Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy- Key Concepts
- Evidence Base for CRS and HIPEC for Colorectal Peritoneal Metastases (CPM)
- The Role of Systemic Chemotherapy: Before or After CRS and HIPEC?
- Prophylactic CRS and HIPEC in Advanced Cancer
- Synchronous Colorectal Peritoneal and Other Site Oligo-Metastases
- Palliative CRS for CPM
- Conclusion
- References
- Introduction
- Pseudomyxoma Peritonei (PMP): The Pathophysiology of Peritoneal Disease and the Re-distribution Phenomenon
- The Peritoneal Cavity
- Colorectal Cancer and the Concept of Resectable Peritoneal Metastases
- The Peritoneal Cancer Index (PCI)
- Cytoreductive Surgery: “Complete Cytoreductive (CC)” Scoring System
- Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
- Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)
Malignancy- In which of the following clinical scenarios should cytoreductive surgery and intraperitoneal chemotherapy be considered?
- A 57-year-old woman presents with worsening abdominal fullness and poorly localized abdominal pain. One year ago she had uneventful appendectomy. She brings you her medical showing that a low-grade appendiceal neoplasm was found on pathology. Computed tomography (CT) demonstrates evidence of multiple fluid filled lesions throughout the abdomen. What is the most appropriate next step in her treatment?
- A 62-year-old woman is found to have a large near-obstructing sigmoid cancer on colonoscopy; biopsy returns as adenocarcinoma. Preoperative staging includes a carcinoembryonic antigen (CEA) level of 8 ng/mL, and imaging shows a few prominent lymph nodes near the sigmoid lesion. She is referred for surgical management. Frozen section on peritoneal nodules found near the lesion return as adenocarcinoma, and oncological resection is completed. Which of the following is the best determinant of the prognosis for this patient?
Management of Appendiceal Neoplasms (2019)- Management of Appendiceal Neoplasms (2025)
Malignancy- A 56-year-old woman presents for evaluation of increasing abdominal girth, fullness, and abdominal pain. On examination, her abdomen is distended and she has had progressive weight loss of 50 lbs over the last 1 year. Computed tomography is performed (Figure). Her gynecologic examination and transvaginal ultrasonography findings are normal. Findings of colonoscopy are unremarkable. What is the best step in management?
- You are consulted by the emergency department about a patient with a large bowel obstruction caused by an obstructing right colonic mass. On exploration, you note that she has peritoneal carcinomatosis in the right lower quadrant, with a normal-appearing liver and ovaries. You perform a right colectomy with primary anastomosis, and a biopsy of her metastatic disease. Final pathology report is consistent with metastatic appendiceal mucinous neoplasm. Staging shows no evidence of distant metastatic disease aside from her known isolated peritoneal lesions. What is the best treatment option to improve her overall survival?
- Management of Colon Cancer (2022)
- About ASCRS Textbook of Colon and Rectal Surgery
- Appendiceal Neoplasms
- Management of Rectal Cancer (2020)