Peritoneal carcinomatosis from colorectal cancer
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Peritoneal Carcinomatosis from Colorectal Cancer
Review Article D. P. Korkolis, Ch. Aggeli, I. Passas, G. Plataniotis Received 14/09/2011 Accepted 14/10/2011
Abstract
Introduction
Peritoneal carcinomatosis is the most frequent cause of death in patients treated for colorectal cancer. It presents with a rate of 25-35% and is traditionally followed by median survival of less than 6 months. In 1982, Paul Sugarbaker proposed combined cytoreductive surgery with intraperitoneal hyperthermic chemotherapy in the treatment of peritoneal carcinomatosis as a local relapse of the disease; he achieved a five-year survival rate of >30%. The spectrum of peritoneal carcinomatosis ranges from the presence of some tiny surface nodules, usually near the primary site of the tumour, to the full coverage of the peritoneal surface with invasive neoplastic massive tumours, with or without clinical evidence of systemic metastatic disease. In 10-15% of patients it appears synchronous with the primary tumour and in 20-50% as a late recurrence. The intrabdominal relapse of colorectal cancer can be successfully treated with radical oncologic cytoreductive peritonectomy and intraoperative intraperitoneal hyperthermic chemotherapy. The aim is the complete excision of the macroscopically visible neoplastic disease (peritonectomy and excision of all infected organs) as well as treatment of the remnant microscopic disease with intraoperative intraperitoneal hyperthermic chemotherapy. This combined approach can be performed with acceptable rates of surgical morbidity and mortality in high volume reference centres. A multivariate oncologic approach in combination with a meticulous patient selection, significantly improves the survival rate compared to the conventional palliative chemotherapy.
Generalized metastatic disease is the main cause of death in patients suffering from colorectal cancer. However, in contrast to other malignant diseases, the presence of distant metastatic tumour masses (e.g. Liver, Lungs) or peritoneal spread, does not preclude an attempt to treat a selected groups of patients, with an intention to cure. Twenty-five to 35% of patients with colorectal cancer present with peritoneal carcinomatosis. The usual approach of aggressive surgical resection followed by systemic chemotherapy offers a median overall survival of no more than 6 months. In 1982, P. Sugarbaker attempted to approach peritoneal carcinomatosis as a local relapse of colorectal cancer and developed a pioneer treatment method. This was based on a radical oncologic cytoreductive resection in combination with hyperthermic intraoperative intraperitoneal chemotherapy, in order to treat both macroscopic and remnant microscopic disease. As such, he achieved a 30% five-year survival rate for patients that, otherwise, would have been considered to be “end stage” [1].
Key words:
Colorectal cancer, Peritoneal carcinomatosis, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy
D. P. Korkolis (Corresponding author) Ch. Aggeli, I. Passas, G. Plataniotis - 1s
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