Use of hyperthermic intraperitoneal chemotherapy (HIPEC) in management of peritoneal carcinomatosis from colorectal origin.

Approximately 1 in 30 patients suffering from colorectal cancer (CRC) will develop peritoneal carcinomatosis (PC) in the absence of systemic spread. The mechanisms giving rise to PC in CRC are incompletely understood, but involve a complex stepwise interaction between the malignant cell and mesothelial layer. Systemic palliative chemotherapy is usually offered, but of limited activity in PC. Cytoreductive surgery followed by intraperitoneal hyperthermic chemoperfusion (HIPEC) has been described recently in management of isolated PC originating from CRC, based on a sound biological rationale of synergism and a pharmacokinetical advantage. Several retrospective series, one prospective randomized trial, and a meta analysis have clearly shown a survival benefit for patients treated with cytoreduction + HIPEC provided a complete (R0) resection is performed. Toxicity of the procedure is considerable, and mainly depends on the extent of surgery. Future trials are needed to provide more solid evidence in favor of surgery in PC originating from CRC in the era of modern chemotherapy and to better define the role of HIPEC as an adjunct to surgery.