Surgery and intracavitary chemotherapy for peritoneal carcinomatosis from colorectal origin

A subset of patients with colorectal cancer (CRC) develops synchronous or metachronous isolated peritoneal disease. The development of peritoneal carcinomatosis (PC) can be conceptualized as a series of well defined steps including cell shedding, adhesion to mesothelial cells and underlying matrix, and invasion of submesothelial tissue. Surgical cytoreduction combined with hyperthermic intraperitoneal chemoperfusion (HIPEC) has evolved as the standard of care in patients with mucinous appendiceal tumors including the pseudomyxoma peritonei syndrome. Recently, this approach was extended to patients with peritoneal carcinomatosis (PC) from non appendiceal CRC. In this review, we discuss the biological rationale, clinical methods, and oncological outcomes associated with cytoreduction and intracavitary chemotherapy in CRC patients suffering from peritoneal disease spread.