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Definition of Patients Presenting a High Risk of Developing Peritoneal Carcinomatosis After Curative Surgery for Colorectal Cancer: A Systematic Review.
Abstract
BACKGROUND:
In colorectal cancer, complete cytoreductive surgery
associated with hyperthermic intraperitoneal chemotherapy achieves
encouraging results in early peritoneal carcinomatosis (PC), but this
early detection can only be accurately accomplished during a systematic
second-look surgery. This costly and invasive approach can only be
proposed to selected patients. The objective of this study was to
identify risk factors predictive of developing PC after curative surgery
for colorectal cancer.
METHODS:
After a systematic review of the literature published
between 1940 and 2011, all clinical studies reporting the incidence of
PC after curative surgery for colorectal cancer were searched for
factors associated with the primary tumor that were likely to influence
the incidence of recurrent PC.
RESULTS:
Sixteen clinical studies were considered informative, all
nonrandomized, three prospective and 13 retrospective, including 4-395
patients. Overall, the methodological quality of the reported studies
was low. Data were available for the following factors: synchronous PC,
synchronous ovarian metastases, perforated primary tumor, serosal and/or
adjacent organ invasion, histological subtype, and positive peritoneal
cytology with reported incidences of recurrent PC between 8 and 75 %. No
study was found that mentioned an impact of lymph node invasion, tumor
location, laparoscopy, occlusive tumors, or bleeding tumor on recurrent
PC.
CONCLUSIONS:
Evidence regarding the incidence of recurrent PC after
curative surgery for colorectal cancer is poor. Emerging data indicate
three situations that could result in a real higher risk of recurrent
PC: synchronous PC, synchronous isolated ovarian metastases, and a
perforated primary tumor.
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