Selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and perioperative intraperitoneal chemotherapy

Background: Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has been suggested as a treatment option for patients with colorectal peritoneal carcinomatosis. However, the survival benefit is achieved at the expense of moderate to high perioperative morbidity and mortality. Methods: This review summarized the important prognostic factors for survival; outlined the patient selection process from major peritonectomy centers, paying particular attention to preoperative evaluation; and identified areas for potential improvement. Emphasis was placed on a strict patient selection process to avoid futile aggressive treatments. Results: Currently, contrast-enhanced computed tomography, magnetic resonance imaging, positron emission tomography, and laparoscopy have been utilized in the preoperative evaluation process to identify potential surgical candidates. Patients with good performance status, low volume of peritoneal disease, and absence of extra-abdominal metastases are more likely to benefit from the combined treatment. Conclusions: Quantitative assessment of the extent of disease is possible and should be performed at the time of primary cancer operation. Careful selection of patients to identify surgical candidates with favorable prognostic indicators is important.