Prevention of Peritoneal Carcinomatosis from Colon Cancer in High-Risk Patients.

Introduction: Epidemiological data indicate that peritoneal spread from colorectal cancer is an event that involves 10–15% of patients at the time of primary cancer resection and about 25–50% of patients with recurrent disease, generally leading to death within weeks or months. The study compared the outcome in patients with advanced colonic cancer at high risk of peritoneal metastases without peritoneal or systemic spread, treated with standard colectomy or a more aggressive combined surgical approach. Materials and Methods: The experimental group underwent hemicolectomy, omentectomy, bilateral adnexectomy, hepatic round ligament resection, and appendectomy, followed by HIPEC. The control group comprised patients treated with standard surgical resection during the same period in the same hospital by different surgical teams. Results: Outcome data, morbidity, peritoneal recurrence rate, and overall, and disease-free survival, were compared. Peritoneal recurrence developed in 4% of patients in the experimental group and 22% of controls without increasing morbidity. Actuarial overall survival curves disclosed no significant differences, whereas actuarial disease-free survival curves showed a significant difference between groups. Conclusion: A more aggressive preventive surgical approach combined with HIPEC reduces the incidence of peritoneal recurrence in patients with advanced mucinous colonic cancer and also significantly increases disease-free survival compared with a homogeneous control group treated with a standard surgical approach without increasing morbidity.