Update on the prevention of local recurrence and peritoneal metastases in patients with colorectal cancer

Table 1 National Institutes of Health randomized study: Long-term intraperitoneal 5-fluorouracil can prevent the occurrence of peritoneal metastases n (%)

	Sites of treatment failure for IV or IP 5-FU
	No. of patients	No. of recurrences	Peritoneal surface	Liver
IP 5-FU	36	13 (36)	2/10	3/11
IV 5-FU	30	11 (37)	10/11	4/11
Statistical analysis P2			0.003	1.000

From ref. [11] with permission. 5-FU: 5-fluorouracil.

Table 2 Current indications for proactive management of peritoneal metastases and local-regional progression for colon cancer

1Biopsy-proven cancer nodule(s) on any peritoneal surface including the primary cancer (T4)

1Positive biopsy or pathologic enlargement of an ovary

1Cancer at the surgical margin of resection (R-1)

Perforation through the malignancy (iatrogenic by colonoscopy or spontaneous)

Positive peritoneal cytology

Adjacent organ involvement or fistula formation

Lymph nodes positive at the margins of resection

Rupture of the primary cancer during resection

¹Eligible for second-look plus hyperthermic perioperative chemotherapy.

Table 3 Cytoreductive surgery and hyperthermic perioperative chemotherapy for proactive management of local recurrence and peritoneal metastases for colorectal cancer

Credits	Debits
Long-term survival in 50% of patients	Many patients treated for a few to benefit
Selection factors have been well defined	The surgical technology is complex and requires an extended learning curve
An important addition to the MDT for management of colorectal malignancy	Referral by medical oncologist are often late with a large extent of disease
Morbidity (10%) and mortality (1%) at experienced centers is acceptable	So far a uniform HIPEC treatment has not emerged; perioperative chemotherapy needs to be optimized

HIPEC: Hyperthermic perioperative chemotherapy.