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Colorectal Peritoneal Metastases: Correlating Histopathological Findings and Disease Biology

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Pathology of Peritoneal Metastases

Abstract

Cytoreductive surgery with or without HIPEC is a potentially curative approach for a small percentage of patients with colorectal peritoneal metastases. In patients undergoing surgery, the survival is significantly prolonged over systemic chemotherapy alone. Locoregional recurrence and disease progression which occurs in over 80% of the patients remains a problem. Completeness of cytoreduction and the surgical peritoneal cancer index (PCI) are the two most important prognostic factors determining treatment outcomes. Even in patients with a low PCI and complete cytoreduction, recurrence is common. Clinical research is focused on searching for molecular markers that can identify poor candidates for the procedure. Some aspects of disease biology and evolution of peritoneal metastases are still poorly understood which could be used to determine patient prognosis and develop different therapeutic approaches. Not all patients benefit from HIPEC, there may be some in whom systemic chemotherapy is not required and prophylactic approaches have failed to prevent PM in clinical trials so far. Neoadjuvant chemotherapy is offered to many patients with both resectable and unresectable disease. The pathological response to chemotherapy has prognostic value but has not been utilized for therapeutic decision making. This chapter focuses on routine histopathological findings that could be further exploited to better evaluate prognosis and treat patients.

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Authors and Affiliations

  1. Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India

    Aditi Bhatt

  2. Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France

    Olivier Glehen

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  1. Aditi Bhatt
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  2. Olivier Glehen
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Correspondence to Olivier Glehen .

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  1. General and Oncologique Surgery, Centre Hospitalier Lyon-Sud, Lyon, France

    Olivier Glehen

  2. Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India

    Aditi Bhatt

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Bhatt, A., Glehen, O. (2020). Colorectal Peritoneal Metastases: Correlating Histopathological Findings and Disease Biology. In: Glehen, O., Bhatt, A. (eds) Pathology of Peritoneal Metastases. Springer, Singapore. https://doi.org/10.1007/978-981-15-3773-8_4

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