Abstract
Modern management of colorectal cancer (crc) with peritoneal metastasis (pm) is based on a combination of cytoreductive surgery (crs), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (hipec). Although the role of hipec has recently been questioned with respect to results from the prodige 7 trial, the role and benefit of a complete crs were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, crc with pm is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with pm from crc should be referred to, or discussed with, a pm surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of pm from crc and to reflect on the new practice standards set by recent publications on the topic.
Highlights
Colorectal cancer is the 3rd most commonly diagnosed cancer and the 4th leading cause of cancer-related mortality in the world[1]
Management of pms from crc is based on a combination of cytoreductive surgery, systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy
The prodige 7 trial[14], a randomized trial evaluating the benefits of hipec after complete crs of pms from crc, was presented at the American Society of Clinical Oncology meeting in June 2018 and reported a 15% cure rate at 5 years, the best results ever reported in a controlled study for such a cohort
Summary
Colorectal cancer (crc) is the 3rd most commonly diagnosed cancer and the 4th leading cause of cancer-related mortality in the world[1]. The prodige 7 trial[14], a randomized trial evaluating the benefits of hipec after complete crs of pms from crc, was presented at the American Society of Clinical Oncology meeting in June 2018 and reported a 15% cure rate at 5 years (not yet published), the best results ever reported in a controlled study for such a cohort. In 2015, in an effort to meet patient need and to ensure the highest standard of care possible, the Canadian HIPEC Collaborative Group published guidelines for the use of crs and hipec in patients with pms arising from crc[15]. Several important studies leading to changes in practice have been published or presented Those studies recently led expert groups from France[16], Spain[17], and the United States[18] to publish new guidelines for the management of affected patients.
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