title: Results of systematic second-look surgery in patients at high risk of developing colorectal peritoneal carcinomatosis.
abstract: OBJECTIVE
  The aim of this prospective study was to analyze the impact of second-look surgery in an attempt to treat peritoneal carcinomatosis (PC) at an early stage in a series of patients at high risk of developing PC from colorectal cancer.
  
  
  BACKGROUND
  The prognosis of colorectal PC has recently been improved with hyperthermic intraperitoneal chemotherapy (HIPEC) after complete cytoreductive surgery (CCRS), and could be further improved if PC could be treated at an early stage. But, currently, the diagnosis of early PC is not accessible to imaging.
  
  
  METHODS
  From 1999 to 2006, 29 patients without any sign of recurrence on imaging studies underwent second-look surgery 13 months after resection of the primary tumor. Patients were selected according to primary tumor-associated criteria: resected minimal synchronous macroscopic PC (n = 16), synchronous ovarian metastases (n = 4), perforated primary tumor (n = 9).
  
  
  RESULTS
  PC was found and treated with CCRS plus HIPEC in 16 of 29 (55%) cases, corresponding to 10 of 16 patients with initial PC, 3 of 4 patients with synchronous ovarian metastases and 3 of 9 patients with a perforated primary tumor. There was no postoperative mortality, and morbidity (grade III/IV) occurred in 14% of cases. After a median follow-up of 27 months (range, 6-96), 8 of 16 patients treated with CCRS and HIPEC are free of disease, 4 relapsed in the peritoneum, and 4 developed isolated visceral metastases.
  
  
  CONCLUSIONS
  Performing second-look surgery at 1 year in selected patients at high risk of developing PC allowed the early detection and treatment of PC in 55% of cases. Our preliminary results have encouraged us to pursue this strategy and to evaluate it in a prospective multicenter trial.
authors: Department of Surgical Oncology; Institut Gustave Roussy, Cancer Center, Villejuif, France.
authors: Dominique
authors: D
authors: Elias
authors: Diane
authors: D
authors: Goéré
authors: Daniela
authors: D
authors: Di Pietrantonio
authors: Valérie
authors: V
authors: Boige
authors: David
authors: D
authors: Malka
authors: Niaz
authors: N
authors: Kohneh-Shahri
authors: Clarisse
authors: C
authors: Dromain
authors: Michel
authors: M
authors: Ducreux
mesh_terms: D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000556:secondary; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D024162:Second-Look Surgery