Indications for CRS and HIPEC in Peritoneal Metastases from Colorectal Carcinoma

Abstract

Peritoneal metastases from colorectal cancer were considered incurable in the past. Locoregional treatment strategies have changed this, showing an improved prognosis in treated patients as compared with a systemic chemotherapy alone. A strong effect has the complete removal of all visible disease at the peritoneal site, in patients with a low tumor burden (Peritoneal Cancer Index <15) and isolated peritoneal metastases. It appears that the hyperthermic intraperitoneal chemotherapy may consolidate the surgical results; however, for certain regimens including a high dose of oxaliplatin for a short course of 30 minutes, recent studies have failed to prove it. Nevertheless, in patients treated by a multimodality strategy with locoregional and systemic therapies, a surprisingly good survival with 42 months median survival was achieved. The accurate selection of appropriate patients in a multidisciplinary tumor board is mandatory, as well as the performance of this treatment in specialized centers. This will minimize the mortality and the failure to rescue as these patients do have an increased postoperative morbidity. Modern biomolecular markers will have to be included in the selection process. Whereas the surgical technique was improved significantly over the last years, the delivery of hyperthermic chemotherapy into the peritoneal cavity has not changed much. Future activities should focus on methods to improve this and maintain the good tumor control offered by surgery.