title: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: survival outcomes and patient selection.
abstract: BACKGROUND
  Chemotherapy hyperthermic intraperitoneal chemotherapy (HIPEC) is playing an ever increasing role in the management of colorectal cancer (CRC) with peritoneal metastases (PM) as results approach those of surgical resection of liver metastases. Selection criteria for treatment type, sequence and timing of currently available therapies remain ill-defined.
  
  
  METHODS
  We review the current published literature analyzing outcomes by treatments with surgery, systemic chemotherapy, cytoreductive surgery (CRS) and HIPEC, and ongoing clinical trials. A clinical pathway that incorporates all currently available therapies, determining the timing and sequence of such therapies was constructed.
  
  
  RESULTS
  Most of the literature on outcome data comes from studies reporting the results of CRS and HIPEC with large series showing a median survival of 32-47 months. Meanwhile, the vast majority of patients, over 90% in the United States, are being treated with palliative systemic therapies following the NCCN guidelines.
  
  
  CONCLUSIONS
  Cooperation between medical and surgical oncologists represents an unmet need in oncology when it comes to patients with CRC with PM. The presented clinical pathway constitutes a feasible and much needed first step to start this cooperation.
authors.affiliation: Department of Surgical Oncology, Cancer Treatment Centers of America, Philadelphia, PA 19124, USA.
authors.forename: Jesus
authors.initials: J
authors.lastname: Esquivel
keywords: Cytoreductive surgery (CRS); colorectal cancer (CRC); hyperthermic intraperitoneal chemotherapy (HIPEC); peritoneal carcinomatosis