection in the emergency context because it does not add a better free-disease survival and could hinder a better combined treatment modality[23,24].…”

Section: Clinical Presentationmentioning

confidence: 99%

Colorectal peritoneal metastases: Optimal management review

Sánchez-Hidalgo

Rodríguez‐Ortiz

Arjona‐Sánchez

et al. 2019

WJG

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The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.

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Section: Clinical Presentationmentioning

confidence: 99%

Colorectal peritoneal metastases: Optimal management review

Sánchez-Hidalgo

Rodríguez‐Ortiz

Arjona‐Sánchez

et al. 2019

WJG

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“…In addition, a recent French study have suggested that the addition of Oxaliplatin-HIPEC on the top of cytoreductive surgery does not influence both overall survival and disease-free survival but suggest that HIPEC with Oxaliplatin may be beneficial for patients with a medium PCI. [11][12][13][14][15]27 Therefore, at the present time, the role of HIPEC in the treatment of PC is not clear, and long-term results have to be awaited to assess the role of prophylactic/ adjuvant HIPEC.…”

Section: Discussionmentioning

confidence: 99%

“…The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved median survival rates of up to 64 months; peritoneal cancer index (PCI) and complete surgical cytoreduction (CRS-0) are the two main predictors of prognosis with this strategy. [8][9][10][11][12][13][14][15] Nonetheless, CRS and HIPEC are not risk-free, with nonnegligible associated morbidity and mortality. 16,17 Numerous clinical, pathological, and biological factors have been studied to identify patients with the highest risk of having synchronous or developing metachronous PC and to be able to diagnose it early, while the PCI is still low, and have an impact on outcomes in this population.…”

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confidence: 99%

Prophylactic HIPEC in pT4 Colon Tumors: Proactive Approach or Overtreatment?

et al. 2019

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Background. The peritoneum is the second most common site for metastasis in patients with colorectal cancer. Various factors have been studied to identify patients at risk of developing peritoneal carcinomatosis (PC), including T4 tumors. The objectives were to assess the incidence of synchronous and metachronous PC, explore potential risk factors for developing PC as the only site of metastasis, and identify which patients might be candidates for prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC). Methods. We conducted a retrospective analysis of 125 patients with pT4 colon cancer who underwent surgery in a single center between January 2010 and December 2014. Results. Of the 947 colon cancer patients who underwent surgery, 125 (13.2%) were diagnosed with pT4a or b colon carcinoma. The median follow-up was 3.7 years. The overall rate of PC was 34.3%, being synchronous in 12% and metachronous in 22.3% of cases. The 8% and 6% of synchronous and metachronous cases of PC respectively were isolated (single site) metastasis. The incidence of PC was 6.1% at 1 year and 14.5% at 3 years after surgery. pT4 was not found to be an independent risk factor for the development of PC (p = 0.231). Nonetheless, the rate of metachronous PC as a single site of metastasis was higher in patients with pT4 tumors and peritoneal nodules around the primary tumor and/or tumor perforation (p = 0.027) and/or who underwent emergency surgery (p = 0.043) than other patients.

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“…Prophylactic HIPEC to complete second-look surgery has been tested as an adjuvant treatment in colorectal cancer patients at risk of peritoneal recurrence. 8 Second-look exploration with prophylactic HIPEC in a selected group of patients with resected lowgrade appendiceal tumors at risk of peritoneal relapse has been proposed. [9][10][11] Laparoscopy could be the ideal means for a HIPEC delivery protocol to treat patients with LAMN at high risk of peritoneal failure.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic hyperthermic intraperitoneal chemotherapy for appendiceal tumors

Sommariva

Tonello

Simoni

et al. 2020

Asian J Endoscop Surgery

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Introduction: The application of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal and appendix cancer at risk of peritoneal seeding is an appealing strategy to prevent peritoneal metastases. Here, we present the technical details and postoperative outcomes of laparoscopic HIPEC performed with prophylactic intent in three patients with low-grade appendiceal neoplasm (LAMN) considered at risk of peritoneal recurrence. Materials and Surgical Technique: Three patients with LAMN previously treated outside our department were selected for second-look laparoscopic exploration and HIPEC. The study received institutional review board approval. A Hasson trocar was inserted around the umbilicus. Four additional 10-mm trocars were inserted-one each in the left and right upper and lower quadrants. After full abdominal exploration, laparoscopic cytoreductive surgery was performed. Perfusion catheters were inserted through the four lateral trocars in the abdominal quadrants. HIPEC was performed with mitomycin 12 mg/m 2 and cisplatin 90 mg/m 2 for 60 minutes at a target temperature of 41.0 C. The postoperative course was uneventful, except for an episode of fluid leak due to dural tear (treated with supine bed rest for 48 hours and resulting in no adverse sequelae). The median length of hospital stay was 11 days. After a median follow-up of 36 months, all patients were asymptomatic with no evidence of recurrence. Discussion: Laparoscopic HIPEC for LAMN at risk of peritoneal recurrence appeared to be feasible, safe, and associated with a favorable postoperative outcome. More studies with larger samples of patients and with a standardized design are needed to better analyze the oncological value of this approach.

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Strategies to Prevent Peritoneal Carcinomatosis Arising from Colorectal Cancer

Cited by 15 publications

References 92 publications

Colorectal peritoneal metastases: Optimal management review

Colorectal peritoneal metastases: Optimal management review

Prophylactic HIPEC in pT4 Colon Tumors: Proactive Approach or Overtreatment?

Laparoscopic hyperthermic intraperitoneal chemotherapy for appendiceal tumors

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