New Perspectives in the Management of Colorectal Cancer: What about Peritoneal Carcinomatosis?

The special issue (Special Issue on Colorectal Cancer, Volume 92, number 1: 1–108, 2003) of the journal dedicated to new techniques and modern treatment modalities concerning colorectal cancer was most informative; yet we were perplexed with the absence of comment or review regarding the new management strategies for peritoneal carcinomatosis. Despite advances in the early detection of colon and rectal cancer, carcinomatosis remains a major problem for these patients. It is detected in approximately 10 % of patients at the time of primary cancer resection (1). In contrast to the two other major anatomic sites for colorectal dissemination (lymph node and liver metastases) peritoneal carcinomatosis has long been considered a terminal condition with no curative treatment options. For example, in a multicentric prospective study on the natural history of carcinomatosis from nongynaecologic malignancies, the median overall survival was 5.2 months for colorectal patients (2). In a more recent retrospective analysis of 3019 colorectal cancer patients, 13 % of patients presented with carcinomatosis and had a median survival of 7 months (3). During the last decade there has been an increasing interest in a combined treatment of peritoneal carcinomatosis with cytoreductive surgery and perioperative intraperitoneal chemotherapy. The concept of tumour volume reduction of peritoneal surface malignancy which has been reported in the past for ovarian cancer and its combination with a local-regional chemotherapy acts as a “dose intensification device” that allows a potentially curative treatment option. Theoretically, cytoreductive surgery and its peritonectomy procedures is performed to treat the macroscopic disease and perioperative intraperitoneal chemotherapy to treat residual microscopic residual disease.