Surgery and chemotherapy for colorectal cancer spread to the peritoneum

This review analyzed the effectiveness of combined surgery and chemotherapy for colorectal cancer which has spread to the wall of the abdomen.

Many colorectal cancer patients are diagnosed after the cancer has already spread. Cancer that has spread to the peritoneum (the abdominal wall) is termed “colorectal peritoneal metastasis” (CPM). There are many types of treatment available. Cytoreductive surgery (CS) aims to reduce tumor size.  Chemotherapy targets the cancer. The overall aim is to block growth and further development.  

A combination of CS and intraperitoneal chemotherapy (direct delivery of chemotherapeutic drugs through the abdomen into the peritoneum) has been suggested as treatment for CPM. Two types of intraperitoneal chemotherapy have been investigated. HIPEC (hyperthermic intraperitoneal chemotherapy) delivers heated chemotherapy during surgery. EPIC (early post-operative intraperitoneal chemotherapy) delivers the chemotherapy after surgery.

The authors analyzed the results of 28 papers. The efficiency of CS and IPC in the treatment of CPM was investigated.

For patients who had CS and HIPEC, average survival was 22.2 to 62.7 months. In comparison, average survival of the patients who had received systemic chemotherapy alone (through an IV tube delivering chemotherapy directly to the bloodstream) was 12.6 to 23.9 months.  On average, 90% of CS and HIPEC patients survived for 1 year, 81% survived for 2 years and 25-51% survived for 5 years. In comparison, 55% of chemotherapy only patients survived for 1 year, 65% survived for 2 years and 13% survived for 5 years. 

60% of CS and EPIC patients survived for 2 years and 28% survived for 5 years. In comparison, 10% of chemotherapy only patients survived for 2 years and 5% survived for 5 years. The average survival for CS and EPIC patients was 32 months, compared with 14 months in the chemotherapy only group.

Deaths related to treatment occurred in 0-12% of patients in each study. The most common side effects were surgical wound infection or reopening after surgery (3-12% of patients), the formation of fistulae (abnormal connections between two organs; 1-11% of patients) and abscess (pockets of infection; 1.8-14% of patients). Blood toxicity was reported in 2-52% of cases. 4% to 20.8% of patients had further surgery.

The authors suggest that CS and IPC increase the survival of CPM patients. . 

Consult your doctor to discuss treatment techniques for peritoneal metastasis.