J Cancer 2013; 4(3):262-269. doi:10.7150/jca.5831


Patients at Risk for Peritoneal Surface Malignancy of Colorectal Cancer Origin: The Role of Second Look Laparotomy

Björn LDM Brücher1,7,8✉, Alexander Stojadinovic2,8, Anton J. Bilchik3,8, Mladjan Protic4,8, Martin Daumer5,8, Aviram Nissan6,8, Itzhak Avital7,8

1. Theodor-Billroth-Academy®, Munich, Germany
2. Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, and the United States Military Cancer Institute, Washington, D.C. USA
3. John Wayne Cancer Institute, Santa Monica, CA, USA
4. Clinic of Abdominal, Endocrine, and Transplantation Surgery, Clinical Center of Vojvodina, University of Novi-Sad, Medical Faculty, Novi Sad, Serbia
5. Sylvia Lawry Center for MS Research, Munich, Germany
6. Department of Surgery, Hadassah University, Jerusalem, Israel
7. Bon Secours Cancer Institute, Richmond, VA, USA
8. INCORE = International Consortium of Research Excellence of the Theodor-Billroth-Academy®

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Brücher BLDM, Stojadinovic A, Bilchik AJ, Protic M, Daumer M, Nissan A, Avital I. Patients at Risk for Peritoneal Surface Malignancy of Colorectal Cancer Origin: The Role of Second Look Laparotomy. J Cancer 2013; 4(3):262-269. doi:10.7150/jca.5831. Available from https://www.jcancer.org/v04p0262.htm

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Peritoneal surface malignancy (PSM) is a frequent occurrence in the natural history of colorectal cancer (CRC). Although significant advances have been made in screening of CRC, similar progress has yet to be made in the early detection of PSM of colorectal cancer origin. The fact that advanced CRC can be confined to the peritoneal surface without distant dissemination forms the basis for aggressive multi-modality therapy consisting of cytoreductive surgery (CRS) plus hyperthermic intra-peritoneal chemotherapy (HIPEC), and neoadjuvant and/or adjuvant systemic therapy. Reported overall survival with complete CRS+HIPEC exceeds that of systemic therapy alone for the treatment of PSM from CRC, underscoring the advantage of this multi-modality therapeutic approach. Patients with limited peritoneal disease from CRC can undergo complete cytoreduction, which is associated with the best reported outcomes. As early or limited peritoneal carcinomatosis is undetectable by conventional imaging modalities, second look laparotomy is an important means to identify disease in high-risk patients at a stage most amenable to complete cytoreduction. This review focuses on the identification of patients at risk for PSM from CRC and discusses the role of second look laparotomy.

Keywords: Carcinomatosis, colorectal cancer, prospective, randomized, clinical trials, HIPEC, CRS, Oxaliplatin and Mitomycin