St Mark's HospitalLondon North West Healthcare

CRS and HIPEC for Colorectal Peritoneal Metastases

Cancers of the colon and rectum can spread inside the abdominal cavity, leading to tumour deposits on the peritoneum, the inner lining of the abdomen and on the other organs and tissues, known as colorectal peritoneal metastases (CPM). In some patients with colorectal peritoneal metastases (including metastases in the omentum and ovarian metastases, also known as Krukenberg tumours), the CCC team can perform a surgical procedure known as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) to achieve cure or long-term disease control. During CRS, we aim to remove all visible tumour deposits in the abdominal cavity. This is achieved by a combination of peritonectomy (removal of the lining of the abdominal cavity) and organ resections (removal of parts of or whole organs). The abdominal cavity is then washed for one hour with a heated solution containing chemotherapy (HIPEC) to eliminate any microscopic tumour cells circulating in the abdominal cavity.

Though long deemed an experimental procedure, CRS and HIPEC is now a firmly established treatment for patients with colorectal peritoneal metastases. With this procedure, long-term disease control can be achieved, with five year survival rates of at least 45 – 50%. Moreover, the role of CRS and HIPEC in treating patients who are at risk of developing colorectal peritoneal metastases is currently being investigated in several large studies.

At the CCC, we offer CRS and HIPEC for colorectal peritoneal metastases (including omental and ovarian metastases) to patients in the following groups:

  • Peritoneal metastases diagnosed in patients who still have their primary colorectal tumour (synchronous CPM)
  • Peritoneal metastases developed after treatment of the primary tumour (metachronous CPM)
  • Peritoneal metastases in patients with advanced or recurrent pelvic rectal tumours, combining the unique expertise of the CCC team in pelvic oncological surgery with CRS and HIPEC

Although patients with CPM and disease spread to the liver and/or lungs have traditionally been excluded from CRS and HIPEC, we may consider offering treatment at the CCC to patients with very limited CPM and liver/lung metastases. After referral and careful assessment of the patient history, available investigations and outcomes of previous treatment, patients may be considered potentially suitable for CRS and HIPEC. These patients will be invited to attend our CCC outpatient department for extensive counselling on our treatment proposal and a realistic discussion of the risks and benefits. In most patients, we will propose getting updated imaging investigations (commonly CT scans and, in patients with pelvic tumours, MRI scans) and performing a staging laparoscopy, a short operation under a general anaesthetic where we inspect the extent of CPM by inserting a camera and other instruments through small incisions in the abdomen. Based on the imaging results and the findings at laparoscopy, a definitive and individualised treatment plan will be made, combining the various surgical techniques at our disposal, including CRS and HIPEC.

For potential referrers, download an overview of referral and management guidelines for patients with CPM (PDF).