Current Management of Peritoneal Carcinomatosis from Colorectal Cancer

Approximately 5% of colorectal cancer (CRC) patients will develop peritoneal carcinomatosis (PC) in the absence of systemic disease. Iconographic staging is only moderately accurate, but may be improved by diffusion weighted MR imaging. Systemic chemotherapy prolongs survival in PC patients, but is less active than in patients with hepatic metastasis. Intraperitoneal chemotherapy is based mainly on pharmacokinetic and pharmacodynamic observations. An increasing number of patients is treated with cytoreductive surgery followed by hyperthermic intraperitoneal chemoperfusion (HIPEC). Provided a complete resection can be performed, a median survival of almost three years may be achieved. The combined procedure is, however, associated with potentially significant morbidity. In patients with resected CRC at high risk of peritoneal recurrence, planned repeat surgery with “prophylactic”. HIPEC has been shown to significantly reduce the risk of peritoneal recurrence. Cytoreduction and HIPEC should be a component of a multimodal approach, including neoadjuvant and adjuvant therapeutic regimens. Several questions remain, such as the specific role of HIPEC versus surgery alone, and the results of ongoing randomized trials are expected to provide important answers.