Management Of Unexpected Peritoneal Metastases With Primary Colorectal Cancer Using Second-Look Surgery With HIPEC

Peritoneal metastases (PM) will be unexpectedly present in approximately 10% of colorectal cancer patients having primary cancer resection. In the past this was considered to be an incurable condition with a terminal outcome.

In patients determined to have peritoneal dissemination at the time of resection, the intervention was considered palliative. Recently, long term benefit from definitive treatment of PM with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become a reality.

These treatments are now appropriate for primary appendiceal and colorectal cancer determined to have PM at the time of resection.

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Management Of Unexpected Peritoneal Metastases With Primary Colorectal Cancer Using Second-Look Surgery With HIPEC

Peritoneal metastases (PM) will be unexpectedly present in approximately 10% of colorectal cancer patients having primary cancer resection. In the past this was considered to be an incurable condition with a terminal outcome.

In patients determined to have peritoneal dissemination at the time of resection, the intervention was considered palliative. Recently, long term benefit from definitive treatment of PM with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become a reality.

These treatments are now appropriate for primary appendiceal and colorectal cancer determined to have PM at the time of resection.Modifications of the initial management of colorectal cancer patients found upon exploration to have PM are explored in this manuscript. In these patients, not only the primary cancer but also the PM must be optimally treated.

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Management Of Unexpected Peritoneal Metastases With Primary Colorectal Cancer Using Second-Look Surgery With HIPEC

Peritoneal metastases (PM) documented in a patient with primary colon or rectal cancer places the patient at extreme risk for local recurrence or progressive PM diagnosed in follow-up.

In the past, peritoneal seeding diagnosed with the surgical exploration did not result in any major changes in the surgical approach to the disease process. Rather, conventional surgery was performed and then the patient was referred for palliative systemic chemotherapy. At this point in time potentially curative treatments for PM have evolved and become an important part of the standard of care of colorectal malignancy.

In order to optimize the management of peritoneal metastases, a new approach to the primary cancer presenting with PM is required. The goal of manuscript is to describe a clinical pathway so that patients with PM diagnosed at the time of primary colorectal cancer resection receive treatment with curative intent.

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