Dr. Cohen on the Importance of Patient Selection for HIPEC Surgery in CRC

Stacey A. Cohen, MD, physician, Seattle Cancer Care Alliance, associate professor, Division of Medical Oncology, University of Washington (UW) School of Medicine, physician, UW Medicine, associate professor, Clinical Research Division, Fred Hutchinson Cancer Research Center, discusses the importance of patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer (CRC).

Intravenous chemotherapy does not uniformly penetrate the peritoneal cavity, Cohen says. However, patients with peritoneal disease and CRC can have local metastatic spread that differs from the blood-based metastatic spread observed with other visceral sites.

These patients can undergo cytoreductive surgery with the goal of removing all visible sites of disease. Scoring systems are used before and after surgery to determine how much disease the patient has initially and the completeness of the surgery, respectively, Cohen explains.

Additionally, patients whose cytoreductive surgery completely removes visible disease may undergo HIPEC to decrease or eliminate microscopic disease, Cohen says. However, patient selection and discussion with a multidisciplinary tumor board involving medical oncology, surgical oncology, radiology, and pathology is critical to ensure patients are fit for this aggressive treatment approach, Cohen concludes.