Peritoneal carcinomatosis of colorectal origin

No. Surgery requires strict selection. Four criteria are assessed: limited peritoneal extent (low PCI), good functional status, a real possibility of removing all visible disease and no unresectable metastases outside the abdomen. If they are not met, treatment relies on systemic chemotherapy and techniques such as PIPAC.

PRODIGE 7 showed that the decisive factor for survival is complete cytoreduction, not HIPEC. Intraperitoneal chemotherapy adds benefit in selected cases, but it does not make up for incomplete surgery. Its main practical consequence is that the choice of surgical team matters more than the complementary technique added to it.

The indication is decided case by case, always on top of complete cytoreduction. It may benefit mainly patients with moderate peritoneal extent, good general condition and no contraindications to intraperitoneal chemotherapy. After the PRODIGE 7 study it stopped being used routinely for colorectal origin and is now assessed by the multidisciplinary board.

Systemic chemotherapy has two functions. Given before surgery, it shows how the tumor behaves and helps select the patients whose disease responds to treatment. After surgery it may be indicated according to the risk profile, the histology and the findings in the operating room. It complements surgery; it is not an alternative.

The PCI is the score that measures how much disease there is in the peritoneum, from 0 to 39 points. It is calculated by adding up the size of the implants in thirteen regions of the abdomen. A low PCI is associated with a better prognosis and a greater likelihood of complete cytoreduction, so it is one of the factors that decide whether surgery is indicated.

In selected cases, yes. When the liver metastases are few and resectable, a combined approach can be planned: peritoneal cytoreduction and liver resection, in the same operation or in two stages. What rules out surgery is not the liver location as such, but the disease being impossible to remove completely.

Between 6 and 12 hours, depending on the extent of the disease and the number of resections needed. This time includes the HIPEC phase, which is 30 to 60 minutes of perfusion. The duration is not a goal in itself: the rule is not to finish the operation while removable visible disease remains.

The hospital stay is usually 10 to 14 days and full recovery takes between 2 and 3 months, depending on the extent of surgery. The return to a normal diet and daily activity is gradual. The enhanced recovery protocol, with early mobilization and early nutrition, shortens these times.

Check-ups every 3 to 6 months during the first years, with tumor markers (CEA and CA 19-9), chest, abdomen and pelvis CT and colonoscopy according to the established protocol. The aim is to detect a recurrence while it is still limited, because at that point surgery with curative intent can be considered again.

Yes, in selected patients with limited recurrence and good general condition. A second cytoreduction can bring the same benefit as the first if all visible disease can again be removed. The decision is made individually by the multidisciplinary board, assessing the extent, the disease-free interval and the previous response.