Curative treatment of colorectal peritoneal carcinomatosis: current status and future trends

A new therapeutic approach to treat colorectal peritoneal carcinomatosis (PC) is becoming increasingly popular. Its main principle is to treat the macroscopic (visible) malignant peritoneal disease with complete cytoreductive surgery and, immediately after, to treat the remaining microscopic (non visible) malignant peritoneal disease with hyperthermic intraperitoneal chemotherapy (HIPEC). This combined treatment has become the gold standard approach when feasible. It is associated with good oncologic results, considering a 5-year survival rate close to 40% when complete cytoreductive surgery is achieved, and acceptable surgical results, considering a postoperative mortality rate ranging from 3 to 5% and a postoperative morbidity rate ranging from 30 to 50%. The exact effects of each steps of this combined treatment are currently unknown; therefore a randomized controlled trial is on going evaluating the real impact of HIPEC by itself (randomization with or without HIPEC after a complete cytoreductive surgery). One of the future indications of this combined approach might be its use in the very early development of PC. Indeed, early PC is currently only detectable and treatable during a second-look surgery, as recently demonstrated in high-risk patients. A trial is currently comparing the oncologic benefits of this second-look approach with HIPEC to the usual simple survey in patients with a high risk to develop PC.