Multidisciplinary management of peritoneal metastases

Abstract Peritoneal spread from colorectal cancer can occur synchronously, or metachronously, to the diagnosis of a primary colorectal malignancy and is a relatively frequent event. Historically, patients with colorectal peritoneal disease have been managed solely with best supportive care and palliative chemotherapy. While these two facets remain the cornerstone of treatment for most patients, there has been a substantial improvement in survival, and cure in some, in a selected group of patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Patients deriving the most benefit from this aggressive treatment approach have a low volume of disease as quantified by the peritoneal carcinoma index and are amenable to complete cytoreduction at the time of surgery. Ongoing advances in imaging and oncological therapeutics, combined with increasing randomized controlled trials in this field, will help refine patient selection, techniques, and outcomes in patients with peritoneal metastases.