Analysis of tumoral evolution and prognostic factors of multi-site hepatic and peritoneal colorectal metastases processes: from the animal model to an international clinical study

The synchronous presence of liver metastases (LM) and peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is associated with poor outcome and is traditionally considered a contraindication to any surgical approach. However, few series reported a prolonged survival after surgical management, reaching 3 years in selected patients thus suggesting that a curative surgical management may be possible. To date, no standard management pathway has been established, especially if a major liver and peritoneal surgery has to be performed. We postulated that liver regeneration after liver resection could promote PC growth. We constructed an immunocompetent animal model of limited PC. The objective of our study was to analyze the effects of major LR and liver regeneration after hepatectomy on peritoneal carcinomatosis growth and the associated angiogenesis process. Furthermore, we have analyzed a prospective international cohort of patients undergoing synchronous liver resection and cytoreductive surgery with HIPEC. The aim of this study was to describe the outcomes, to identify variables potentially related to poor outcome, in order to establish future guideline for the management of these patients, to optimize the selection of candidates for surgical treatment and determine the best surgical strategy.