title: Repeat cytoreductive surgery (CRS) for recurrent colorectal peritoneal metastases: yes or no?
abstract: OBJECTIVE
  To clarify the role of repeat CRS for recurrent colorectal carcinoma (CRC) through: (i) Systematic review of the literature (ii) Analysis of survival outcomes in a prospective cohort.
  
  
  METHODS
  (i) Pubmed and MEDLINE from 1980 to July 2013 searched using terms: colorectal carcinoma, peritonectomy, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), redo, repeat, and iterative. (ii) Kaplan-Meier Survival analysis of consecutive patients undergoing repeat CRS at St George Hospital between Jan 2000 and July 2013.
  
  
  RESULTS
  (i) The search strategy yielded 309 articles, 5 meeting inclusion criteria, reporting on 91 patients. Median overall survival from first CRS ranged from 39 to 57.6 months with 3-yr survival of 50%, and 5-year survival of 30%. Median survival from second CRS was 20-months with 1-yr survivals of 72% and 66% and 2-year survivals of 50% and 44%. (ii) Repeat CRS performed on 18 patients found median survival from first CRS was 59 months, with 1, 3, and 5-year survival of 100%, 52% and 26% respectively. Median survival from repeat CRS was 22.6 months with 1, 2, and 3-year survival of 94%, 48% and 12% respectively.
  
  
  CONCLUSIONS
  The current data on repeat CRS in CRC is relatively immature and more data is required before drawing clear conclusions. Patient selection should be on a case by case basis conducted through a MDT process with emphasis on surrogate markers for favourable outcomes.
authors.affiliation: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Australia; St George Clinical School, University of New South Wales, Australia.
authors.forename: B H M
authors.initials: BH
authors.lastname: Williams
authors.affiliation: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Australia.
authors.forename: N A
authors.initials: NA
authors.lastname: Alzahrani
authors.affiliation: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Australia; St George Clinical School, University of New South Wales, Australia.
authors.forename: D L
authors.initials: DL
authors.lastname: Chan
authors.affiliation: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Australia; St George Clinical School, University of New South Wales, Australia.
authors.forename: T C
authors.initials: TC
authors.lastname: Chua
authors.affiliation: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Australia; St George Clinical School, University of New South Wales, Australia. Electronic address: david.morris@unsw.edu.au.
authors.forename: D L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018579:Patient Selection; D010529:Peritoneal Cavity; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome
keywords: Colorectal carcinoma; Cytoreductive surgery; Outcomes; Reoperation; Review; Surgery