Abstract
Peritoneal metastases (PM) from colorectal cancer (CRC) still represent a huge health-care problem. Recent population-based studies report an overall 3.5–4.2% incidence of CRC-PM after potentially curative primary surgery [ [1] Segelman J. Granath F. Holm T. et al. Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2012; 99: 699-705 Crossref PubMed Scopus (306) Google Scholar , [2] van Gestel Y.R. Thomassen I. Lemmens V.E. Pruijt J.F. van Herk-Sukel M.P. Rutten H.J. et al. Metachronous peritoneal carcinomatosis after curative treatment of colorectal cancer. Eur J Surg Oncol. 2014; 40: 963-969 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar ]. These rates can reach up to about 25% in locally advanced CRC penetrating visceral peritoneum (pT4a), or directly infiltrating surrounding organs (pT4b) [ 1 Segelman J. Granath F. Holm T. et al. Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2012; 99: 699-705 Crossref PubMed Scopus (306) Google Scholar , 2 van Gestel Y.R. Thomassen I. Lemmens V.E. Pruijt J.F. van Herk-Sukel M.P. Rutten H.J. et al. Metachronous peritoneal carcinomatosis after curative treatment of colorectal cancer. Eur J Surg Oncol. 2014; 40: 963-969 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar , 3 Baratti D. Kusamura S. Iusco D. et al. Hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of primary curative surgery in patients with colorectal cancer at high risk for metachronous peritoneal metastases. Ann Surg Oncol. 2017; 24: 167-175 Crossref PubMed Scopus (27) Google Scholar ]. Accordingly, the peritoneum is one of the most common site of metastatic spread for CRC, following the liver and lung, even though incidences may be likely underestimated because PM are more difficult to detect than liver or lung metastases.
Highlights
Past, present and future of adjuvant hyperthermic intraperitoneal chemotheray (HIPEC) in patients at high risk for colorectal peritoneal metastases
A strategy involving local-regionally delivered chemotherapy to prevent the outgrowth of occult peritoneal seeding into macroscopic metastases is supported by a strong rationale: first, cytoreductve surgery (CRS) combined with hyperthermic intraperitoneal chemotheray (HIPEC) improve colorectal cancer (CRC)-Peritoneal metastases (PM) survival, but most patients are not suitable for this demanding treatment due to extensive peritoneal involvement, systemic metastases, and/or poor clinical conditions
In the palliative setting, modern systemic chemotherapy (s-CT) and targeted agents appear to be less effective for peritoneal metastatic CRC than non-peritoneal metastatic CRC
Summary
Present and future of adjuvant HIPEC in patients at high risk for colorectal peritoneal metastases. The use of HIPEC for the prevention or early treatment of CRC-PM has been tested at different time-points, either simultaneously with primary surgery [3e5], at the time of second-look surgery after adjuvant s-CT [6], or as a staged procedure at 5e8 weeks postoperatively [7].
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