Consensus statement and clinical pathway for the management of colon cancer with peritoneal metastases in the state of Delaware

Elsevier

Available online 10 January 2023, 101895

Surgical OncologyAuthor links open overlay panel

State of Delaware Peritoneal Surface Malignancies Task Force (DE-PSM-TF)

AbstractBackground

Increasing data suggests that the combination of modern systemic therapies and Cytoreductive surgery with or without Hyperthermic Intraperitoneal Chemotherapy (HIPEC) may improve the outcome of patients with colon cancer with peritoneal metastases. Patient selection and sequence of treatments remains ill-defined.

Materials and methods

A working group, the State of Delaware Peritoneal Surface Malignancies Task Force (DE-PSM-TF), was created including representatives from medical and surgical oncology from the acute care hospitals in Delaware. An extensive review of all available literature was carried out. Virtual meetings were held, and interpretation and discussion of the data was conducted.

Results

A clinical pathway that includes a multidisciplinary evaluation at the time of diagnosis of colon cancer with peritoneal metastases and reflects a consensus from the Task Force on 7 key points that suggest the management of these patients based on the severity of their peritoneal metastases and incorporates all currently available therapies was created. The sequence of therapies of this multimodality treatment was determined by the Peritoneal Surface Disease Severity Score (PSDSS) (Fig. 1).

Conclusion

The current pathway represents a comprehensive, team effort that should improve the outcome of patients with Colon Cancer with peritoneal metastases in the state of Delaware by having multidisciplinary discussions at the time of diagnosis, selecting the best order of sequence of currently available therapies in order to maximize benefits and minimize morbidity.

Section snippetsBackground

It has been almost 200 years since Reybard performed the first successful resection of a colon cancer with an anastomosis [1]. Since then, surgery has remained the hallmark therapy for localized primary colorectal cancer. Treatment options and even the staging of metastatic disease has changed significantly in the past few decades [2]. Surgery for liver and/or lung metastases is an everyday event. The peritoneum is the second most common site for metastatic disease in colorectal cancer,

Material and methods

We identified the total number and location of the acute care hospitals in Delaware. We then selected a point of contact at each institution and identified a representative multi-disciplinary group of providers under the umbrella of the State of Delaware Peritoneal Surface Malignancies Task Force (DE-PSM-TF). We held several virtual meetings over a span of 6 months and discussed all current literature on the subject of colon cancer with peritoneal dissemination. We did not include rectal

Results

Fig. 1 demonstrates the Clinical Pathway for the Management of Colon Cancer with Peritoneal Dissemination in the State of Delaware. Figures 3,4 and 5 represent data capturing forms (see Fig. 2).

1.

This should include a recent colonoscopy to rule out a synchronous or metachronous primary colon cancer, a CEA. CT scan of the chest, abdomen, and pelvis with maximum oral and intravenous contrast. A PET scan should be considered in those patients in whom there is evidence or suggestion of hematogenous

Discussion

Peritoneal metastases occur in about 10%–20% of patients with colon cancer. In addition, autopsy studies estimate that 20% of patients with adenocarcinoma (28% of those with node positive disease) and 48% of mucinous tumors have peritoneal disease [17]. The outcome of these patients has been seen as remarkably poor and worse than those patients with metastatic disease to the liver and/or lung [18]. Most of them will have other sites of hematogenous dissemination and will be treated with

Conclusion

The suggested clinical pathway represents an agreement by medical and surgical oncologists of the State of Delaware for the management of patients with colon cancer with peritoneal dissemination. We believe that as systemic therapies improve, the role of a complete surgical eradication of metastatic disease to the peritoneum in those patients with colon cancer with favorable biology increases. We also agree that at the present time, patients who have a complete cytoreduction should receive

Author agreement

All authors made a substantial contribution to the conception and design of the study, data acquisition and interpretation of the data. All had the opportunity of revising it for important intellectual content and approved the final, submitted version.

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