Abstract
Aimthe surgical workup for colorectal cancer peritoneal metastases (CRCPM) is complex and should be managed in specialized centers. Diagnostic and therapeutic algorithms (DTA) have been proposed to balance optimal patients management and correct use of resources. Aim of this study was to establish a consensus on DTA for CRCPM patients in Italy. Methoda panel of 18 delegated members of centers afferent to Peritoneal Surface Malignancies Onco-team of the Italian Society of Surgical Oncology was established. A list of statements regarding the DTA of patients with CRCPM was prepared according to different activities and decision-making nodes with a defined entry and exit point. Consensus was obtained through RAND UCLA methodology. Resultstwo different DTA were defined and approved according to the modality of presentation of CRCPM (synchronous and metachronous). A consensus was also obtained on 17 of the 19 statements related to DTA. Conclusiona shared model of DTA is now available for healthcare providers to monitor appropriateness in diagnosis and treatment of patients with isolated peritoneal metastases from CRC.
Highlights
Colorectal cancer (CRC) represents the third most commonPlease cite this article as: A
Peritoneum is a rare site of CRC spread (4.8e8.3%) [3e5], peritoneal metastases (PM) are associated with the worst prognosis compared to other metastatic sites, with a median overall survival of 16,3 months [6]
The statements were related to different decision-making points in the clinical algorithm of colorectal cancer peritoneal metastases (CRCPM) patients: 7 (1e7) the management of patients diagnosed with synchronous disease, 7 the multidisciplinary evaluation (8e14), 1 (15) the hyperthermic intraperitoneal chemotherapy (HIPEC) regimen, 4 the role of perioperative systemic chemotherapy (16e19) (Table 1)
Summary
Colorectal cancer (CRC) represents the third most common. The median overall survival for patients with CRC metastatic disease have improved significantly and is currently estimated around 30 months [2]. Peritoneum is a rare site of CRC spread (4.8e8.3%) [3e5], peritoneal metastases (PM) are associated with the worst prognosis compared to other metastatic sites (liver, lung, lymph nodes), with a median overall survival of 16,3 months [6]. Cytoreductive surgery associated (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be effective in prolonging survival compared to systemic treatment alone [9e12]. Optimal cytoreduction with less than 2.5 mm (so called cytoreduction grade 0 or 1) and limited tumor diffusion inside the peritoneal cavity (expressed by the peritoneal cancer index, PCI) represent the most important prognostic factors for recurrence and survival in CRCPM treated with CRS-HIPEC [13,14]
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