Management of peritoneal carcinomatosis from colorectal cancer: current state of practice

Peritoneal carcinomatosis is a common manifestation of colorectal cancer and has traditionally been regarded as a terminal disease with a short median survival. Over the 2 past decades, a new local-regional therapeutic approach combining cytoreductive surgery with intraperitoneal chemohyperthermia (hyperthermic intraperitoneal chemotherapy) has evolved. Because of its significant but acceptable morbidity and mortality and cost, careful patient selection is needed for this comprehensive management plan. Quantitative prognostic indicators are necessary as an assessment of a patient's eligibility for combined treatment. In large phase II studies, international registries, and in one phase III study, this therapeutic strategy demonstrated promising survival results with possibility of cure. In all studies, complete cytoreduction with no visible disease remaining is a requirement for long-term benefit. Further collaboration between peritoneal surface malignancy treatment centers may help to standardize indications and techniques for hyperthermic intraperitoneal chemotherapy and peritonectomy. The development and validation of novel protocols and guidelines will allow surgeons and oncologists who discover colorectal carcinomatosis to treat these patients effectively.