Role of Cytoreduction Surgery With HIPEC in the Management of Peritoneal Carcinomatosis From Colorectal Cancer and Pseudomyxoma Peritonei

Abstract

For most cancers, peritoneal carcinomatosis (PC) usually is considered a systemic disease and portends a very poor prognosis. However, in colorectal cancer, especially the mucinous colorectal adenocarcinoma (MCA) subtype and epithelial appendiceal neoplasms-particularly pseudomyxoma peritonei (PMP)-the pattern of PC represents local celomic extension of disease rather than systemic metastasis. Among the treatment options for isolated PC, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the de facto standard of care in many institutions, based on prospective single-center and multicenter studies and randomized clinical data. However, the use of HIPEC seems to benefit only patients who have undergone complete CRS and present with favorable histology (MCA and PMP). Determining the feasibility of complete CRS is the key to adequate patient selection, because peritoneal tumor burden, both before and after CRS, is the main prognostic factor. If complete CRS is achieved, HIPEC may be offered in the effort to improve long-term outcomes.