Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2019; 25(27): 3484-3502
Published online Jul 21, 2019. doi: 10.3748/wjg.v25.i27.3484
Colorectal peritoneal metastases: Optimal management review
Juan Manuel Sánchez-Hidalgo, Lidia Rodríguez-Ortiz, Álvaro Arjona-Sánchez, Sebastián Rufián-Peña, Ángela Casado-Adam, Antonio Cosano-Álvarez, Javier Briceño-Delgado
Juan Manuel Sánchez-Hidalgo, Lidia Rodríguez-Ortiz, Álvaro Arjona-Sánchez, Sebastián Rufián-Peña, Ángela Casado-Adam, Antonio Cosano-Álvarez, Javier Briceño-Delgado, Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
Author contributions: Sánchez-Hidalgo JM, Arjona-Sánchez A and Rodríguez-Ortiz L contributed to the conception and design of the review; Sánchez-Hidalgo JM, Rodríguez-Ortiz L, Casado-Adam A and Cosano-Álvarez A contributed to literature review and analysis; Sánchez-Hidalgo JM, Rodríguez-Ortiz L wrote the article; Sanchez-Hidalgo JM, Rodríguez-Ortiz L and Arjona-Sánchez A contributed to drafting and critical revision and editing; Sánchez-Hidalgo JM, Rufian-Peña S and Briceño-Delgado J approved the final version.
Conflict-of-interest statement: Any author has any potential conflicts of interest to declare. No financial support was received for this review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Juan Manuel Sánchez-Hidalgo, MD, PhD, Doctor, Surgical Oncologist, Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain. juanmanuelsanchezhidalgo@hotmail.com
Telephone: +34-957-010000
Received: February 27, 2019
Peer-review started: March 1, 2019
First decision: April 5, 2019
Revised: May 20, 2019
Accepted: June 22, 2019
Article in press: June 23, 2019
Published online: July 21, 2019
Abstract

The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.

Keywords: Peritoneal metastases, Colorectal cancer, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Peritoneal carcinomatosis

Core tip: Patients with peritoneal metastases from colorectal cancer have classically been associated with limited survival and treated only with palliative surgery and systemic support. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, often combined with systemic treatment, are increasingly performed with a curative intent for well-selected patients. Recent data suggests an important improvement of overall and disease-free survival for these patients. This article aims to review the state of art for the management of peritoneal metastases from colorectal origin and to confine the latest experts’ consensus and future directives.