title: Incidence and treatment of recurrent disease after cytoreductive surgery and intraperitoneal chemotherapy for peritoneally metastasized colorectal cancer: A systematic review.
abstract: BACKGROUND
  The optimal treatment for peritoneal carcinomatosis (PC) of colorectal origin is a combination of cytoreductive surgery and intraperitoneal chemotherapy (CRS + IPC). Although 5-year survival rates of up to 40% have been reported, recurrent disease remains common and is estimated to be a strong negative prognostic factor for survival. This systematic review elaborates on the incidence of recurrent disease and the possibilities to prevent and treat recurrence.
  
  
  METHODS
  Two searches were performed. To identify the magnitude of recurrent the disease, a search was performed in Pubmed and EMBASE until September 2014. A second search was performed in Pubmed to identify treatment of recurrent disease with secondary CRS + IPC.
  
  
  RESULTS
  The first search resulted in 139 and 94 articles in Pubmed and EMBASE respectively. Among those, 28 were included. Overall recurrence rates ranged from 22.5 to 82%. Local, systemic and combined local-systemic recurrence ranged from 6 to 42.5%, 10.4-43% and 5.8-21.5%. Median time to recurrence varied from 9 to 23 months, three-year disease free survival ranged from 14 to 41.5%. The second search resulted in 140 articles among which 17 met the inclusion criteria. A total of 190 patients underwent secondary CRS. Median survival after the second procedure ranged from 18 to 55.7 months. One, two and three-year survival ranged between 66 and 94, 44-50 and 0-66%.
  
  
  CONCLUSIONS
  Recurrence is very common after cytoreductive surgery and intraperitoneal chemotherapy for PC of colorectal origin. Repeat cytoreductive surgery suggests a potential survival benefit for a highly selected group. Therefore, strategies to prevent recurrence are of the utmost importance.
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
authors.forename: T R
authors.initials: TR
authors.lastname: van Oudheusden
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
authors.forename: S W
authors.initials: SW
authors.lastname: Nienhuijs
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Department of Research, Eindhoven Cancer Registry/Comprehensive Cancer Centre the Netherlands (IKNL), PO Box 213, 5600 AE Eindhoven, The Netherlands.
authors.forename: V E
authors.initials: VE
authors.lastname: Lemmens
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: ignace.d.hingh@cze.nl.
authors.forename: I H
authors.initials: IH
authors.lastname: de Hingh
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D006801:Humans; D006979:Hyperthermia, Induced; D015994:Incidence; D007263:Infusions, Parenteral; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Colorectal cancer; Cytoreductive surgery; Intraperitoneal chemotherapy; Peritoneal carcinomatosis; Recurrent disease