Gómez-Portilla Alberto, Cendoya Iñaki, López de Tejada Iñaki, Olabarria Iñaki, Magrach Luis, Martínez de Lecea Concepción, Gil Alberto, Valdovinos Mercedes, Larrabide Iñaki, Ruiz de Alegría Natalia, Fernández José Luis, Cachorro Irune, Contreras María del Carmen, Castañeda Josu, Uriarte Arantxa, Boado María Victoria, Urturi José Antonio, Ulibarrena Miguel Angel
Programa de Carcinomatosis Peritoneal, Servicio de Cirugía, Policlínica San José, Vitoria, Alava, Spain.
Cir Esp. 2005 Jan;77(1):6-17. doi: 10.1016/s0009-739x(05)70796-x.
Colorectal cancer is the most frequent digestive tumor. The incidence of abdominal dissemination is high and all studies of the natural history of colorectal carcinomatosis demonstrate that prognosis in these patients is poor, with a mean survival of between 5 and 9 months. Furthermore, the results of systemic adjuvant treatment are disappointing, with a maximum survival of 18 months. Consequently, other treatment strategies need to be studied and developed. We present a review of the principles that underlie Sugarbakers treatment protocol, which includes maximal cytoreductive surgery for the treatment of macroscopic disease through peritonectomy together with perioperative intraperitoneal intensification chemotherapy for residual microscopic disease. We present all the phase II studies with more than 10 treated patients published in the medical literature by the main groups working in this line of treatment, together with the only phase III study published to date. With this new therapeutic alternative, the mean overall survival at 2 and 5 years is 40% and 20% respectively. Based on these results, this new therapeutic approach is recommended as the treatment of choice in these unfortunate patients. The limits of the treatment of advanced colorectal cancer are also discussed.
