Role of HIPEC in the Prevention of Peritoneal Metastasis from Colorectal, Gastric and Appendiceal Cancer

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have offered new hope for patients with peritoneal metastasis from colorectal and gastric cancers. However, this treatment can be offered only to a small, select group of patients, and even in this select group, only a small proportion can be cured. Hence, prevention of peritoneal metastasis assumes importance. Currently, three approaches are being evaluated to prevent colorectal peritoneal metastasis using HIPEC: a proactive approach, in patients considered to be at high risk of microscopic peritoneal dissemination; an adjuvant approach, in the immediate or delayed postoperative period after primary resection; and a second-look approach, during a systematic second-look operation approximately 1 year after primary resection. The effectiveness of HIPEC in preventing gastric peritoneal metastasis has already been shown in a number of randomised studies from Asia and is also currently being evaluated in Western patients. The results of ongoing trials could well be a game changer in the prevention of colorectal and gastric cancer-associated peritoneal metastasis. Unlike colorectal and gastric cancer, mucinous appendiceal neoplasms, which are the commonest cause of pseudomyxoma peritonei, pursue a more indolent course, and even patients with extensive disease are amenable to curative resection. However, early diagnosis can lead to a prolongation in survival, and strategies to prevent peritoneal dissemination are recommended during surgery for mucinous appendiceal neoplasms.