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Surgery for Peritoneal Carcinomatosis from Colorectal Origin: Techniques and Limitations

Colorectal cancer can give rise to peritoneal carcinomatosis (PC) by different mechanisms. Advanced (T3 or T4) tumors can cause PC by direct invasion of the peritoneum or shedding (exfoliating) of cells from the tumor’s surface. When peritoneal washings from colon cancer patients are analysed with molecular techniques (RT-PCR), micrometastatic cells can be detected in up to 24% of patients (1). Loose cells are transported throughout the abdomen by the physiological peritoneal fluid flow. The diaphragm and greater omentum, where absorption of particulate matter occurs, are therefore frequent locations of PC. Secondly, PC can be caused by inadvertent tumor spread during surgery fro a primary colorectal cancer. The incidence of tumor seeding during curative resection of colorectal cancer varies from 3-28% (2). Most patients with PC, however, are treated in the context of locally recurrent disease. In a small proportion of colorectal cancer patients, the peritoneal surface is the only site of recurrent disease. In a recent review, the incidence of (PC) in colorectal cancer patients was 13% (3). In that series, a total of 80 patients had localized disease in the absence of systemic metastases, representing 3 per cent (80 of 2756) of the study population. Calculations made in the Netherlands suggest that in that country, approximately 200 patients per year with colorectal cancer would be a candidate for debulking surgery for PC. Assuming a comparable incidence in Belgium, no more than 125 patients per year would require surgery.