Cytoreductive surgery plus intraperitoneal chemohyperthermia in patients with colorectal cancer at high risk for local-regional recurrence.

This article was written to define the situations in which early second-look surgery with a combined treatment should be indicated in patients at high risk of developing peritoneal carcinomatosis (PC). Through a review of the literature, this is a definition of the second-look concept and of the different groups of patients at risk, in different situations (after resection of the primary, after initial cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy, and after the discovery of isolated carcinoembryonic antigen elevation or isolated peritoneal uptake on positron emission tomography scan). Systematic second-look surgery for early treatment of asymptomatic PC is probably beneficial in patients presenting a high risk of developing PC after resection of their primary. The benefit seems considerably lower for the other groups of high-risk patients.

Pharmacokinetics of heated intraoperative intraperitoneal oxaliplatin after complete resection of peritoneal carcinomatosis.

The results of three prospective clinical trials are reported: the first one was aimed at determining the appropriate dose of heated (42 degrees C) intraperitoneal oxaliplatin following complete resection of peritoneal carcinomatosis by studying its pharmacokinetics. The recommended dosage was set at 460 mg/m2 in 2 L/m2 of peritoneal instillation. Using these data another phase 2 study on 24 patients with colorectal peritoneal carcinomatosis treated with the preceding regimen was initiated; the 2-year survival rate was 74% after a minimal follow-up of 18 months. A pharmacokinetic study using intraperitoneal oxaliplatin at the same dose but in various hypotonic solutions did not show any specific pharmacologic advantage and was associated with excessive postoperative bleeding.