Peritoneal Carcinomatosis of Colorectal Origin

No. Surgery requires strict selection. Four criteria are weighed: limited peritoneal extent (low PCI), good functional status, a realistic chance of removing all visible disease, and no unresectable metastases outside the abdomen. When those 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. The practical consequence is that choosing the surgical team matters more than the technique added to the operation.

The indication is decided case by case, and always on top of a complete cytoreduction. It may benefit patients with moderate peritoneal extent, good general condition and no contraindication to intraperitoneal chemotherapy. Since PRODIGE 7 it is no longer applied routinely in colorectal origin and is assessed at a multidisciplinary meeting.

The PCI is the score that measures how much disease is in the peritoneum, from 0 to 39 points. It is calculated by adding implant size across thirteen abdominal regions. A low PCI is associated with a better prognosis and a higher chance of complete cytoreduction, so it helps decide whether surgery is indicated.

In selected cases, yes. When 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 surgery out is not the liver involvement itself, but disease that cannot be removed completely.

Systemic chemotherapy serves two purposes. Given before surgery, it shows how the tumour behaves and helps select patients whose disease responds to treatment. After surgery it may be indicated according to risk profile, histology and operative findings. It complements surgery rather than replacing it.

With complete cytoreduction (CC-0), five-year survival ranges from 30% to 40% in selected series, clearly better than systemic chemotherapy alone. The figures depend on the extent of disease, the tumour biology and, above all, on whether all visible disease was removed at the operation.

Between 6 and 12 hours, depending on the extent of disease and the number of resections needed. That includes the HIPEC phase, 30 to 60 minutes of perfusion. Duration is not a goal in itself: the operation is not considered finished while removable visible disease remains.

The hospital stay is usually 10 to 14 days and full recovery takes two to three months, depending on how extensive the surgery was. The return to normal eating and daily activity is gradual. Enhanced recovery protocols, with early mobilisation and early nutrition, shorten those timescales.

Check-ups every three to six months during the first years, with tumour markers (CEA and CA 19-9), thoraco-abdominal-pelvic CT and colonoscopy according to protocol. The aim is to detect a recurrence while it is still limited, because that is when surgery with curative intent can be considered again.

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

In centres with demonstrated experience in peritoneal surface malignancy and enough case volume. In this disease, results depend directly on how many procedures of this type the team performs and on having a multidisciplinary board that reviews every indication. Our institute works to that model in Barcelona and Madrid.