Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the Treatment of Colorectal Peritoneal Carcinomatosis

Abstract

Until recently, palliative treatment approaches were being used in patients with colorectal peritoneal carcinomatosis. However, recent developments have changed this perspective. The most important of these developments is the cytoreductive surgery with HIPEC. This practice promises a longer survival for this patient group, which was formerly considered to be in the terminal period. Therefore, we aimed to present this method, which is up to date and equally important, along with current literature. The peritoneum represents the second most common site of metastasis following the liver in patients with colorectal cancer. Peritoneal metastasis mostly develops in the presence of spontaneous or iatrogenic tumor perforation, ovarian metastasis, T4 tumors, mucinous/signet ring cell, and positive cytology. Although today, the use of CRS + HIPEC remains controversial in patients with colorectal peritoneal metastases, it provides survival in selected patients for up to 48 months. Even their strategies are different; their goals are common in improving oncological outcomes. While prophylactic treatment is given with the thought that if peritoneal carcinomatosis develops, preemptive treatment is based on the surgical detection and treatment of peritoneal implants, which are overlooked, even if there is no radiological or clinical evidence of peritoneal carcinomatosis during the follow-up after the initial treatment. It is good to be careful when evaluating the results of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) because there is an accumulation of more than 30 years behind this treatment.