Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies-A Comprehensive Review

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Oncology

Background:

• Peritoneal surface metastases (PSM) from digestive malignancies significantly worsen patient prognosis.
• Cytoreductive surgery (CRS) and systemic chemotherapy offer survival benefits for selected PSM patients.
• The combination of CRS with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly explored for PSM.

Purpose of the Study:

• To review the current evidence and controversies surrounding CRS plus HIPEC for PSM from various digestive cancers.
• To discuss the limitations of existing trials and the need for future research on HIPEC regimens.
• To explore alternative treatments like pressurized intraperitoneal aerosolized chemotherapy (PIPAC) for unresectable PSM.

Main Methods:

• Review of clinical trials and existing literature on CRS and HIPEC for PSM.
• Analysis of survival data from studies including PRODIGE 7, PROPHYLOCHIP, and COLOPEC trials.
• Discussion of treatment outcomes for specific cancers like colorectal, gastric, and pseudomyxoma peritonei.

Main Results:

• CRS plus HIPEC is the gold standard for pseudomyxoma peritonei, achieving 10-year overall survival (OS) of 70-80%.
• For gastric cancer PSM, CRS plus HIPEC shows median OS >40 months in select patients (PCI ≤6), but requires randomized trial validation.
• Oxaliplatin-based HIPEC in colorectal cancer PSM has shown controversial results, failing to consistently improve long-term outcomes in major trials.

Conclusions:

• The role of CRS plus HIPEC in colorectal cancer PSM requires further investigation with optimized regimens.
• CRS plus HIPEC is highly effective for pseudomyxoma peritonei.
• Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a promising palliative option for unresectable PSM, particularly in gastric cancer.