Patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer

Abstract

Colorectal cancer is the most common origin of peritoneal metastasis in total, with 15% metastasizing to the peritoneum. In order to provide satisfactory peritoneal recurrence-free survival and low morbidity and mortality rates appropriate patient selection is crucial. Literature research (Pubmed) from 2013 to 2020 was performed including the terms “colorectal”, “peritoneal”, “metastasis”, “cytoreductive surgery”, “HIPEC” and “patient selection”. Despite predictive models the rate of non-therapeutic laparotomy is still high. Patients evaluated for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) should ideally undergo laparoscopy. CRS and HIPEC should be scheduled if a completeness of cytoreduction (CC)-0 score is achievable with a moderate peritoneal cancer index (PCI) (<15), ≤ three resectable liver metastases and, if applied, response to systemic chemotherapy. Signet ring histology can be seen as a relative contraindication. Presence of mutations (RAS/RAF), disease setting, primary tumor side, lymph node ratio and time point of systemic chemotherapy do not impact the treatment algorithm as yet.