Canadian guidelines on the management of colorectal peritoneal metastases

Modern management of colorectal cancer (CRC) with peritoneal metastasis (PM) is based on a combination of cytoreductive surgery (CRS), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (HIPEC). Although the role of hipec has recently been questioned with respect to results from the PRODIGE 7 trial, the role and benefit of a complete CRS were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, CRC with PM is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with PM from CRC should be referred to, or discussed with, a PM surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of PM from CRC and to reflect on the new practice standards set by recent publications on the topic.