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Recommendations for the optimal management of peritoneal metastases in patients with colorectal cancer: a TTD and GECOP-SEOQ expert consensus statement

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Abstract

Peritoneal metastases (PM) occur when cancer cells spread inside the abdominal cavity and entail an advanced stage of colorectal cancer (CRC). Prognosis, which is poor, correlates highly with tumour burden, as measured by the peritoneal cancer index (PCI). Cytoreductive surgery (CRS) in specialized centres should be offered especially to patients with a low to moderate PCI when complete resection is expected. The presence of resectable metastatic disease in other organs is not a contraindication in well-selected patients. Although several retrospective and small prospective studies have suggested a survival benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to CRS, the recently published phase III studies PRODIGE-7 in CRC patients with PM, and COLOPEC and PROPHYLOCHIP in resected CRC with high-risk of PM, failed to show any survival advantage of this strategy using oxaliplatin in a 30-min perfusion. Final results from ongoing randomized phase III trials testing CRS plus HIPEC based on mitomycin C (MMC) are awaited with interest. In this article, a group of experts selected by the Spanish Group for the Treatment of Digestive Tumours (TTD) and the Spanish Group of Peritoneal Oncologic Surgery (GECOP), which is part of the Spanish Society of Surgical Oncology (SEOQ), reviewed the role of HIPEC plus CRS in CRC patients with PM. As a result, a series of recommendations to optimize the management of these patients is proposed.

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Acknowledgements

The authors are grateful for the editorial assistance of Dr Manuel Benavides with this manuscript.

Funding

TTD and GECOP-SEOQ have not received external financial support for this project.

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Authors and Affiliations

  1. Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain

    Cristina Grávalos

  2. Departamento de Cirugía, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain

    Fernando Pereira

  3. Medical Oncology Department, Navarra University Hospital, Navarra’s Health Research Institute (IdiSNA), Pamplona, Spain

    Ruth Vera

  4. Unit of Surgical Oncology and GE09 Research in Peritoneal and Retroperitoneal Oncology Surgery, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain

    Alvaro Arjona-Sánchez

  5. Medical Oncology Department, Sant Joan Despí - Moisés Broggi Hospital/ICO-Hospitalet, Barcelona, Spain

    Ferran Losa

  6. Surgery Department, Sant Joan Despí - Moisés Broggi Hospital, Hospitalet de Llobregat, Spain

    Isabel Ramos

  7. Medical Oncology Department, Gregorio Marañón General University Hospital, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain

    Pilar García-Alfonso

  8. Surgery Department, Gregorio Marañón General University Hospital, Madrid, Spain

    Luis Gonzalez-Bayón

  9. Surgery Department, Virgen de la Arrixaca Clinical University Hospital, University of Murcia, IMIB, Murcia, Spain

    Pedro Antonio Cascales-Campos

  10. Medical Oncology Department, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Center for Biomedical Research in Cancer Network (CIBERONC), Carlos III Health Institute, Córdoba, Spain

    Enrique Aranda

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Each co-author has initially written one of the parts of the review, although the first two authors (CG and FP), who have conceptualized and designed it, have corrected each one of the parts to avoid repetitions and preparing the original draft; all authors have commented on subsequent draft versions and approved the final version of the manuscript.

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Correspondence to Fernando Pereira.

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Grávalos, C., Pereira, F., Vera, R. et al. Recommendations for the optimal management of peritoneal metastases in patients with colorectal cancer: a TTD and GECOP-SEOQ expert consensus statement. Clin Transl Oncol 25, 3378–3394 (2023). https://doi.org/10.1007/s12094-023-03204-7

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