title: Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal metastases.
abstract: OBJECTIVE
  To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).
  
  
  METHODS
  An electronic literature search was carried out to identify publications reporting oncological outcome data (overall survival and/or disease free survival and/or recurrence rates) following CRS and IPC for treatment of CPM. Studies reporting outcomes following CRS and IPC for cancer subtypes other than colorectal were only included if data were reported independently for colorectal cancer-associated cases; in addition studies reporting outcomes for peritoneal carcinomatosis of appendiceal origin were excluded.
  
  
  RESULTS
  Twenty seven studies, published between 1999 and 2013 with a combined population of 2838 patients met the predefined inclusion criteria. Included studies comprised 21 case series, 5 case-control studies and 1 randomised controlled trial. Four studies provided comparative oncological outcome data for patients undergoing CRS in combination with IPC vs systemic chemotherapy alone. The primary indication for treatment was CPM in 96% of cases (2714/2838) and recurrent CPM (rCPM) in the remaining 4% (124/2838). In the majority of included studies (20/27) CRS was combined with hyperthermic intraperitoneal chemotherapy (HIPEC). In 3 studies HIPEC was used in combination with early post-operative intraperitoneal chemotherapy (EPIC), and 2 studies used EPIC only, following CRS. Two studies evaluated comparative outcomes with CRS + HIPEC vs CRS + EPIC for treatment of CPM. The delivery of IPC was performed using an "open" or "closed" abdomen approach in the included studies.
  
  
  CONCLUSIONS
  The available evidence presented in this review indicates that enhanced survival times can be achieved for CPM after combined treatment with CRS and IPC.
authors.affiliation: Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10 Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom.
authors.forename: Reza
authors.initials: R
authors.lastname: Mirnezami
authors.affiliation: Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10 Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Moran
authors.affiliation: Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10 Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Harvey
authors.affiliation: Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10 Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Cecil
authors.affiliation: Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10 Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom.
authors.forename: Kandiah
authors.initials: K
authors.lastname: Chandrakumaran
authors.affiliation: Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10 Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom.
authors.forename: Norman
authors.initials: N
authors.lastname: Carr
authors.affiliation: Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10 Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom.
authors.forename: Faheez
authors.initials: F
authors.lastname: Mohamed
authors.affiliation: Reza Mirnezami, Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Imperial College London, 10 Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Mirnezami
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D009364:Neoplasm Recurrence, Local; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Colorectal cancer; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Intraperitoneal chemotherapy; Peritoneal metastasis