Optimization of Patient Selection for Surgical Approach to Peritoneal Metastases from Gastrointestinal Cancer Using Cytoreductive Surgery and Perioperative Chemotherapy

Abstract Gastrointestinal cancer can metastasize by hematogenous routes to the liver, by lymphatic channels to regional lymph nodes, and by penetration of the bowel wall to the peritoneal surfaces. For patients who have isolated peritoneal metastases, a new management plan with curative intent has evolved over the last 30 years. Now patients with peritoneal dissemination are evaluated by the multidisciplinary team for treatment by cytoreductive surgery plus perioperative chemotherapy. Major progress in the treatment of peritoneal metastases has occurred as a result of more clearly defined selection criteria. Now it is possible to identify patients who are likely to benefit and exclude those who may undergo extensive surgery with little or no added longevity or improved quality of life. Success with the combined treatment is dependent on complete cytoreductive surgery (CRS) before initiation of the perioperative chemotherapy. The large variations in success with peritoneal metastases treatment is dependent upon the success of hyperthermic perioperative chemotherapy (HIPEC) and early postoperative chemotherapy (EPIC) to maintain the absence of intraperitoneal cancer achieved by the surgical complete response. Prevention of a recurrence of peritoneal metastases after complete cytoreduction can be divided into two distinct time periods. Secondary prevention involves the peritoneal metastases diagnosed in follow up. The selection factors important in assessmen...
Source: Current Colorectal Cancer Reports - Category: Cancer & Oncology Source Type: research