Surgery for colorectal peritoneal carcinomatosis

Abstract

Peritoneal carcinomatosis occurs in patients with advanced gastrointestinal and gynecological malignancies and also in patients who experience recurrence after treatment failure of the primary tumor. Malignant disease in the peritoneal cavity is a morbid and significant predictor of a diminished survival in a cancer patient. Systemic chemotherapy alone will not be adequate to palliate or treat patients with peritoneal carcinomatosis. Cytoreductive surgery is a new surgical technique that is performed using peritonectomy procedures to allow total eradication of peritoneal tumors. Intraperitoneal chemotherapy regimens such as intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) are effective adjuvant treatment to treat the minimal residual disease after cytoreductive surgery to reduce the risk of locoregional recurrence. A substantial body of evidence available in the current literature has documented the survival benefits of combining cytoreductive surgery and intraperitoneal chemotherapy to treat a previously fatal phase of malignancy. This review provides a summary of the developments in the understanding and treatment of peritoneal surface malignancy from colorectal cancer.

Synchronous liver resection with cytoreductive surgery for the treatment of liver and peritoneal metastases from colon cancer: results from an Australian centre

“…A maximum score of 39 was therefore possible . CRS as described by Sugarbaker consists of the macroscopic removal of all tumour and can be achieved by a combination of anterior parietal, right and left subphrenic, pelvic, greater omentectomy ± splenectomy and lesser omentectomy ± cholecystectomy …”

“…8,9 CRS as described by Sugarbaker consists of the macroscopic removal of all tumour and can be achieved by a combination of anterior parietal, right and left subphrenic, pelvic, greater omentectomy ± splenectomy and lesser omentectomy ± cholecystectomy. 9,10 Intraoperative ultrasound was performed in all patients to detect possible LM. A complete resection of all detectable LM was performed by partial hepatectomy with intermittent vascular exclusion and resection was performed using ultrasonic dissection (Sumisonic ME2210; Simitomo Bakelite Co. Ltd., Tokyo, Japan or Selector Spembly; Integra Lifesciences (Ireland) Ltd, Dublin, Ireland).…”

Appendiceal carcinoma associated with microsatellite instability

“…The selection of the surgical procedure depends on the type of appendiceal carcinoma, as well as the location and size of the tumor mass. The recommended treatment is right hemicolectomy followed by combined adjuvant intraperitoneal chemotherapy, supplemented by additional cycles of systemic chemotherapy (15)(16)(17)(18). The reported 5-year survival for appendiceal carcinoma patients ranges between 20 and 60%, depending on the degree of invasion of parenchymal organs and/or regional lymph node metastases (19)(20)(21).…”

Editorial

“…However, implementation of new and combined surgical and oncological procedures has led to improved survival for selected patient populations. Even treatment with cytoreductive surgery and intraperitoneal hyperthermic chemotherapy approaches as presented by Chua TC et al [3] has resulted in some patients being long-term survivors.…”