Second-look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic features.

Assuming that peritoneal carcinomatosis is a local/regional dissemination of disease, a treatment strategy utilizing cytoreductive surgery and intraperitoneal chemotherapy was developed to treat colon cancer. In an attempt to improve knowledge of the mechanisms controlling abdominal and pelvic recurrences and for better selection of patients for reoperation, we studied those patients who had a second-look surgery following cytoreduction for peritoneal carcinomatosis from colorectal cancer. A group of 18 patients with symptoms and signs of recurrent peritoneal carcinomatosis were treated with reoperative surgery after definitive cytoreduction and intraperitoneal chemotherapy. An analysis of clinical features of these patients was performed using survival as an endpoint for evaluation of prognosis. The data suggest that the clinical features to be used to select patients for a second-look procedure after prior cytoreduction were the completeness of resection at the time of initial cytoreduction (p = 0.04) and the completeness of resection at the time of the second look (p = 0.066). In addition, a limited extent of peritoneal carcinomatosis distribution found at the time of the second look predicted a favorable result. A new objective assessment of peritoneal carcinomatosis, the peritoneal cancer index, was found to be of help during patient selection (p = 0.066). We concluded that second-look surgery with potential curative intent should be considered in patients who had a complete initial cytoreduction and those in whom total removal of the recurrence is judged possible at the time of the second look. At the time of abdominal exploration, a limited distribution and volume of peritoneal carcinomatosis as defined by the peritoneal cancer index should be considered. Palliative debulking procedures should be used to alleviate symptoms in other patients.