Dr. Mogal on Patient Selection for Cytoreductive Surgery in CRC

Harveshp D. Mogal, MD, MS, FACS, DABS, FSSO, physician, Seattle Cancer Care Alliance, associate professor, Department of Surgery, University of Washington (UW) School of Medicine, program director, Regional Cancer Therapies, UW Medicine, discusses the importance of patient selection for cytoreductive surgery in colorectal cancer (CRC) with peritoneal involvement.

Although the risk of morbidity and mortality from cytoreductive surgery has declined significantly with the integration of improved surgical techniques and perioperative management, cytoreductive surgery is still associated with inherent risks and a relatively high morbidity rate in patients with CRC, Mogal explains. As such, selection is critical when considering cytoreductive surgery in a patient with peritoneal involvement.

Patients should be fit for surgery and have an adequate functional status, Mogal says. This is important because many patients receive preoperative systemic therapy.

Additionally, most patients with significant medical comorbidities, such as life-threatening cardiovascular comorbidities, are not eligible for cytoreductive surgery. These procedures are long and pose significant physiological stress on the patient’s body. As such, patients with significant comorbid conditions would likely have a prohibitive morbidity or mortality with cytoreductive surgery, Mogal concludes.