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Peritoneal Metastases

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Extreme Hepatic Surgery and Other Strategies

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Abstract

Occurring either synchronously or metachronously to the primary tumor, peritoneal metastases (PM) are diagnosed in 8–20% of the patients with colorectal cancer (CRC). Diagnosis of PM is mostly done at a very advanced stage because no symptoms are fully specific of PM, and because of the low sensitivity of the imaging exams. However, risk factors of developing PM have been identified, which can help to diagnose PM at an early stage, and to evaluate new treatment protocols as the systematic second-look surgery. The prognosis of patients with PM from CRC has been widely improved with the development of a new therapeutic approach consisting of a complete cytoreductive surgery (CCRS) of the PM followed by hyperthermic intraperitoneal chemotherapy (HIPEC). This strategy makes it possible to obtain a median survival up to 63 months, with an overall 5-year survival rate close to 40% in selected patients, provided there is complete removal of macroscopic disease. The selection of patients is made roughly on clinical parameters and intra-operative findings. An absolute contraindication for CCRS plus HIPEC is a poor general status, the presence of extraperitoneal metastases (except three liver metastases easily resectable) and huge, diffuse, incompletely resectable Peritoneal Cancer (PC). Thus, complete cytoreductive surgery followed by HIPEC is currently the gold-standard treatment when it is possible, leading to obtaining survival results similar to those obtained with hepatectomy for liver metastases from CRC. The main progress will be to early-operate these patients, or to propose a prophylactic approach to those presenting a high risk of developing PM.

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Authors and Affiliations

  1. Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France

    Diane Goéré MD, Léonor Benhaim, Charles Honoré & Dominique Elias

  2. Department of Pathology, Gustave Roussy, Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France

    Peggy Dartigues

  3. Department of Radiology, Gustave Roussy, Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France

    Caroline Caramella

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  1. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Eduardo de Santibañes

  2. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

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  5. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Martin de Santibañes

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Goéré, D., Dartigues, P., Caramella, C., Benhaim, L., Honoré, C., Elias, D. (2017). Peritoneal Metastases. In: de Santibañes, E., Ardiles, V., Alvarez, F., Busnelli, V., de Santibañes, M. (eds) Extreme Hepatic Surgery and Other Strategies. Springer, Cham. https://doi.org/10.1007/978-3-319-13896-1_23

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