Second Look Surgery and Hyperthermic Intraperitoneal Chemotherapy for Patients with Colorectal Cancer at High Risk of Peritoneal Carcinomatosis: A Single Center Experience.

Background: Second look surgery, complete cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has the rational to treat patients with high recurrence risk, at an early stage with low peritoneal carcinomatosis index (PCI) score and give a better chance of cure. The purpose of this study is to evaluate our results in terms of morbidity and oncologic benefit for the patient. Materials and Methods: Data were retrospectively collected from all patients with second look surgery and HIPEC between April 2012 and May 2018. Twelve patients with limited carcinomatosis initially resected or perforated tumour (in the literature, 70% and 50% of risk for peritoneal recurrence respectively) were identified (colorectal n=8 and appendicular cancer n=4). At second look a HIPEC was systematically proposed, even if there was no evidence of macroscopic recurrence. Results: Median follow-up from initial diagnosis was 24,8 months (range 9 -67). The mean PCI score was 1 (range 0 – 8). Only 2 patients out of 12 had PCI score other than 0 but histopathology showed peritoneal disease in 3 patients. Three patients were explored by laparoscopy and HIPEC was performed by mini laparotomy. One 90 days, Dindo-Clavien grade IIIb complication occurred (8%) and no mortality. Mean hospital stay was 14 days (range 8 -29). All patients are alive in the follow up but 5 of them presented recurrent disease (42%): 1 peritoneal with redo HIPEC, 1 hepatic with partial hepatectomy, 1 pulmonary resected, 1 multisite recurrence. Conclusions: In our series of 12 patients, with a theoretical risk of 50 to 70% of peritoneal relapse, we only identified 1 (8%) of peritoneal recurrence suggesting that this strategy can be considered as an essential weapon in the management of colorectal cancer and this with an acceptable morbidity.