Recommendations for general surgeons facing incidental peritoneal carcinomatosis of colorectal origin

Abstract

Synchronous peritoneal carcinomatosis (PC) accounts for 5–15% of patients presenting with colorectal cancer. Major advances have been made in the therapeutic approach of this disease, which until recently was considered terminal and treated with palliative intent. Currently cytoreductive surgery (CS) in association with hyperthermic intra-peritoneal chemotherapy (HIPEC) is becoming the standard of care for PC due to colorectal cancer. 1 Esquivel J. Sticca R. Sugarbaker P. et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Ann Surg Oncol. 2007; 14: 128-133 Crossref PubMed Scopus (348) Google Scholar , 2 Verwaal V.J. van Ruth S. de Bree E. et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003; 21: 3737-3743 Crossref PubMed Scopus (1533) Google Scholar Impressive 5-year survival rates of 30% have been reported in selected patients with colorectal cancer and PC treated by this combined modality. 3 Glehen O. Kwiatkowski F. Sugarbaker P.H. et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004; 22: 3284-3292 Crossref PubMed Scopus (940) Google Scholar For the general surgeon, a new management problem has emerged where PC is an incidental finding at the time of primary tumour excision. Surgeons will therefore need to adopt new attitudes in order to optimise patient treatment in this situation.