Abstract
Peritoneum is one of the common sites of metastasis in advanced stage colorectal cancer patients. Colorectal cancer patients with peritoneal metastases (PM) are traditionally believed to have poor prognosis, which indicates it is of no value to adopt surgical treatment. With the advancement of surgical techniques, hyperthermic intraperitoneal chemotherapy (HIPEC), and multidisciplinary treatment in recent years, the cognition and treatment strategies of colorectal peritoneal metastases (CPM) have changed dramatically. In terms of prognosis, CPM under the palliative systemic treatment shows an inferior outcome compared with nonperitoneal metastasis. Nevertheless, some CPM patients amenable to the complete peritoneal cytoreductive surgery (CRS) combined with HIPEC may achieve long-term survival. The prognostic factors of CPM comprise peritoneal carcinomatosis index (PCI), completeness of cytoreduction score (CC score), the presence of extraperitoneal metastasis (liver, etc.), Peritoneal Surface Disease Severity Score (PSDSS), Japanese peritoneal staging, and so forth. Taken together, literature data suggest that a multimodality approach combining complete peritoneal CRS plus HIPEC, systemic chemotherapy, and targeted therapy may be the best treatment option for PM from colorectal cancer.
Highlights
Peritoneal spread is common in advanced stage colorectal cancer patients and was reported in the past to be associated with a poor prognosis [1,2,3]
colorectal peritoneal metastases (CPM) patients under the palliative systemic treatment were reported to be connected with poor outcomes, but the prognosis of CPM patients will change noticeably with effective surgical therapy combined with hyperthermic intraperitoneal chemotherapy (HIPEC)
The results showed that there were no statistical differences between the liver metastases group and the peritoneal metastases (PM) group in 5-year overall survival (OS) rates (38.5% and 36.5%, resp.; p > 0.05)
Summary
Peritoneal spread is common in advanced stage colorectal cancer patients and was reported in the past to be associated with a poor prognosis [1,2,3]. It has been reported that 88% of colorectal peritoneal metastases (CPM) had other concomitant distant metastases [6]. PM is traditionally perceived as the advanced manifestation of colorectal cancer, with a median survival of 5–7 months, which hardly has the healing possibility and the value of surgical treatment [1, 7, 8]. The attitude towards the therapeutic strategies for CPM has changed tremendously with the update of the concept of multidisciplinary treatment and advances in surgical techniques and hyperthermic intraperitoneal chemotherapy (HIPEC) [10, 11]. In this review we commit to exploring the recent advances in multidisciplinary treatment for CPM
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