title: Revised guidelines for second-look surgery in patients with colon and rectal cancer.
abstract: Proper indications for a second surgical intervention in patients with colorectal cancer have always been a controversial subject. Surgeons find benefit in a second-look operation where a limited extent of cancer is discovered and resected with negative margins. However, a negative exploratory laparotomy or an intervention that is unable to achieve an R0 resection provides little or no benefit. Unfortunately, this type of intervention may place the patient in a worse condition, leading to morbidity or mortality. This manuscript attempts to define clinical parameters of primary colorectal cancer that are associated with a pattern of recurrence and that can be definitively addressed by second-look surgery. Also, new surgical technologies that may assist in achieving a potentially curative resection of local-regional recurrence are described. Cytoreductive surgery with peritonectomy and perioperative intraperitoneal chemotherapy with hyperthermia is presented as a new treatment option for reoperative surgery. A new management plan utilized in patients at high risk for local-regional recurrence may result in a high likelihood of conversion of a second-look cancer-positive patient to a long-term survivor.
authors.affiliation: Washington Cancer Institute, Washington, DC 20010, USA. Paul.Sugarbaker@medstar.net
authors.forename: Paul H
authors.initials: PH
authors.lastname: Sugarbaker
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D007263:Infusions, Parenteral; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery*; D010347:Patient Care Planning / Q000592:standards; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D024162:Second-Look Surgery / Q000592:standards*; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents