Comprehensive Clinical Plasma Medicine

Hans-Robert Metelmann, Thomas von Woedtke, and Klaus-Dieter Weltmann

Colorectal cancer (CRC) is the third most common cancer in the world and the second leading cause of cancer death in the United States. In 2012 an estimated 103,170 new cases of colon cancer and approximately 40,290 rectal cases were newly diagnosed with 51,690 related deaths from these combined cancers [1]. There is evidence of peritoneal carcinomatosis (PC) in 8–10% of these patients at the time of diagnosis and 25% during the progression of their disease [2–5].

PC is associated with a poor prognosis. Patients are considered to have a terminal condition with a 6–10 month median survival time [2–7]. The standard treatment for advanced stage CRC and PC is systemic chemotherapy which is considered palliative with minimal improvement in patient survival. Advanced chemotherapeutic regimens such as FOLFOX have been reported to improve survival to a median of 15.7 months [8, 9].

Cytoreductive surgery (CRS) combined with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) has evolved over the past 20 years as a new approach for the treatment of PC. CRS is described as removal of gross tumor follow by HIPEC treatment. Despite limited evidence to support CRS and HIPEC, there are some reports that this new approach has reported beneficial results [10]. Although there are promising results, CRS and HIPEC is associated with a significant morbidity, mortality, increase operating time, prolonged ICU care which results in an increase cost in patient care. This new multimodality approach is limited to several factors; age, extra abdominal disease (liver or lung metastasis), and peritoneal cancer index (PCI) which is the most common prognostic indicator and relies on the spread of the disease based on a scoring systems and the capability of complete removal of the gross tumor. PCI score calculates the spread of tumor in 13 areas of the abdomen in combination with tumor size. It ranges from 0 to 39 points.