title: Outcome of surgery for colorectal cancer in the presence of peritoneal carcinomatosis.
abstract: OBJECTIVE
  The detection of peritoneal carcinomatosis (PC) in colorectal cancer patients frequently results in a dilemma with regard to the optimal treatment strategy, especially when PC is encountered unexpectedly during surgery. The aim of this study was to evaluate outcomes of patients undergoing surgery for colorectal carcinoma in the presence of synchronous PC.
  
  
  METHODS
  Patients diagnosed with primary colorectal cancer and synchronous PC in three community hospitals were selected from the Eindhoven Cancer Registry database. Outcomes of postoperative complications, in-hospital mortality and overall survival were collected and analyzed according to the type of intervention performed.
  
  
  RESULTS
  Between 1995 and 2009, 169 colorectal cancer patients were diagnosed with synchronous PC, most of them unexpectedly during surgery (n = 130). 142 patients underwent surgery: primary tumor resection (n = 91), palliative procedure (n = 46) or exploration only (n = 5). In-hospital mortality was 41% after palliative surgery and 14% after primary tumor resection. Median survival was 12 weeks after palliative surgery or exploration as opposed to 55 weeks after primary tumor resection.
  
  
  CONCLUSIONS
  PC is most often encountered unexpectedly during surgery for colorectal cancer. Results of palliative procedures are very poor with a high in-hospital mortality rate and short survival. Resection of the primary tumor can be performed safely with relatively good outcomes but some patients could have benefited from an even more radical approach when the presence of PC would have been diagnosed at an earlier stage. Improvement of imaging techniques to detect PC prior to surgery is therefore urgently needed. Until this is the case, a high index of suspicion is required when subtle signs of PC are encountered.
authors.affiliation: Department of Medical Oncology, Catharina Hospital, Post Box 1350, 5602 ZA Eindhoven, The Netherlands.
authors.forename: Y L B
authors.initials: YL
authors.lastname: Klaver
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
authors.forename: I H J T
authors.initials: IH
authors.lastname: de Hingh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult