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Multimodality Treatment for Colorectal Peritoneal Metastases

  • Aditi Bhatt
  • Sanket Mehta
  • François Quénet
Chapter

Abstract

Approximately 50% of the patients with colorectal cancer will develop peritoneal metastases at some point in their disease timeline. An aggressive locoregional therapy comprising of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) has led to a significant prolongation in overall survival and even cure in certain selected patients with this condition which portends a poor long-term outcome. For patients with a good performance status, a predicted peritoneal cancer index of <17–20 in whom complete removal of macroscopic disease is possible, CRS and HIPEC should be considered the standard of care. However, the percentage of patients that fall in this category is small, and strategies for improving outcomes in other patients are being developed. Neoadjuvant strategies comprising of systemic and intraperitoneal chemotherapy and new methods of intraperitoneal drug delivery like pressurized intraperitoneal aerosol chemotherapy (PIPAC) have shown promising results and are being evaluated prospectively. It is the patients with limited peritoneal disease that experience the maximum benefit from a curative approach; hence, the focus has shifted to the early detection and even prevention of the occurrence of colorectal peritoneal metastases.

Keywords

Colorectal cancer Peritoneal metastases Peritoneal carcinomatosis Cytoreductive surgery HIPEC PIPAC 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Surgical OncologyFortis HospitalBangaloreIndia
  2. 2.Division of Peritoneal Surface OncologySaifee HospitalMumbaiIndia
  3. 3.Department of Surgical OncologyInstitut régional du Cancer de Montpellier (ICM)MontpellierFrance

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