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Surgical Management of Colorectal Cancer Peritoneal Metastases: Current Indications, Controversies, and Future
Michelle Horowitz1, Christopher T Aquina2
1Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, AdventHealth Orlando, Orlando, Florida, USA.
Background:
Isolated peritoneal metastases occur in approximately 4-8% of patients with colorectal cancer and are associated with a very poor prognosis with systemic therapy alone. While cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have traditionally been a controversial treatment regimen for colorectal cancer peritoneal metastases due to a high rate of morbidity and a perceived limited efficacy, recent studies have confirmed its safety and have demonstrated the ability to achieve long-term survival in carefully selected patients.
Summary:
This narrative review presents the current indications, controversies, and future directions of CRS, HIPEC, and additional emerging treatment modalities in the surgical management of colorectal cancer peritoneal metastases.
Key Messages:
Peritoneal metastases in colorectal cancer signify a poor prognosis. Management of peritoneal disease includes CRS with or without HIPEC. The use of CRS has been established as an effective treatment modality with acceptable morbidity and long-term quality of life. However, the efficacy of HIPEC continues to be debated. Patient functional status, tumor biology, degree of disease burden, and the feasibility of achieving complete cytoreduction are central to the success of the operation. Emerging treatment options, such as pressurized intraperitoneal aerosolized chemotherapy, represent promising alternative treatment options for patients.
