Update on the prevention of local recurrence and peritoneal metastases in patients with colorectal cancer. [Review]
Citation: World Journal of Gastroenterology. 20(28):9286-91, 2014 Jul 28.PMID: 25071322Institution: MedStar Washington Hospital CenterDepartment: Surgery/General SurgeryForm of publication: Journal ArticleSubject headings: *Antineoplastic Combined Chemotherapy Protocols/tu [Therapeutic Use] | *Colectomy | *Colorectal Neoplasms/pa [Pathology] | *Colorectal Neoplasms/th [Therapy] | *Neoplasm Recurrence, Local/pc [Prevention & Control] | *Peritoneal Neoplasms/pc [Prevention & Control] | *Peritoneal Neoplasms/sc [Secondary] | Chemotherapy, Adjuvant | Humans | Hypothermia, Induced | Neoadjuvant Therapy | Patient Selection | Risk Factors | Treatment OutcomeYear: 2014ISSN:- 1007-9327
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 25071322 | Available | 25071322 |
The prevention of a disease process has always been superior to the treatment of the same disease throughout the history of medicine and surgery. Local recurrence and peritoneal metastases occur in approximately 8% of colon cancer patients and 25% of rectal cancer patients and should be prevented. Strategies to prevent colon or rectal cancer local recurrence and peritoneal metastases include cytoreductive surgery and hyperthermic perioperative chemotherapy (HIPEC). These strategies can be used at the time of primary colon or rectal cancer resection if the HIPEC is available. At institutions where HIPEC is not available with the treatment of primary malignancy, a proactive second-look surgery is recommended. Several phase II studies strongly support the proactive approach. If peritoneal metastases were treated along with the primary colon resection, 5-year survival was seen and these results were superior to the results of treatment after peritoneal metastases had developed as recurrence. Also, prophylactic HIPEC improved survival with T3/T4 mucinous or signet ring colon cancers. A second-look has been shown to be effective in two published manuscripts. Unpublished data from MedStar Washington Cancer Institute also produced favorable date. Rectal cancer with peritoneal metastases may not be so effectively treated. There are both credits and debits of this proactive approach. Selection factors should be reviewed by the multidisciplinary team for individualized management of patients with or at high risk for peritoneal metastases.
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