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 Printable version |
Results of systematic second-look surgery in patients at high risk of developing colorectal peritoneal carcinomatosis |
Hépato-Gastro. Volume 18, Number 6, 595-600, Novembre-Décembre 2011, Mini-revue
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 Résumé
Texte intégral
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Author(s) : Diane Goéré, Dominique Elias |
Summary : The concept of second-look surgery is based on the encouraging results of surgical excision followed by hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of colorectal carcinomatosis, and on the lack of effective imaging examinations for the diagnosis of carcinomatosis at a early stage. We conducted a first study in patients operated for colorectal cancer, asymptomatic, without clinical or biological sign of recurrence, with a high risk of developing carcinomatosis. Three groups of patients at risk were selected: patients with synchronous carcinomatosis localized and resected, patients with synchronous ovarian metastases, and those with a perforated primary tumor. A colorectal carcinomatosis was present in 16/29 (55%) patients during the second-look. In a second study, patients at high risk for carcinomatosis, surgical second-look as previously described, followed by a systematic hyperthermic intraperitoneal chemotherapy, were performed in 41 patients. After a median follow-up of 30 [9-109] months, the 5-year overall and disease-free survival rates were 90% and 44%. After these encouraging preliminary results, a randomized phase III multicenter study (Prodige 19, NCT01226394), in patients at high of developing peritoneal carcinomatosis, comparing a standard monitoring (clinical monitoring, biological and morphological exams) after 6 months of adjuvant chemotherapy, to a systematic surgical exploration combined with HIPEC, whether or not a carcinomatosis was visible, is on going. |
Keywords : peritoneal carcinomatosis, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy colorectal cancer, second-look surgery |
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