Past, present and future of adjuvant HIPEC in patients at high risk for colorectal peritoneal metastases

Peritoneal metastases (PM) from colorectal cancer (CRC) still represent a huge health-care problem. Recent population-based studies report an overall 3.5–4.2% incidence of CRC-PM after potentially curative primary surgery [ [1] Segelman J. Granath F. Holm T. et al. Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2012; 99: 699-705 Crossref PubMed Scopus (306) Google Scholar , [2] van Gestel Y.R. Thomassen I. Lemmens V.E. Pruijt J.F. van Herk-Sukel M.P. Rutten H.J. et al. Metachronous peritoneal carcinomatosis after curative treatment of colorectal cancer. Eur J Surg Oncol. 2014; 40: 963-969 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar ]. These rates can reach up to about 25% in locally advanced CRC penetrating visceral peritoneum (pT4a), or directly infiltrating surrounding organs (pT4b) [ 1 Segelman J. Granath F. Holm T. et al. Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2012; 99: 699-705 Crossref PubMed Scopus (306) Google Scholar , 2 van Gestel Y.R. Thomassen I. Lemmens V.E. Pruijt J.F. van Herk-Sukel M.P. Rutten H.J. et al. Metachronous peritoneal carcinomatosis after curative treatment of colorectal cancer. Eur J Surg Oncol. 2014; 40: 963-969 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar , 3 Baratti D. Kusamura S. Iusco D. et al. Hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of primary curative surgery in patients with colorectal cancer at high risk for metachronous peritoneal metastases. Ann Surg Oncol. 2017; 24: 167-175 Crossref PubMed Scopus (27) Google Scholar ]. Accordingly, the peritoneum is one of the most common site of metastatic spread for CRC, following the liver and lung, even though incidences may be likely underestimated because PM are more difficult to detect than liver or lung metastases.