Harveshp D. Mogal, MD, MS, FACS, DABS, FSSO, physician, Seattle Cancer Care Alliance, associate professor, Department of Surgery, University of Washington (UW) School of Medicine, program director, Regional Cancer Therapies, UW Medicine, discusses the role of cytoreductive surgery in colorectal peritoneal carcinomatosis.

Although not all patients with colorectal peritoneal carcinomatosis are amenable for cytoreductive surgery, well-selected patients can derive a significant benefit from the operation, Mogal says. Findings from the phase 3 PRODIGE 7 trial (NCT00769405) showed that although adding hyperthermic intraperitoneal chemotherapy with oxaliplatin to cytoreductive surgery didn’t improve overall survival, complete cytoreductive surgery led to satisfactory survival outcomes when used as a curative intervention in patients with peritoneal carcinomatosis from colorectal cancer. 

As such, cytoreductive surgery is preferred compared with systemic chemotherapy alone in well-selected patients, Mogal explains. Patient selection should incorporate a discussion with the patient within a well-established and experienced cancer center that utilizes multidisciplinary tumor boards, Mogal concludes.

Videos

Harveshp D. Mogal, MD, MS, FACS, DABS, FSSO, discusses the role of cytoreductive surgery in colorectal peritoneal carcinomatosis.  



Dr. Mogal on the Role of Cytoreductive Surgery in Colorectal Peritoneal Carcinomatosis  

Harveshp D. Mogal, MD, MS, FACS, DABS, FSSO, physician, Seattle Cancer Care Alliance, associate professor, Department of Surgery, University of Washington (UW) School of Medicine, program director, Regional Cancer Therapies, UW Medicine, discusses the importance of patient selection for cytoreductive surgery in colorectal cancer (CRC) with peritoneal involvement.

Although the risk of morbidity and mortality from cytoreductive surgery has declined significantly with the integration of improved surgical techniques and perioperative management, cytoreductive surgery is still associated with inherent risks and a relatively high morbidity rate in patients with CRC, Mogal explains. As such, selection is critical when considering cytoreductive surgery in a patient with peritoneal involvement. 

Patients should be fit for surgery and have an adequate functional status, Mogal says. This is important because many patients receive preoperative systemic therapy.

Additionally, most patients with significant medical comorbidities, such as life-threatening cardiovascular comorbidities, are not eligible for cytoreductive surgery. These procedures are long and pose significant physiological stress on the patient’s body. As such, patients with significant comorbid conditions would likely have a prohibitive morbidity or mortality with cytoreductive surgery, Mogal concludes.

Harveshp D. Mogal, MD, MS, FACS, DABS, FSSO, discusses the importance of patient selection for cytoreductive surgery in colorectal cancer with peritoneal involvement.  



Dr. Mogal on Patient Selection for Cytoreductive Surgery in CRC 

Harveshp D. Mogal, MD, MS, FACS, DABS, FSSO, physician, Seattle Cancer Care Alliance, associate professor, Department of Surgery, University of Washington (UW) School of Medicine, program director, Regional Cancer Therapies, UW Medicine, discusses the incidence and prognosis of peritoneal carcinomatosis in colorectal cancer (CRC).

Isolated peritoneal carcinomatosis is a challenging complication that occurs in approximately 10% of patients with CRC, Mogal says. Patients with peritoneal disease have inherently poor biology, which makes them difficult to treat. Moreover, patients with peritoneal carcinomatosis have a worse overall prognosis compared with patients with isolated lung or liver metastases, as well as patients with combined lung and liver metastases.

Additionally, systemic therapies that are effective in treating patients with isolated lung or liver metastases are not as effective in patients with peritoneal disease. The median survival with modern chemotherapy is approximately 18 months in patients with peritoneal disease. The addition of sequential targeted therapy to chemotherapy can extend survival to around 29 months, but more effective systemic agents are needed for this disease subgroup, Mogal concludes.

Harveshp D. Mogal, MD, MS, FACS, DABS, FSSO, discusses the incidence and prognosis of peritoneal carcinomatosis in colorectal cancer. 



Harveshp D. Mogal, MD, MS, FACS, DABS, FSSO

Articles

Dr. Mogal on the Role of Cytoreductive Surgery in Colorectal Peritoneal Carcinomatosis

Dr. Mogal on Patient Selection for Cytoreductive Surgery in CRC

Dr. Mogal on the Incidence and Prognosis of Peritoneal Carcinomatosis in CRC