Despite advances in early detection of CRC, peritoneal disease spread continues to be a common mode of disease progression, as 8% of patients with CRC have synchronous peritoneal spread of disease at time of primary resection, and up to 25% of patients with recurrent colorectal cancer have disease confined to the peritoneal cavity 3.In about 30% of patients, PSM remains the primary reason for death in patients with CRC 4. Hence, PSM is a frequent manifestation in the natural history of colorectal cancer (CRC), and is associated with marked deterioration in quality of life (QOL) and limited survival. Nearly 8,000 patients are diagnosed with synchronous peritoneal surface malignancy (PSM) each year 2. This review focuses on the identification of patients at risk for PSM from CRC and discusses the role of second look laparotomy.Īpproximately 150,000 patients are diagnosed with colorectal cancer (CRC) in the US each year and one third of patients die annually from this disease 1. As early or limited peritoneal carcinomatosis is undetectable by conventional imaging modalities, second look laparotomy is an important means to identify disease in high-risk patients at a stage most amenable to complete cytoreduction. Patients with limited peritoneal disease from CRC can undergo complete cytoreduction, which is associated with the best reported outcomes. Reported overall survival with complete CRS+HIPEC exceeds that of systemic therapy alone for the treatment of PSM from CRC, underscoring the advantage of this multi-modality therapeutic approach. The fact that advanced CRC can be confined to the peritoneal surface without distant dissemination forms the basis for aggressive multi-modality therapy consisting of cytoreductive surgery (CRS) plus hyperthermic intra-peritoneal chemotherapy (HIPEC), and neoadjuvant and/or adjuvant systemic therapy. Although significant advances have been made in screening of CRC, similar progress has yet to be made in the early detection of PSM of colorectal cancer origin. Peritoneal surface malignancy (PSM) is a frequent occurrence in the natural history of colorectal cancer (CRC).
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