Colorectal Peritoneal Metastases

Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS and HIPEC) has been shown to be beneficial in highly selected patients and is a recommended treatment option by NICE in the UK in specialised peritoneal malignancy centres.

Patients with CPM can present at the time of their bowel cancer diagnosis (synchronous) which means that the bowel tumour is still there or CPM can develop some time after the bowel cancer was removed (metachronous).  The current principles of managing CPM combine the use of systemic chemotherapy (combination of drugs delivered in the vein or orally in multiple cycles) and or surgery in highly selected patients. Every patient is assessed based on their individual circumstances and a treatment plan is agreed.

The first question to be answered in patients with CPM referred for consideration for CRS and HIPEC is if complete cytoreduction (removal of all abnormal tissue) can be achieved with surgery. To answer this we sometimes recommend doing a Staging Laparoscopy if we can not make this decision from the information we have from the staging CT, PET CT or MRI scans.

CRS and HIPEC has been shown to be most successful in patients with limited or contained CPM i.e. low volume metastases and therefore most likely that complete cytoreduction will be achieved and/or patients who have shown stability of their disease process over time.

In general systemic metastases (spread of tumour to the liver or lungs) and CPM together are a negative prognostic factor. However in selected patients CRS and HIPEC along with other surgical techniques and systemic chemotherapy can still improve the outcome of patients compared to systemic chemotherapy alone.  In selected patients with synchronous liver and peritoneal deposits (tumour has spread to the liver and the peritoneum at the some time) CRS and HIPEC can be combined with liver surgery.  Usually this is the case if both the liver and peritoneal disease are not present in high volume. In some instances we follow a two stage approach where the liver or peritoneal disease is dealt with two separate operations with or without systemic chemotherapy between the two operations.

As is the case for all cancer patients every patient is assessed at our SMDT and the treatment plan is established based on the patients individual circumstances aiming at the best possible outcome.