Surgery for Peritoneal Metastases from Colorectal Cancer: What Are the Limits?

摘要

Peritoneal metastases of coloreetal cancer are diagnosed in 4-20% of patients and represent the third metastatic site after the liver and lungs. The treatment is based on complete resection (CRS) of peritoneal lesions followed by hyperthermic intraperitoneal chemotherapy (HIPEC) following the publication in 2003 of the results of the Dutch phase 3 trial. Since then, patient survival has been significantly improved reaching 40% at 5 years, and this is because of a better knowledge of the disease, prognostic factors and a better selection of patients. Indications and contraindications of CRS followed by HIPEC have been defined and refined in recent years, to better understand the limits of this combined treatment. In 2018, the results of the PRODIGE 7 therapeutic trial, the first study evaluating the potential benefit of HIPEC (with oxaliplatin) compared with complete resection alone, were reported at the ASCO Congress. The overall survival and disease-free survival rates were similar in both groups. Will these results upset our practices in France and abroad? It is impossible to answer this question right now. In order to define a common attitude among these patients with colorectal peritoneal metastases, and to propose future studies, a French consensus conference is planned for November 2018.