title: Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis: Does it really save lives?
abstract: The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases (60%), perforated tumor onset or intraoperative tumor rupture (50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: Delia
authors.initials: D
authors.lastname: Cortes-Guiral
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: Pedro Antonio
authors.initials: PA
authors.lastname: Cascales-Campos
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Badía Yébenes
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: Ismael
authors.initials: I
authors.lastname: Guijo Castellano
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: León Carbonero
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Martín Valadés
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Garcia-Foncillas
authors.affiliation: Delia Cortes-Guiral, Alfredo Badía Yébenes, Ismael Guijo Castellano, Damian Garcia-Olmo, Department of General Surgery (Peritoneal Surface Surgical Oncolongy), Fundación Jiménez Díaz Hospital, 28050 Madrid, Spain.
authors.forename: Damian
authors.initials: D
authors.lastname: Garcia-Olmo
mesh_terms: D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D018570:Risk Assessment; D024162:Second-Look Surgery
keywords: Colo-rectal cancer; High-risk patients; Hyperthermic intraperitoneal chemotherapy; Peritoneal carcinomatosis; Second-look surgery