Do we still need CRS and HIPEC in colorectal cancer in times of modern chemotherapy and immunotherapy?
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memo https://doi.org/10.1007/s12254-020-00647-4
Do we still need CRS and HIPEC in colorectal cancer in times of modern chemotherapy and immunotherapy? Elisabeth Gasser · Pamela Kogler · Andreas Lorenz · Reinhold Kafka-Ritsch · Dietmar Öfner · Alexander Perathoner
Received: 14 June 2020 / Accepted: 18 August 2020 © The Author(s) 2020
Summary Peritoneal carcinomatosis from colorectal cancer is associated with a poor prognosis and is usually treated with systemic chemotherapy and immunotherapy alone. In patients with isolated peritoneal carcinomatosis (PC) without nonperitoneal metastases, however, cytoreductive surgery (CRS) has been shown to significantly improve outcome and to achieve even cure in selected patients in combination with systemic therapy. The additional use of a hyperthermic intraperitoneal chemotherapy (HIPEC) is primarily indicated to control microscopical residual tumor tissue in the peritoneal cavity after successful CRS. Another more recent option is the application of an adjuvant HIPEC to prevent peritoneal carcinomatosis in high risk patients with pT4 cancer or perforated cancer at the time of or after primary surgery. The aim of this short review is to highlight the corresponding available literature and assess the
Dr. E. Gasser · PD Dr. P. Kogler · Dr. A. Lorenz · PD Dr. R. Kafka-Ritsch · Univ. Prof. Dr. D. Öfner · Assoc. Professor PD Dr. med. univ. A. Perathoner () Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria [email protected] Dr. E. Gasser [email protected] PD Dr. P. Kogler [email protected] Dr. A. Lorenz [email protected] PD Dr. R. Kafka-Ritsch [email protected] Univ. Prof. Dr. D. Öfner [email protected]
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role of CRS and HIPEC in the context of modern chemotherapy and immunotherapy. Keywords Hyperthermic intraperitoneal chemotherapy · Cytoreductive surgery · Peritoneal carcinomatosis
In western countries 15–20% of patients with colorectal cancer present with stage UICC IV disease at the time of diagnosis. Approximately 8–10% of all colorectal cancer patients present with synchronous peritoneal metastases and up to 40% develop metachronous peritoneal carcinomatosis (PC) during the course of the disease. Peritoneal metastases are associated with a poor prognosis, a high mortality and a significantly impaired quality of life due to ascites and bowel obstruction [1–4]. The traditional treatment strategy for PC was palliative systemic chemotherapy. A surgical approach was performed only in cases of very limited local involvement, bowel obstruction or perforation; however, according to the development of successful multimodal curative treatment strategies in oligometastatic patients with limited liver or lung metastases, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the last two decades have become a legitimate treatment option with curative intent in patients with isolated PC, because it is in
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