English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Peritoneal carcinomatosis (PC) is no longer considered as a systemic disease. There is mounting evidence for a local spread theory [1]. Peritoneal tumor implantation occurs due to multiple mechanisms including serosal invasion, leakage of malignant cells through the lymphatics, or as a result of imprudent dissection [2]. The exact extent of the PC can be determined precisely only during surgery. The peritoneal cancer index (PCI, Washington Cancer Institute) is usually used to quantify PC. This explains why the estimation of the extent of PC was sub-optimal in historical series where patients were treated systematically without formal staging [3]. In the most recent revision of the TNM staging system [4], metastatic colorectal cancer (CRC) at initial diagnosis is sub-classified into stage IVA or IVB disease according to the number or site of metastases. In this system, PC is subclassified into stage IVB, whereas other metastases to a sole organ such as liver or lung are sub-classified into stage IVA, which is considered to indicate better survival. The new TNM classification system was proposed and validated before publication by the American Joint Committee on Cancer (AJCC) Hindgut Taskforce based on a large population-based study, surveillance, epidemiology, and end results (SEER) of patients with CRC treated between 1994 and 2005 in the USA [5, 6]. The major historical series (i.e., before the era of newer chemotherapy, cytoreductive surgery [CRS], and heated intraperitoneal chemotherapy, [HIPEC]) suggested a poor prognosis with a median survival around 6 months and absolutely no long-term survivors [6–8]. However, for almost a decade now, the prognosis of patients with PC of colorectal origin has been improving. This is mainly due to two factors, the use of oxaliplatinbased chemotherapy [9] and the combination of CRS with HIPEC as a possible treatment modality [10]. These findings raise the question of whether sub-classification into stage IVB is still appropriate and clinically relevant. Ishida et al. [11] conducted a retrospective study in order to investigate the overall survival in metastatic CRC patients based on the sites of metastasis in the era of modern chemotherapy. The authors found that patients with isolated PC had a median survival of 36.6 months, as compared to a median survival of 32.5 months (p = 0.48) for patients in the IVA group. These figures were significantly higher than those of patients with distant metastases with or without PC [14.7 months (p = 0.07) and 12.9 months (p \ 0.01), respectively]. The authors recommend including patients with isolated PC in the IVA group rather than those in the IVB group. Only about a third of all patients with PC would be suitable for an aggressive, multimodal therapy, combining CRS with HIPEC and systemic chemotherapy. In order to improve the prognosis, complete resection of the entire macroscopically visible tumor mass is mandatory. Remaining microscopic tumor cells should be eradicated immediately after resection with HIPEC. With such an approach, median survival has been reported to reach more than 30 months, with 3or 5-year survival rates of more than 30 %, in some series [12]. Patient selection is, however, crucial. A positron emission tomography (PET) scan is a valuable tool for selecting patients with isolated PC On behalf of the Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (iNOELS), France.

Peritoneal carcinomatosis of colorectal origin: is it really an end-stage disease?