title: Results of systematic second-look surgery plus HIPEC in asymptomatic patients presenting a high risk of developing colorectal peritoneal carcinomatosis.
abstract: OBJECTIVE
  To analyze the impact of systematic second-look surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) performed 1 year after resection of the primary tumor in asymptomatic patients at high risk of developing peritoneal carcinomatosis (PC).
  
  
  METHODS
  From 1999 to 2009, 41 patients without any sign of recurrence on imaging studies underwent second-look surgery aimed at treating limited PC earlier and more easily. They were selected based on 3 primary tumor-associated criteria: resected minimal synchronous macroscopic PC (n = 25), synchronous ovarian metastases (n = 8), and perforation (n = 8).
  
  
  RESULTS
  PC was found and treated with complete surgery plus HIPEC in 23 of the 41 (56%) patients. The other patients underwent complete abdominal exploration plus systematic HIPEC. Median follow-up was 30 (9-109) months. One patient died postoperatively at day 69. Grade 3-4 morbidity was low (9.7%). The 5-year overall survival rate was 90% and the 5-year disease-free survival rate was 44%. Peritoneal recurrences occurred in 7 patients (17%), 6 of whom had macroscopic PC discovered during the second-look (26%), and one patient had no macroscopic PC (6%). In the univariate analysis, the presence of PC at second-look surgery was a significant risk factor for recurrence (P = 0.006).
  
  
  CONCLUSIONS
  Selection criteria for high-risk patients appear to be accurate. In these patients, the second-look strategy treated peritoneal carcinomatosis preventively or at an early stage, yielding promising results. This study has allowed us to design a multicentric randomized trial (comparing the second-look + HIPEC approach versus standard follow-up alone), which is beginning.
authors.affiliation: Department of Surgical Oncology, Institut Gustave Roussy, Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.forename: C
authors.initials: C
authors.lastname: Honoré
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.forename: M
authors.initials: M
authors.lastname: Ducreux
authors.forename: V
authors.initials: V
authors.lastname: Boige
authors.forename: D
authors.initials: D
authors.lastname: Malka
authors.forename: P
authors.initials: P
authors.lastname: Burtin
authors.forename: C
authors.initials: C
authors.lastname: Dromain
authors.forename: D
authors.initials: D
authors.lastname: Goéré
mesh_terms: D000328:Adult; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D024162:Second-Look Surgery