We have read with great interest the editorial by Dr. Barrios1 that was recently published in this journal with his reflections motivated by the results of the French phase III multicenter Prodige 7 study.2 These results demonstrated that radical cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) do not provide greater overall survival than CRS followed by adjuvant systemic chemotherapy in the treatment of patients with peritoneal carcinomatosis of colorectal origin. In the Prodige 7 study,2 not only were no differences found for overall survival between the study groups (41.2 months versus 41.7 months), but, more importantly, there was a clear detriment to the group of patients treated with HIPEC due to the induced toxicity, with a Clavien grade III-V morbidity rate of 24 %, compared to only 13 % in the control group.
These shockingly unexpected results have led some authors to even propose the disappearance of HIPEC from the surgical therapeutic armamentarium in an editorial article published in the prestigious European Journal of Surgical Oncology (EJSO),3 which motivated our Letter to the Editor4 in which we argued the transcendental value of CRS accompanied by adjuvant systemic chemotherapy.
In our letter, we discussed the 4 best publications in the medical literature to date in patients treated for peritoneal carcinomatosis of colorectal origin. The median overall survival rates range from 36.6 months reported by Ihemelandu and Sugarbaker,5 41.2 and 41.7 months contributed by the Prodige 7 study,2 47.5 months obtained by the Bergonié de Bordeaux Institute group,6 and 62.7 months published by Elias et al.7
In his editorial, Dr. Barrios1 communicated his magnificent results at the Hospital de Sant Joan Despí Moisés Broggi, with a median survival of 40.5 months.
Although the role of HIPEC can be questioned, the only thing that has been clearly demonstrated in all these experiences mentioned (including those of the Prodige 7 study2 and Dr. Barrios1) is that only when the last tumor cell is eradicated from the peritoneal cavity with CRS CC0 followed by abundant lavage of detritus (with or without hyperthermia) for the treatment of residual microscopic disease, and only when these patients are treated with the best systemic chemotherapy schemes, only then can one aspire to chronization and long survival rates in this group of patients considered incurable until now.
We must aspire to surgical excellence, demanding the tutored learning of CRS CC0, the “cornerstone” of the treatment of colorectal peritoneal carcinomatosis, in order to offer all our patients a ray of hope, and healing in selected cases.
FundingThe present has received no specific funding from public, commercial, or non-profit entities.
Conflict of InterestsNone.
Please cite this article as: Gómez Portilla A. Tratamiento radical de la carcinomatosis peritoneal. Tiempos de cambio. Cir Esp. 2019;97:608–609.
